Diseases of the Pleura
description
Transcript of Diseases of the Pleura
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Diseases of the Pleura
JB
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What is the pleura? A closed sac of serous membrane which contains
serous fluid.
There is a visceral pleura which covers each lobe and
passes into the separating fissure.
There is a parietal pleura adherent to the chest wall
and diaphragm. It is continuous with the visceral pleura
around the edges of the hilum.
The pleural cavity
only with a thin film of serous fluid.
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http://www.merck.com/media/mmhe2/figures/MMHE_04_052_01_eps.gif
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Pleural disease
1. Focal plaque formation
2. Calcification
3. Diffuse thickening
4. Effusion
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Pleural effusion
Excess fluid in the pleural cavity.
This fluid can be:
Serous fluid (hydrothorax)
Blood (haemothorax)
Chyle (chylothorax)
Pus (empyema)
Can be transudate or exudate
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Causes
Transudative: LVF and cirrohsis of the liver
Exudative; bacterial pneumonia, cancer and PE
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Radiological appearances
No air bronchograms (as would be present with consolidation)
Concave upper boarder (meniscus)
No mediastinal shift
Consider lateral view
Terminates around midcardiac border
Can be loculated (smooth, homogenous, elliptical opacity)
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Loculated pleural fluid in left major
fissure
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Pleural Plaques
Circumscribed areas of pleural thickening,
located on parietal pleura.
3-10mm in thickness
1-5cm in length
Typically linked to asbestos exposure
Smooth or nodular
Calcified and non calcified
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Radiological appearance
Isolated pleural thickening
Easier to identify on the periphery
Does it follow interpulmonary structures? If so,
it is probably not pleural
Commonly found around anterior border of ribs
Bilateral and in mid and axially regions
Calcification around diaphragm
Patchy appearance
Consider previous radiographs, slow growing!
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Other causes of calcification
Silicosis
Treated lymphoma
Sarcoidosis
Pneumoconiosis
The above can all give the appearance of
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Egg Shell Calcification of Lymph
Nodes
Occurs in 5% of patients.
Also seen in silicosis,
pneumoconiosis &
lymphoma following
radiotherapy.
Calcification appears about 6
years after onset of the
disease & is associated with
advanced pulmonary disease
& steroid therapy.
(Chapman, Nakielny, 2003)
Source:http://pathhsw5m54.ucsf.edu/cts/unknown5/eggshell.html
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calcification of hilar
lymph nodes
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Industrial lung disease
They can give similar nodular patterns but do
not give the same calcified appearance of
asbestos related pleural disease
Chronic lung disease will be discussed elsewhere
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Diffuse pleural thickening
Generally uniform increase in pleural width
Can be calcified but not extensively
Rarely involves the mediastinum
Diagnosed predominantly by CT
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Mesothelioma
Malignant neoplasm of the mesothelial cells of
the pleura
Asbestos exposure
Can be difficult to differentiate from metastatic
disease
85-90% male
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Radiological appearance
Unilateral lobulated pleural thickening encasing
the entire lung
Occasionally, can be seen as multiple masses
Unilateral effusion
Loss of lung volume on affected side
No meniscus
Differential: metastatic adenocarcinoma,
lymphoma
Look for presence of pleural plaques