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pLEURAL SPACE.pptx
- 1. PLEURA AND PLEURALSPACE Dr Winston Makanga, M.B.Ch.B., M.Med. (Surg) Consultant General and Laparoscopic Surgeon
- 2. Outline • Introduction anddefinition • Anatomy • Physiology • Pathology • General approach to treatment
- 3. Introduction & definition •Pleura • Pleural cavity
- 4. Surgical anatomy • Parietalpleura • Costal (thickest) • Cervical • Mediastinal • Diaphragmatic • Visceral pleura • Arterial, venous and lymphatics • One layered mesothelium with underlying elastic stromal tissue (endothoracic fascia)
- 5. • Histological architectureof the pleural surfaces • Note the thickness of the endothoracic fascia
- 6. Physiology • 0.01mL/kg/hr fluidproduced by the pleura (mainly parietal) • Reabsorbed by lymphatics (90% visceral pleura) • Reduces friction between the lungs and chest wall • Cavity is in basal negative pressure due to elastic pull of the lung and chest wall -2 to -5 cmH2O (-4 mmHg) • Differential pressure in the apex vs base in the upright position • Increase in volume of the cavity during inhalation results in further drop in pressure (-25 to -30 cmH2O) causing entry of air via the tracheobronchial system
- 8. Pathology • Pneumothorax • Traumatic(blunt vs penetrating) • Spontaneous (primary vs secondary) • Pleural effusion • Hemothorax • Empyema thoracis • Emphysema • Mesothelioma
- 9. Management • Chest tubeinsertion • Pleuridesis • Decortication • VATS 6th rib Mid-axillary line Pec major
- 10. Video assisted ThoracicSurgery
- 11. Review • Definitions • Anatomy •Physiology • Pathology • Treatment
- 12.