胸膜疾病英文版pleural-disease
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• Dullness to percussion • Decreased breath sounds • Pleural friction rub
Chest X-Ray
• Fluid in X-ray seen as a dense, white shadow with a concave upper edge (fluid level) anterior rib(<4, 2-4, >2)
Thoracentesis
• A needle is inserted into the chest wall to remove the collection of fluid
• Determines the type of fluid (transudate or exudate)
Pleural fluid analysis
Ultrasonography
• Ultrasonographic guidance is indicated if difficulty is encountered in obtaining pleural fluid or if the effusion is small to perform thoracentesis
+8 cm H2O
oncotic pressure
+34 cm H2O
(30+5+8)34=9cmH2O
34(11+5+8)=10
Development of Pleural Effusion
•
pulmonary capillary hydrostatic pressure
(CHF, constrictive pericarditis) transudate
Pleural fluid analysis
Appearance
Colour
yellow, Bloody, chocalate,milky, black
•
plasma oncotic pressure (hypoalbuminemia, liver cirrhosis)
•
pleural membrane permeability exudate
(pneumonia, TB, CTD，malignancy, PE)
•
lymphatic obstruction (malignancy)
•
trauma (esophagus,thoracic duct rupture )
Symptom
• Dyspnea (most common) • Mild, non-productive cough • Severe cough with sputum or blood
– Pneumonia vs. bronchial lesion
Pleural Diseases
Pleural effusion
Pleural Space
• Visceral Pleura – attached to lungs. • Parietal Pleura – attached to chest wall. • Pleural space
– 5-15 mL of fluid secreted by the pleural cells. – Minimizes friction as the two pleural surfaces
Parietal Pleura
hydrostatic pressure +30
cm H2O
Pleural Space
-5 cm H2O
Visceral Pleura
hydrostatic pressure +11
cm H2O
oncotic pressure
+34 cm H2O
oncotic pressure
• Constant chest pain
– Cancerous invasion of chest wall
• Pleuritic chest pain
– PE vs. inflammatory pleural effusion
Physical Examination
• Mediastinal shift away from the effusion Decreased tactile fremitus
• Male, 70 year old with an 80pack-year history of smoking and a history of coronary heart disease.
• He was suffered from increasing shortness of breath for 1 week. And he also had chest pain on the right side that worsens with deep inspiration. He was afebrile.
• Chest examination revealed dullness to percussion, the absence of fremitus, and diminished breath sounds on the right side. No distended neck veins, no peripheral edema was observed. The chest radiograph was showed as picture
Appearance, Specific gravity, Protein content, Cell counts, Glucose, LDH , Adenisine deaminase (ADA), Gram stain and culture, Cytologic examination, etc.
glide over each other during inspiratiowk.baidu.com and expiration.
Let’s review
Rib cage Lung
Pleural Space Visceral Pleura Parietal Pleura
Pleural effusion transport
Chest X-Ray
• Fluid in X-ray seen as a dense, white shadow with a concave upper edge (fluid level) anterior rib(<4, 2-4, >2)
Thoracentesis
• A needle is inserted into the chest wall to remove the collection of fluid
• Determines the type of fluid (transudate or exudate)
Pleural fluid analysis
Ultrasonography
• Ultrasonographic guidance is indicated if difficulty is encountered in obtaining pleural fluid or if the effusion is small to perform thoracentesis
+8 cm H2O
oncotic pressure
+34 cm H2O
(30+5+8)34=9cmH2O
34(11+5+8)=10
Development of Pleural Effusion
•
pulmonary capillary hydrostatic pressure
(CHF, constrictive pericarditis) transudate
Pleural fluid analysis
Appearance
Colour
yellow, Bloody, chocalate,milky, black
•
plasma oncotic pressure (hypoalbuminemia, liver cirrhosis)
•
pleural membrane permeability exudate
(pneumonia, TB, CTD，malignancy, PE)
•
lymphatic obstruction (malignancy)
•
trauma (esophagus,thoracic duct rupture )
Symptom
• Dyspnea (most common) • Mild, non-productive cough • Severe cough with sputum or blood
– Pneumonia vs. bronchial lesion
Pleural Diseases
Pleural effusion
Pleural Space
• Visceral Pleura – attached to lungs. • Parietal Pleura – attached to chest wall. • Pleural space
– 5-15 mL of fluid secreted by the pleural cells. – Minimizes friction as the two pleural surfaces
Parietal Pleura
hydrostatic pressure +30
cm H2O
Pleural Space
-5 cm H2O
Visceral Pleura
hydrostatic pressure +11
cm H2O
oncotic pressure
+34 cm H2O
oncotic pressure
• Constant chest pain
– Cancerous invasion of chest wall
• Pleuritic chest pain
– PE vs. inflammatory pleural effusion
Physical Examination
• Mediastinal shift away from the effusion Decreased tactile fremitus
• Male, 70 year old with an 80pack-year history of smoking and a history of coronary heart disease.
• He was suffered from increasing shortness of breath for 1 week. And he also had chest pain on the right side that worsens with deep inspiration. He was afebrile.
• Chest examination revealed dullness to percussion, the absence of fremitus, and diminished breath sounds on the right side. No distended neck veins, no peripheral edema was observed. The chest radiograph was showed as picture
Appearance, Specific gravity, Protein content, Cell counts, Glucose, LDH , Adenisine deaminase (ADA), Gram stain and culture, Cytologic examination, etc.
glide over each other during inspiratiowk.baidu.com and expiration.
Let’s review
Rib cage Lung
Pleural Space Visceral Pleura Parietal Pleura
Pleural effusion transport