Some Important Chest Diseaes Prof . El Sayed Abdel Fattah Eid Lecturer of Internal Medicine Delta University

Pleural Effusion A pleural effusion is an abnormal collection of fluid in the pleural space resulting from excess fluid production or decreased absorption or both. Etiology Congestive heart failure Pneumonia Liver disease (cirrhosis) End-stage renal disease Nephrotic syndrome Cancer Pulmonary embolism Lupus and other autoimmune conditions

Clinical Presentation Shortness of breath Chest pain, especially on breathing in deeply (pleurisy, or pleuritic pain) Fever Cough

Diagnosis 1- Chest X-ray film: Pleural effusions appear on chest X-rays as white space at the base of the lung. 2- Computed tomography (CT)

Treatment Treatment for pleural effusions may often simply mean treating the medical condition causing the pleural effusion. Examples include giving antibiotics for pneumonia, or diuretics for congestive heart failure.

Thoracentesis

Tube thoracotomy (chest tube) A small incision is made in the chest wall, and a plastic tube is inserted into the pleural space. Chest tubes are attached to suction and are often kept in place for several days.

Tuberculosis Definition: Chronic granulomatous infection caused by mycobacterium TB. Two types of TB bacilli can cause human TB: Human TB and Bovine TB. Routes of infection: Inhalation of air born- bacilli with droplets from the patient with open TB or direct contact like kissing or use of patient related materials. TB lung lesion may be: proliferative which appear as lung patch with hilar lymphadenopathy, or exudative lesion (productive) with caseation and outpouring of inflammatory exudates.

Clinical picture of pulmonary TB: -Fever -Cough dry or productive. -Hemoptysis. -Dyspnea. -General manifestationa as loss of weight,, loss of appetite, night sweat, night fever. -On examination there may be signs of consolidation, cavitation, pleural effusion, lung collapse and fibrosis.

Obesity Management Program Investigations: -Sputum examination or TB bacilli by Ziehl Neelsen stain, or culture / sensitivity.

-PCR: TB/ DNA (from sputum, broncho-alveolar lavage or pleural fluid). -Tuberculin skin testing. -Plain X-ray chest: may reveal consolidation, cavitaion or pleural effusion. -ESR: very high ESR in active lesions. -Pleural biopsy.

Treatment of pulmonary TB:: A- Drugs used in treatment of TB include (combined regimns and for prolonged durations): -Isonicotinic acid Hydrazide (INH) -Rifamipicin. -Streptomycine. -Ethambutol. -Pyrazinamid B- Surgery: Some indications may necessitate thoracoplasty or resection.

Prevention of TB: Prevention of tuberculosis includes: Early diagnosis of cases by mass radiography. Sputum microscopy in suspected areas to detect the source of infection. Use of BCG vaccination especially newly born or nation-wide basis Chemoprophylaxis by INH in exposed subjects. Effective treating schemes in sanatoria or dispensaries.

Lung Abscess Definition: Intrapulmonary suppuration with necrosis of lung tissue and cavity formation. Causes: A- Primary lung abscess: no previous lung lesion. However, some predisposing conditions may be found as: coma, fits, operations, alcoholism, foreign body inhalation. B- Secondary lung abscess: 1- lung disease: pneumonia, bronchiactasis, infarction, collapse, or lung cyst. 2- Extension from mediastinum, subdiaphragmatic space. 3- Hematogenous spread.

Clinical Picture: -Symptoms of cough, fever, toxemia -Expectoration of big amount of foul sputum. -Signs of lung consolidation or cavitations. -Clubbing of fingers. Complications: - Fibosis, bronchiactasis, chronicity. -Extension to the pleura leading to empyema. -Blood soread eg brain abscess. -Amylodosis.

Investigation: -Plain X-ray chest, CT chest or MRI. -Culture /sensitivity of the sputum. -Bronchoscopy. -Blood picture: leucocytosis.

Treatment   -Antibiotics. -Drainage. -Treatment of the cause. -Surgery for chronic resistant cases

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