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A mesothelial surface lining the lungs and mediastinum
Mesothelial cells designed for fluid absorption
Hallmark of disease is the pleural effusion
THE PLEURA
Transudate (low protein)
cardiac failure
hypoproteinaemia
Exudate (high protein)
pneumonia
TB
connective tissue disease
malignancy (primary or metastatic)
PLEURAL EFFUSION
Full of acute inflammatory cells
Empyema
Can become chronic
PURULENT EFFUSION
Serofibrinous pleuritis
Reflects pulmonary inflamation e.g tuberclosis, pneumonia, infarcts, abcesses or systemic diseases (R.A and uremia)
Supparative pleuritis or empyema
Reflects pleural space infection leading to pus accumulation
Hemorrahgic pleuritis
Occurs with bleeding disorders, neoplastic involvment
VARIOUS PATTERNS MAY BE SEEN
Hemothorax(ruptured aortic aneurysm)
Chylothorax ( collection of milky lymph) due to neoplastic lymphatic obstruction.
NON INFLAMMATORY EFFUSIONS
HEMOTHORAX
Air in pleural space
Trauma
Rupture of bulla
PNEUMOTHORAX
PNEUMOTHORAX
LARGE BULLAE
Primary
benign (rare)
malignant mesothelioma
Secondary
common (adenocarcinomas - lung, GIT, ovary)
PLEURAL NEOPLASIA
Localized
Noninvasive
Fibrosing
Also occur at other sites
Not related to asbestose
Resection is usually curative
SOLITARY FIBROUS TUMOR
Associated with asbestose exposure in 90% cases only 20% have pulmonary asbestosis
MALIGNANT MESOTHELIOMA
Pts present with chest pain, dyspnea and recurrent pleural effusions
Highly malignant tumors that invade the lung and can metastasize widely.
Fewer pts survive longer than 2yrs.
CLINICAL FEATURES
MESOTHELIOMA
http://www.mesothelioma.com/images/pleural-mesothelioma.jpg
PLEURAL BIOPSY - MESOTHELIOMA
Mixed spindle cell
(mesenchymal) and epithelial differentiation
METASTASES IN PLEURA
Cytology,
biopsy
Difficult to diagnose
Immunohistochemistry for lineage specific antigens may help
Medicolegal importance
DIFFERENTIAL DIAGNOSIS OF MALIGNANT EFFUSIONS
http://www.mesothelioma.com/images/pleural-mesothelioma.jpg
REFFERENCES
http://www.mdguidelines.com/empyema/definition
http://treatment-zone.blogspot.com
http://www.medicinenet.com/imagecollection/pneumothorax_picture/picture.htm