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Diseases Of The Pleura And Mediastinum Notes

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Q17. Diseases of the Pleura and Mediastinum Pleural Effusion (PE) PE is an accumulation of fluid in the pleural space (the space between the lungs an the chest wall). Normally, there is some fluid there, which lubricates the surfaces and prevents friction, however, an increase in production or decrease in removal results in accumulation - which can restrict the lungs. PE is a pathological process, rather than a specific diagnosis. Diseases which can cause pleural effusion include

• Heart failure

• Infection (pyothorax)

• Chylothorax

• Neoplasia (hemangiosarcoma, mammary gland tumors, lymphosarcoma)

• Liver disease or gastrointestinal disease if the blood protein levels become severely low

C.S

• Tachypnea, shallow respiration, respiratory distress

• Decreased bronchovesicular sounds in the affected areas, and/or increased bronchovesicular sounds in the nonaffected areas.

• Hyporesonance on percussion, with detection of a fluid line.

• Cough due to other diseases

• Systemic illness, clinical findings of other diseases - pneumonia, lung cancer Diagnosis Thoracocentesis - also therapeutic benefit. For cytology, protein concentration and total nucleated cell count. Xray - Pleural effusion is seen as a white area which can obscure the sillouette of the heart. X rays should be taken again after removal of the fluid. USG - for the presence of fluid and can also use it to guide needles for thoracocentesis

Treatment Drain the effusion, but find out what the primary cause is, and treat that. Types of Fluid The type of fluid can indicate which disease is likely causing the pleural effusion; Fluid

What is it

Which Diseases

Transudate

low protein conc and low numbers of MO, LO, mesothelial cells

Increased hydrostatic pressure; Right side CHF Pericardial disease Decreased oncotoc pressure; Hypoalbuminaemia Lymphatic Obstruction; Diaphragmatic hernia Neoplasia (rare)

Modified Transudate

slightly higher protein conc and cell count which includes NO and Mononuclear cells

Exudate (Non-septic)

High protein conc, with No, Eo, Mo and Lo

FIP Neoplasia Chronic diaphragmatic hernia Torsion of a lung lobe

Exudate (Septic)

Extremely high cell count with mainly degenerative neutrophils, and bacteria

Pyothorax

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