PLEURAL EFFUSION-EMPYEMA-PNEUMOTHORAX

Slides:



Advertisements
Similar presentations
Case 2 STEPHANIE M. GO.
Advertisements

Larissa Bornikova, MD July 17, 2006
Pneumothorax.
Iskander Al-Githmi, MD, FRCSC, FRCSC (Ts & CDs), FCCP
Approach to Pleural Effusion
PULMONARY AIR LEAK SYNDROME RT 256. AIR LEAKS: Pathophysiology High transpulmonary pressures applied to the lungs Alveoli overdistend and rupture Air.
Garrett Waagmeester 4/25/2014.  Total pleural fluid volume: mL/kg  Fluid produced by systemic vessels of the parietal pleura, primarily less.
Pneumothorax. What is a pneumothorax? Air within the pleural cavity (i.e. between visceral and parietal pleura) The air enters via a defect in the visceral.
Pleural Fluid Analysis. ll- pleural fluid analysis It comprises of -pleural fluid appearance - Biochemical tests ( Protein, LDH). -Cytological tests (
Indications for Thoracentesis
Respiratory Disorders: Pleural & Thoracic Injury by Charlotte Cooper RN, MSN, CNS modified by Kelle Howard RN, MSN.
Parapneumonic Effusions and Empyema
Diagnosis and Management of Malignant Pleural Effusion 衛生署桃園醫院內科加護病房主任莊子儀醫師 2006 年 7 月 20 日.
The EPEC-O Curriculum is produced by the EPEC TM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong.
Respiratory Disorders: Pleural and Thoracic Injury
Diseases of the pleura 1-Spontaneous pneumothorax Is the accumulation of air inside the pleural cavity, occurring without any known etiology.More in males,more.
DISEASES OF THE PLEURA.
Pleural Effusion.
Mesothelioma. Is a malignant tumour of pleura, usually resulting from asbestos exposure. Asbestos is the major single cause and there is a history of.
Chapter 25 Pleural Diseases
Pleural Effusion, Pneumothorax and Atelectasis
Pleural Effusions.
Respiratory Pleural and Thoracic Injury. Pleural injury : Normal physiology- visceral, parietal pleura & pleural space.
Pneumothorax.
כירורגית בית החזה. The Overlooked Issue Accumulation of air in the pleural space that leads to partial or total collapse of the affected lung.
بسم الله الرحمن الرحیم با سلام.
Respiratory Disorders: Pleural & Thoracic Injury
By Dr. Zahoor Diseases of Pleura.
Respiratory Pleural and Thoracic Injury Marnie Quick, RN, MSN, CNRN.
Clinical Approach to PLEURAL EFFUSIONS.
1 Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 23 Effusion and Empyema Chapter 23 Pleural Effusion.
Respiratory Pleural and Thoracic Injury Marnie Quick, RN, MSN, CNRN.
Presentation 3: TRAUMA Emergency Care CLS 243 Dr.Bushra Bilal.
Disorders of the Pleura and Mediastinum Dr. Gerrard Uy.
Pleural Disease.
Pleural fluid. Case study A 70-year-old women presents with slowly increasing dyspnea. She cannot lie flat without feeling more short of breath. She has.
Pleural Effusions Kara Lee Gallagher USC School of Medicine.
Tension Pneumothorax Chris Adkins. Definition (1)  tension pneumothorax ( noun)  Definition of TENSION PNEUMOTHORAX  pneumothorax resulting from a.
Pleural Effusion.
Respiratory Disorders: Pleural and Thoracic Injury
PNEUMOTHORAX TUCOM Internal Medicine 4th year Dr. Hasan.I.Sultan
Para Pneumonic Effusion BY Professor Of Pediatrics, Head of Allergy & Clinical Immunology Unit - Mansoura University Egypt.
Pleural effusion Riahi taghi,M.D.. Etiology Fluid formation: parietal pleura Fluid formation: parietal pleura Fluid removal: parietal pleura (lymphatic)
Pleural Disease.
TM The EPEC-O Project Education in Palliative and End-of-life Care - Oncology The EPEC TM -O Curriculum is produced by the EPEC TM Project with major funding.
Complications related to Pneumothorax and Chylous Fluid Accumulation
Pleural Effusion Marvin Chang, PGY2 April 2015.
Chest Injuries Main Causes of Chest Trauma Blunt Trauma- Blunt (direct) force to chest. Penetrating Trauma- Projectile that enters chest causing small.
1 Dr. SIRAJ WALI. 2 3 PLEURAL SPACE The pleura consists of 2 layers 1 – parietal pleura 2 – visceral pleura The space between the 2 layers is called.
Pleural Diseases Magdy Khalil MD, FCCP, EDIC
Gail L. Lupica PhD, RN, CNE Nurs 211.  The diaphragm contracts down, and the external intercostals muscles move the chest wall outward. Air rushes.
SYB Marni Scheiner MS IV Marni Scheiner MS IV. Case HPI: 78 yo M, brought to ED by ambulance in complete cardiac arrest. Patient was with his family out.
Malignant Pleural Effusion
بنام خداوند جان و خرد کزین برتر اندیشه بر نگذرد. PATHOPHYSIOLOGY OF THE PLEURAL DISEASE.
Josephine Mak Waikato Cardiothoracic Unit
Pneumothorax.
Chapter 12 Respiratory System.
Chest Trauma تهیه کننده : حسین احمدی اسلاملو کارشناس ارشد فیزیولوژی.
Chest Trauma Dr. Khayal Al Khayal.
wire-guided chest tube placement
Chapter 22 Pneumothorax CL GA DD
دکتر فرزانه میرمحمدی متخصص طب اورژانس
Respiratory Diseases.
Evaluation Pleural Effusions
Abdallah aljazzazi Pneumothorax.
Andriy Lepyavko, MD, PhD Department of Internal Medicine № 2
C31 Pneumothorax.
Pneumothora x. PNEUMOTHORAX - A pneumothorax (noo-moe-THOR-aks) is a collapse lung. It occurs when air leaks into the space between your lung and chest.
Presentation transcript:

PLEURAL EFFUSION-EMPYEMA-PNEUMOTHORAX Dr Alpana K Somale Lecturer Department of Pediatrics , B.Y.L.Nair Hospital Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer History Dyspnea (most common) Mild, non-productive cough Severe cough with sputum or blood Pneumonia vs. bronchial lesion Constant chest well pain Cancerous invasion of chest wall Pleuritic chest pain PE vs. inflammatory pleural effusion Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer Physical Exam Decreased breath sounds Dullness to percussion Decreased tactile fremitus Pleural friction rub Mediastinal shift away from the effusion Egophany (E to A) Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer Causes CHF Malignancy Infection PE Others include hepatic cirrhosis, hypoalbuminemia, collagen vascular dz, TB, trauma, chylothorax, radiation, or pancreatitis Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer Pathophysiology ↑ Hydrostatic Pressure (e.g. CHF) ↑ Vascular Permeability (e.g. Pneumonia) ↓ Oncotic Pressure (e.g. Nephrotic syndrome ↑ Intrapleural Negative Pressure (e.g. atelectasis) ↓ Lymphatic drainage (e.g. mediastinal carcinomatosis) Cotran, Ramzi, Vinay Kumar, Tucker Collins. Robins Pathologic Basis of Disease. Philadelphia: Elsevier, 1999. Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer Workup CXR/CT Thoracentesis Lab studies on fluids include protein, LDH, cytology, cell count, specific gravity, pH, amylase, glucose, Gram’s stain, bacterial/fungal cultures Plasma LDH and protein AFB stain and Cx if TB suspected If CV dz suspected, send for RF & ANA Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer Treatment Treat underlying dz (such as CHF,nephrotic syndrome) if transudative fluid Exudative fluids - Drain and pleurodese for palliative treatment vs chemo if caused by malignancy Drain if empyema or causing severe respiratory symptoms Surgery Decortication for thick areas restricting breathing Drainage of loculated areas Pleuroperitoneal shunts for recurrent effusions Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer Pneumothorax Defined Definition – “What?” “Pneumo”- gas “Thorax” – chest cavity Analagous to Pleural Effusion Pathophysiology – “How? Pleural space Baseline (-) pressure space Parietal Pleura Visceral Pleura Normal inspiration Diaphragm Transmit (-) Pressure Pathologic inspiration XS gas disrupts transmission of (-) pressure Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer Types of Pneumothorax Spontaneous Pneumothorax Primary - rupture of subpleural bleb “Jimmy is a tall, wiry, 21-year old male, who plays trombone in the marching band….” Secondary - underlying lung/pleural disease #1 – emphysema Chronic bronchitis, asthma, TB, … Traumatic Pneumothorax Open Chest wall is penetrated : outside air enters pleural space Closed Chest wall is intact Ex. Fractured rib Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer Types of Pneumothorax 2 Tension Pneumothorax “Ball-valve mechanism” Injury to pleura creates a tissue flap that opens on inspiration and closes on expiration One of our own patients Variations Hemo-thorax Chylo-thorax Injury to thoracic duct Empyema Parapneumonic effusions in community-acquired pneumonia Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer Symptoms Dyspnea Pleuritic chest pain Nerve endings at pleural capsule Sense of impending doom Sudden onset Tension pneumothorax Spontaneous pneumothorax Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer Physical Exam - Signs Unstable patients vs. Stable patients Vital Signs Asymmetric chest expansion Deviated trachea Diminished breath sounds unilaterally Hyper-resonance unilaterally Decreased tactile fremitus Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer Diagnosis Stable patient CXR Monitor size by measuring distance from lateral lung margin to chest wall Be sure that pneumothorax is not expanding Unstable patient Thoracentesis Rapid release of air Vital signs stabilize rapidly Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer Imaging Plain Radiographs Upright PA on inspiration Detect other pathologies: pneumonia, cardiac, etc. Partially collapsed lung Tension Pneumothorax Trachea and mediastinum deviate contralaterally Ipsilateral depressed hemi-diaphragm Chest CT Not routine Only to assess the need for surgery (thoracotomy) Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer Treatment Small pneumothorax Resolve over days to weeks Supplemental oxygen and observation Tension pneumothorax Immediate decompression via chest tube or needle thoracostomy Spontaneous pneumothorax Asymptomatic – outpatient, f/u with serial CXR Symptomatic – inpatient, chest tube Recurrent pneumothorax – CT to evaluate need for thoracotomy Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer Tube Thoracostomy a.k.a. Chest tube Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer

Dr Alpana K Somale, lecturer