pleura

1. DISEASES OF THE
PLEURA
Girmaye Tamrat
5.6.2013
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2. 20:19

3. OUTLINE
Pnemothorax
Empyema
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4. 20:19

5. PATHOPHYSIOLOGY
 A pneumothorax , size
 compresses lung tissue
 reduces pulmonary compliance
 ventilatory volumes & diffusing capacity.
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6. CLASSIFICATIONS OF PNEUMOTHORAX
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1.Spontaneous
A. Primary
B. Secondary
Chronic obstructive pulmonary disease
(COPD)
Bullous disease
Cystic fibrosis
Pneumocystis –related
congenital cysts
Idiopathic pulmonary fibrosis
Pulmonary embolism
Neonatal

7.  2.Traumatic
Penetrating
Blunt
3.Iatrogenic
Mechanical ventilation
Thoracentesis
Lung biopsy
Venous catheterization
Postsurgical
4.Other
Esophageal perforation
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8. ETIOLOGY
 Unknown
 Smoking
 Airway disease : COPD
 Obstruction: mucous
plug,bronchoconstriction
 Infection: pneumonia, PCP,TB
 Blebs/ Bullae
 Familial

9. CLINICAL PRESENTATION
 Asymptomatic(<15%)
 Chest pain
 Dyspnea
 Tachycardia
 Subcutaneous crepitations
 Hyperresonance
 Reduced breath sound
 Mediastinal shift
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10.  Hypoxia
 Hypercapnia
 Underlying illness
 Unstable hemodynamics with cyanosis
___Tension pneumothorax
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11. TENSION PNEUMOTHORAX
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12.  Chest radiography
 hyperlucency
 absent pulmonary markings.
 CT scan
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13. 20:19

14. TREATMENT
aim:- remove air
:- allow lung re-
expansion
:- reduce recurrence
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15.  Size of pneumothorax
 Severity of symptoms
 Presence of complications
 Type of pneumothorax:-Psp or Ssp
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16. SIZE OF PNEUMOTHORAX
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17. Options1. observation => small ones may resolve
=> high-flow oxygen
2.simple aspiration=> catheter
=> success-- 65-70%
--35% (ssp)
3.tube thoracostomy
4.pleurodesis :-
Medical:-TTC/Talcum powder
Surgical :-Pleurectomy
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18. COMPLICATIONS
:-recurrence, 10% & 30%
:-reexpansion pulmonary
edema
:-bronchopleural fistula, 3-5%
:-rarely -tension
pneumothorax
pneumomediastinum
pneumopericardium
12/3/3/7/20082013

19. Prognosis
good following successful
treatment
 25-50% recurrence
= higher in ssp
= most occur within the first
year
= higher recurrence with needle
aspiration
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20. EMPYEMA
 is a pyogenic or suppurative
infection of the pleural space.
 are the most common exudative
type of pleural effusion.
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21. ETIOLOGY
 An empyema may occur by
 direct contamination
 wounds of the chest (trauma or surgery)
 from lung parenchymal infection
(postpneumonic)
 intrapulmonary abscess or infected cavity
 from the mediastinum (esophageal
perforation).
 hematologic spread (bacteremia or sepsis)
 Most often, empyemas are the result of a primary
infectious process in the lung.
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22. EXUDATIVE PLEURAL EFFUSION
A . Infectious
 Bacterial
 Parapneumonic Empyema
 TB
 Parasitic
 Fungal
 Viral
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23. B.Intraabdominal Diseases
Acute Pancreatitis,Intraabdominal Abscess etc.
C.Malignant
Primary— Lung, Pleura
Secondary
D.Others
Trauma, Post Operation , Chylothorax
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24. MICROORGANISMS
 Streptococcus or Pneumococcus
pneumonia,S.aureus
 gram-negative and anaerobic
organisms
 Tuberculous empyema
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25. CLINICAL FEATURES
 acute or transitional phase empyema
 present with symptoms of primary
lung infection
cough, fever, sputum production
 symptoms of pleural effusion
chest pain and dyspnea
 systemic illness (anorexia, malaise,
and sweats)
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26.  Chronic empyema
 can mimic other systemic
illnesses with
 anorexia, weight loss, and
lethargy.
Debilitation
Anemia
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27. INVESTIGATION
 Chest radiography
 Acute phase
 pleural effusion
 chronic empyema
 opacification of the affected hemithorax
 CT of the chest
 extent of pleural thickening
 exact location of the empyema cavity
 associated parenchymal disease.
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28. Investigation
CXR---200ml
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29.  Pleural fluid tap
 analysis
 Gram stain (organisms)
 cell count
 polymorphonuclear leukocytic predominance in bacterial
empyema
 lymphocytic predominance in tuberculous empyema
 chemistries (protein, LDH, amylase, and glucose)
 pH (<7.2) all can be useful in making the diagnosis.
 Culture and sensitivity
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30. TREATMENT
Antibiotics
Drainage
Thoracentesis
Thoracostomy
Thoracotomy and
decortication
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31.  Streptokinase and Urokinase
 Open Drainage:-Rib resection
 Nutrition
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32. CHEST TUBE INSERTION AND CARE
Indications
Procedure
Care
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33. SAFE TRIANGLE
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34. EQUIPMENTS
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35. UNDERWATER SEAL SYSTEM
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36. Questions?
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37. Thank You.
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