Pleural Diseases: Comprehensive Medical Study Guide

Overview and Anatomy of the Pleura

• General Overview:

  • Presentation Topic: Pleural Diseases

  • Presenter: Dr. Habibuddin Faqiryar

  • Date: June 15, 2025

• Definition of Pleura:

  • A thin, double-layered serous membrane that covers the lungs and lines the thoracic cavity.

  • Composed of two distinct layers: the parietal pleura and the visceral pleura.

• Anatomical Layers:

  • Parietal Pleura:

  • Anatomical Coverage: Lines the inner surface of the thoracic wall, the diaphragm, and the mediastinum.

  • Innervation: Somatic innervation; highly pain-sensitive. Mainly supplied by the intercostal nerves and the phrenic nerves.

  • Visceral Pleura:

  • Anatomical Coverage: Directly covers the outer surface of the lungs and extends into the interlobar fissures.

  • Innervation: Autonomic innervation; far less pain-sensitive. Supplied by the pulmonary plexus.

  • Pleural Cavity (Pleural Space):

  • The potential space bounded between the parietal and visceral pleurae.

  • Normally contains a small volume of fluid ($10\text{--}20\,\text{mL}$), which serves as a friction-reducing lubricant and facilitates smooth lung movement during respiration.

• Functions of the Pleura:

  • Friction Reduction: Reduces mechanical friction between respiratory surfaces during breathing via pleural fluid.

  • Creation of Negative Pressure: Maintains relative negative intrapleural pressure, which is vital for aiding lung expansion and inflation.

  • Compartmentalization: Isolates the thoracic cavity into discrete anatomical compartments, preventing the direct spread of infections and localized disease between organs.

• Spectrum of Pleural Diseases:

  • Pleuritis (Pleurisy)

  • Pleural Effusion (transudative or exudative)

  • Empyema

  • Neoplastic disorders (Malignant, Metastatic)

  • Pneumothorax (spontaneous, traumatic, tension)

  • Hemothorax

  • Chylothorax

  • Pleural fibrosis

  • Pleural plaques

  • Pleural calcification

Pleuritis (Pleurisy)

• Definition & Clinical Recognition:

  • Pleurisy (or pleuritis) is defined as inflammation of the parietal pleura.

  • Clinically recognized by sharp, localized chest pain that is characteristically exacerbated by deep inspiration, coughing, or sneezing.

• Etiology:

  • Trauma to the chest wall.

  • Postcardiac injury syndrome.

  • Infections (viral, bacterial, or parasitic).

  • Underlying acute respiratory illnesses.

  • Caustic exposure (e.g., drug-induced pleuritis).

  • Autoimmune diseases (e.g., systemic lupus erythematosus, rheumatoid arthritis).

  • Malignancies.

• Clinical Signs and Symptoms:

  • Presence of a pleural friction rub on auscultation.

  • Localized chest wall tenderness.

  • Sharp, pleuritic chest pain.

  • Shallow, rapid breathing (tachypnea) to prevent deep-breath pain.

  • Reduced chest expansion on the affected side.

• Diagnostic Imaging:

  • Chest X-Ray:

  • Frequently normal in early or uncomplicated pleuritis.

  • Infective Causes: May show lobar consolidation indicating pneumonia.

  • Pleural Effusion: May show blunted costophrenic angles or fluid levels.

  • Pulmonary Embolism: May display a wedge-shaped pulmonary infarct, though often normal.

  • Malignancy: May demonstrate pleural thickening or discrete masses.

  • Computed Tomography (CT) Scan:

  • Provides a definitive and highly accurate diagnosis.

• Pharmacological Treatment:

  • Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Indomethacin $50\text{--}100\,\text{mg}$ orally 3 times daily, administered with food or milk.

  • Analgesia/Antitussives: Codeine $30\text{--}60\,\text{mg}$ orally every 8 hours, indicated if no productive cough is present.

Pleural Effusion: Mechanisms and Pathophysiology

• Definition & Physiology of Fluid Dynamics:

  • An abnormal accumulation of fluid in the pleural space, resulting from excess fluid production, decreased lymphatic clearance, or both.

  • Normal relative vacuum sustains extreme adherence between the visceral and parietal pleurae without disruption.

  • Normal fluid volume is approximately $10\,\text{mL}$, containing low protein content (< 1.5\,\text{g/dL}), maintained via a balance of hydrostatic and oncotic pressures.

  • Inflow of fluid occurs primarily from parietal pleura capillaries.

  • Absorption is driven by visceral capillaries (~90%) and lymphatic drainage (~10%).

• Classification by Gross Appearance:

  • Clear / Straw-colored: Transudate (e.g., Congestive Heart Failure) or non-infectious exudate.

  • Purulent: Exudative process or Empyema.

  • Bloody: Malignancy, trauma, pulmonary embolism (PE), or tuberculosis (TB).

  • Milky (Chylous): Chylothorax resulting from lymphatic disruption or thoracic duct obstruction.

  • Black: Aspergillus infection, malignant melanoma, or old pleural hemorrhage.

• General Classification Criteria:

  • Transudates: Result from an imbalance between intravascular hydrostatic and oncotic pressures, leaving the pleural membranes intact.

  • Exudates: Result from local inflammatory processes that increase pleural membrane permeability, decrease lymphatic drainage, or both.

  • Mixed transudative and exudative characteristics can occur simultaneously in specific systemic conditions.

• Pathophysiologic Mechanisms of Fluid Accumulation:

  • Altered permeability of pleural membranes (e.g., inflammation, malignancy, PE).

  • Reduction in intravascular oncotic pressure (e.g., hypoalbuminemia secondary to nephrotic syndrome or cirrhosis).

  • Increased capillary permeability or direct vascular disruption (e.g., trauma, malignancy, infection, pulmonary infarction, drug hypersensitivity, uremia, pancreatitis).

  • Increased capillary hydrostatic pressure within the systemic or pulmonary circulation (e.g., CHF, Superior Vena Cava Syndrome [SVCS]).

  • Reduction of intrapleural pressure due to lung expansion failure ("trapped lung", e.g., extensive atelectasis from an obstructed mainstem bronchus or chronic fibrous contraction).

  • Decreased or blocked lymphatic drainage, including thoracic duct obstruction or rupture (e.g., malignancy, surgical/accidental trauma).

  • Transdiaphragmatic migration of peritoneal fluid via diaphragmatic microperforations or lymphatics (e.g., hepatic hydrothorax, cirrhosis, peritoneal dialysis).

  • Direct movement of excess fluid from pulmonary edema across the visceral pleura.

Etiology and Classification of Pleural Effusions

• Etiology of Transudative Effusions:

  • Congestive Heart Failure (CHF)

  • Cirrhosis (leading to hepatic hydrothorax)

  • Atelectasis (potentially secondary to occult malignancy or pulmonary embolism)

  • Hypoalbuminemia

  • Nephrotic syndrome

  • Peritoneal dialysis

  • Myxedema

  • Constrictive pericarditis

  • Urinothorax (typically secondary to obstructive uropathy)

  • Cerebrospinal fluid (CSF) leak into the pleura (in ventriculopleural shunting or thoracic spinal trauma/surgery)

  • Duropleural fistula (rare complication following spinal cord surgery)

  • Extravascular migration of a central venous catheter

  • Glycinothorax (rare complication of bladder irrigation using a $1.5\%$ glycine solution post-urologic surgery)

• Etiology of Exudative Effusions:

  • Pleural or parenchymal pulmonary inflammation

  • Impaired lymphatic clearance within the pleural space

  • Cephalad movement of inflammatory peritoneal fluid across the diaphragm

  • Altered pleural membrane permeability or direct microvascular destruction

  • Parapneumonic causes (bacterial pneumonia)

  • Malignancy: Most commonly lung cancer, breast cancer, lymphoma, and leukemia; less commonly ovarian carcinoma, stomach cancer, sarcomas, and melanoma

  • Autoimmune / Collagen-vascular diseases: Rheumatoid arthritis, Systemic Lupus Erythematosus (SLE)

  • Infections: Tuberculosis (TB), Pancreatitis-associated effusions, Fungal infections

  • Postcardiac injury syndrome

  • Intra-abdominal abscesses, Meigs syndrome (triad of benign ovarian tumor, ascites, and pleural effusion)

  • Pericardial disease

  • Uremia

  • Chylothorax (marked by elevated triglyceride levels in pleural fluid during acute illness)

  • Fistulas (ventriculopleural, biliopleural, gastropleural)

  • Hypothyroidism

  • Acute Respiratory Distress Syndrome (ARDS)

Clinical Manifestations and Diagnostic Workup of Pleural Effusion

• Patient History Considerations:

  • History of parapneumonic infections or recent febrile pulmonary illness.

  • History of congestive heart failure, chronic hepatitis, or alcohol abuse with cirrhosis.

  • Recent thoracic trauma, thoracic spine surgery, or central line placement.

  • Personal history of malignancy or unexplained weight loss.

  • Occupational history including known asbestos exposure.

  • Medication history and previous exposure to or history of Tuberculosis.

• Clinical Symptoms:

  • Pulmonary Symptoms: Dyspnea, cough, sharp localized pleuritic chest pain aggravated by deep inspiration.

  • Extrapulmonary Symptoms:

  • Bilateral lower extremity edema, orthopnea, paroxysmal nocturnal dyspnea (indicative of CHF).

  • Unilateral leg swelling (indicative of deep vein thrombosis and underlying pulmonary embolism).

  • Night sweats, fever, hemoptysis, unexplained weight loss (indicative of Tuberculosis).

  • Hemoptysis (raising suspicion for primary or metastatic malignancy).

• Physical Examination Findings:

  • Threshold: Effusions < 300\,\text{mL} typically produce no significant clinical physical findings; effusions > 300\,\text{mL} display distinct physical findings.

  • Inspection: Asymmetrical chest expansion, decreased or absent chest wall movement on the affected side, visible dyspnea, tachypnea, and tracheal deviation.

  • Palpation: Decreased or absent tactile fremitus over the fluid-filled area, reduced chest expansion on the affected side, tracheal shift away from the affected side in large effusions.

  • Percussion: Stony dullness on percussion over the site of fluid accumulation.

  • Auscultation:

  • Decreased or absent breath sounds over the effusion.

  • Bronchial breath sounds audible immediately above the fluid level.

  • Decreased or absent vocal resonance over the effusion.

  • Egophony ("E-to-A" change) detectable immediately above the upper margin of the effusion.

• Diagnostic Radiography & Imaging Modalities:

  • Chest X-Ray Views:

  • Posteroanterior (PA) View: Standard view; effusions of $200\text{--}300\,\text{mL}$ display costophrenic angle blunting and a visible meniscus sign.

  • Lateral View: Highly sensitive; detects small effusions missed on standard PA views.

  • Lateral Decubitus View: Superior for detecting minimal fluid amounts and differentiating free-flowing fluid from loculated effusions.

  • Supine View: Common in ICU settings; displays diffuse haziness or a veil-like opacity over the hemithorax as fluid layers posteriorly, with a diminished meniscus sign.

  • Ultrasonography:

  • Significantly more sensitive than plain chest X-rays; reliably identifies small fluid collections down to $5\text{--}10\,\text{mL}$.

  • Crucial for diagnosing, quantifying, and guiding therapeutic procedures (thoracentesis and chest tube placement).

  • Displays anechoic or hypoechoic fluid collections; evaluated using bedside lung ultrasound in emergency (BLUE) protocols.

  • Visualizes complex features such as densely septated loculations.

  • Computed Tomography (CT) Scan:

  • Provides definitive, high-resolution visualization of the pleura and underlying lung parenchyma.

  • High Sensitivity & Specificity: Detects minute, complex, or hidden effusions.

  • Characterization: Differentiates transudates, exudates, empyema, hemothorax, and chylothorax.

  • Pleural Assessment: Clearly highlights pleural thickening, nodularity, and calcifications.

  • Etiology Identification: Uncovers parenchymal masses, deep tissue infections, or occult metastases.

  • Malignancy Staging: Critical for staging primary mesothelioma or metastatic pleural disease.

  • Interventional Guidance: Assists in guiding targeted biopsies or drainage catheter placements when ultrasound is inadequate.

Thoracentesis (Pleural Tap)

• Definition:

  • A invasive procedure performed to extract fluid from the pleural space for diagnostic evaluation, therapeutic alleviation, or both.

• Indications:

  • Diagnostic Volume ($30\text{--}50\,\text{mL}$):

  • Unexplained or new-onset pleural effusion.

  • Suspected pleural infection (e.g., Tuberculosis, acute empyema).

  • Suspected primary or metastatic pleural malignancy.

  • Confirmation of transudative fluid in unclear heart failure presentations.

  • Evaluation of suspected autoimmune pleuritis.

  • Therapeutic Volume ($1\text{--}1.5\,\text{L}$):

  • Rapid relief of severe dyspnea caused by large effusions.

  • Complete drainage of infected or purulent pleural fluid collections.

• Required Equipment:

  • Sterile gloves and surgical drapes.

  • Antiseptic skin preparation (chlorhexidine).

  • Local anesthetic ($1\%$ or $2\%$ lidocaine).

  • Syringes, needles, and flexible connection tubing.

  • Specialized thoracentesis kit or flexible catheter needle set.

  • Sterile collection bottles and diagnostic laboratory vials.

  • Ultrasound machine (strongly recommended to reduce complication risks).

• Pre-Procedure Preparation:

  • Obtain written informed consent.

  • Review diagnostic imaging (X-rays, CT, or bedside ultrasound).

  • Position the patient: Seated upright leaning forward over a bedside table, or placed in a lateral decubitus position.

• Step-by-Step Surgical Procedure:

  • Perform real-time ultrasound examination to select the optimal puncture site.

  • Clean and drape the surgical field in a sterile manner.

  • Infiltrate local anesthetic into the skin, subcutaneous tissues, intercostal muscles, and parietal pleura.

  • Insert the thoracentesis needle or catheter over the upper border of the rib to avoid damaging the neurovascular bundle lying along the lower border of the rib.

  • Aspirate fluid slowly; do not exceed $1\text{--}1.5\,\text{L}$ in a single session to minimize re-expansion pulmonary edema.

  • Dispense fluid samples into appropriate diagnostic collection tubes:

  • Ethylenediaminetetraacetic acid (EDTA) tubes for diagnostic cytology.

  • Heparinized tubes for biochemical analysis and microbiological cultures.

  • Withdraw the catheter, apply firm pressure to the site, and secure a sterile occlusive dressing.

• Post-Procedure Monitoring & Safety:

  • Monitor vital signs closely for signs of pneumothorax, internal hemorrhage, or localized infection.

  • Post-procedure chest X-ray is recommended if the procedure was technically difficult, if air was aspirated during thoracentesis, or if the patient becomes acutely symptomatic.

Diagnostic Criteria and Pleural Fluid Analysis

• Light's Criteria (Distinguishing Exudates from Transudates):

  • An effusion is categorized as an Exudate if it meets one or more of the following three criteria:

  1. Pleural fluid protein / serum protein ratio > 0.5

  2. Pleural fluid LDH / serum LDH ratio > 0.6

  3. Pleural fluid LDH level > 2/3 of the upper limit of normal for serum LDH.

  • If none of these criteria are met, the effusion is classified as a Transudate.

• Comparative Diagnostic Laboratory Table:

Management and Treatment of Pleural Effusion

• General Management Principles:

  • Interventions depend directly on the specific etiology and severity of symptoms.

  • Differentiate clearly between transudative and exudative etiologies.

  • Rapidly relieve dyspnea and respiratory insufficiency.

  • Execute pleural drainage when indicated:

  • Acute dyspnea or severe respiratory compromise.

  • Suspected empyema or complicated parapneumonic effusions.

  • Large volume effusions causing mechanical compression.

  • Diagnostic uncertainty requiring full fluid evaluation.

  • Prevent long-term recurrence.

• Etiology-Specific Interventions:

  • Transudative Effusions (CHF, Cirrhosis, Nephrotic Syndrome):

  • Treat the primary organ dysfunction (e.g., targeted diuretics in CHF; intravenous albumin administration paired with therapeutic paracentesis in liver cirrhosis).

  • Therapeutic thoracentesis reserved for large, symptomatic effusions.

  • Parapneumonic Effusion / Empyema:

  • Empiric intravenous broad-spectrum antibiotic coverage.

  • Urgent fluid drainage via therapeutic thoracentesis or tube thoracostomy.

  • Intrapleural fibrinolytic administration in complex septated cases.

  • Tuberculous Pleural Effusion:

  • Standard anti-tuberculosis therapy (6 to 9 months course).

  • Therapeutic thoracentesis for persistent dyspnea.

  • Chest tube insertion if it progresses to tuberculous empyema.

  • Malignant Pleural Effusion:

  • Serial therapeutic thoracentesis for temporary relief.

  • Placement of an indwelling pleural catheter (IPC) or chemical pleurodesis.

  • Systemic treatment targeting the primary malignancy (chemotherapy, radiation therapy).

  • Hemothorax:

  • Immediate large-bore chest tube drainage.

  • Monitor blood loss, hemograms, and systemic hemodynamics.

  • Surgical thoracotomy if bleeding is persistent or uncontrollable.

Empyema

• Definition:

  • The accumulation of overt pus within the pleural space, most commonly resulting from the direct extension of parenchymal lung infection such as pneumonia.

• Staging Classification:

  1. Exudative Stage: Characterized by thin, sterile, free-flowing fluid in the pleural space.

  2. Fibrinopurulent Stage: Characterized by heavily infected fluid, dense pus, extensive fibrin deposition, and intrapleural loculations.

  3. Organizing Stage: Characterized by dense, thick fibrous peel formation that encapsulates the lung ("trapped lung" or fibrothorax).

• Etiological Factors:

  • Direct Infectious Spread:

  • Bacterial pneumonia: Common pathogens include Streptococcus pneumoniae, Staphylococcus aureus, Klebsiella pneumoniae, Haemophilus influenzae, and various anaerobic species.

  • Tuberculosis.

  • Direct rupture of a lung abscess into the pleural space.

  • Bronchopleural fistula formation.

  • Post-Surgical or Traumatic Origin:

  • Complications following major thoracic or upper abdominal surgery.

  • Penetrating or severe blunt chest trauma.

  • Post-lung resection surgical complications.

  • Gastrointestinal / Esophageal Perforation:

  • Spontaneous or traumatic esophageal rupture.

  • Complications of endoscopic procedures.

  • Direct extension of a subphrenic abscess across the diaphragm.

  • Hematogenous Spread:

  • Rare; occurs secondary to severe systemic bacteremia or sepsis.

• Clinical Signs and Symptoms:

  • Symptoms: High persistent fever (unresponsive to antibiotic therapy), productive cough with purulent or foul-smelling sputum, dull or pleuritic chest pain, progressive dyspnea, fatigue, and severe weight loss in chronic cases.

  • Signs: Decreased chest wall expansion on the affected side, dullness to percussion, significantly decreased or absent breath sounds, egophony audible above the fluid level, and overt signs of systemic sepsis in advanced presentations.

• Diagnostic Assessment & Pleural Fluid Profile:

  • Chest Radiography: Shows costophrenic angle blunting, loculated fluid collections, meniscus sign, or hydroaeric levels (air-fluid interface showing air [A] above fluid [B]).

  • Ultrasonography: Superior for identifying loculations, detecting complex septations, and guiding needle/catheter placement.

  • Contrast-Enhanced CT Scan: Gold standard imaging modality for defining the exact anatomic extent, loculations, septations, and presence of a trapped lung.

  • Empyema Fluid Diagnostic Parameters:

  • Gross Appearance: Grossly purulent (pus-like).

  • WBC Count: Severely elevated, predominantly neutrophils.

  • pH: Acidic (< 7.2).

  • Glucose: Severely reduced (< 40\,\text{mg/dL}).

  • LDH: Extremely high (> 1,000\,\text{IU/L}).

  • Gram Stain / Culture: Frequently positive (especially for anaerobes or Staphylococcus species).

  • AFB Stain / Culture: Positive if tuberculous empyema is present.

• Therapeutic & Surgical Management:

  • Systemic Intravenous Antibiotics:

  • Ceftriaxone plus Metronidazole (provides targeted Gram-positive and anaerobic coverage).

  • Piperacillin-tazobactam (broad-spectrum agent with robust anaerobic activity).

  • Vancomycin or Linezolid (indicated if Methicillin-Resistant Staphylococcus aureus [MRSA] is suspected).

  • Add specific anti-tuberculosis regimens if Mycobacterium tuberculosis is confirmed.

  • Interventional Procedures:

  • Complete surgical drainage of pus.

  • Re-expand the collapsed lung completely.

  • Eliminate pleural space to prevent recurrence or long-term complications.

  • Surgical Indications:

  • Indicated in cases of thick, organized pus, presence of a bronchopleural fistula, or failure of tube drainage; surgical intervention includes formal surgical decortication.

Pneumothorax

• Definition & Pathophysiology:

  • Pneumothorax is defined as the presence of gas or air within the pleural cavity.

  • Clinical sequelae depend directly on the degree of ipsilateral lung collapse.

  • Significant air accumulation can cause a contralateral mediastinal shift and severe hemodynamic collapse.

  • Pathological air entry occurs via a breach in the chest wall (traumatic) or through the pulmonary parenchyma across the visceral pleura.

• Comprehensive Classification system:

  • Spontaneous Pneumothorax:

  • Primary Spontaneous: Occurs in patients without underlying lung disease; typically caused by the rupture of apical subpleural blebs or bullae in tall, thin young individuals and smokers.

  • Secondary Spontaneous: Occurs as a complication of pre-existing pulmonary pathology (e.g., COPD, TB, asthma, pulmonary fibrosis, cystic fibrosis, necrotizing pneumonia, lung cancer).

  • Traumatic Pneumothorax:

  • Caused by blunt or penetrating chest injuries (e.g., rib fractures, stab wounds, gunshot wounds, high-impact motor vehicle accidents).

  • Iatrogenic Pneumothorax:

  • Resulting from medical interventions (e.g., thoracentesis, transthoracic lung biopsy, positive-pressure mechanical ventilation, subclavian/jugular central line placement).

  • Catamenial Pneumothorax:

  • Recurrent pneumothorax occurring in females in association with menstrual cycles, secondary to thoracic endometriosis syndrome.

  • Classification by Anatomic Communication Mechanism:

  • Closed Pneumothorax: Air enters the pleural space without an open chest wall wound.

  • Open Pneumothorax: Direct communication between atmospheric air and pleural space (e.g., open chest wall defect or persistent bronchopleural fistula).

  • Tension Pneumothorax: Life-threatening condition where a one-way valve mechanism allows air into the pleural space during inspiration but prevents its escape during expiration. Leads to complete loss of negative intrapleural pressure, total lung collapse, mediastinal shift, acute compression of the vena cava, and rapid decline in venous return.

  • Classification by Volumetric Size:

  • Small: Air occupies < 15\text{--}20\% of the hemithorax.

  • Large: Air occupies > 20\% of the hemithorax, or displays visible total lung collapse on diagnostic imaging.

• Clinical Findings:

  • Symptoms: Sudden onset of sharp chest pain, dyspnea ranging from mild to severe, cough, anxiety, severe restlessness, cyanosis in severe compromise, and marked hypotension with distended neck veins in tension pneumothorax.

  • Signs: Reduced chest expansion on the affected side, hyperresonance on percussion, decreased or entirely absent breath sounds, tachypnea, tachycardia, and contralateral tracheal deviation (pathognomonic sign of tension pneumothorax).

• Diagnostic Radiography:

  • Chest X-Ray:

  • Visible visceral pleural line separated from the chest wall with complete absence of peripheral lung markings.

  • Associated pulmonary collapse.

  • Deep Sulcus Sign: Highly indicative of pneumothorax on supine radiographies.

  • Mediastinal and tracheal shift away from the affected side in tension pneumothorax.

  • Ultrasonography: Rapid, highly useful diagnostic tool at the bedside.

  • Computed Tomography (CT) Scan: The most sensitive modality for identifying small, apical, or occult pneumothoraces.

• Stepwise Treatment Algorithm:

  • Small Primary Spontaneous (< 15\text{--}20\%$)**:\n - Conservative management: Clinical observation, supplemental high-flow oxygen therapy, and repeated serial chest X-rays.\n - **Large (> 20\%$) or Symptomatic Primary Spontaneous:

  • Interventional removal: Simple needle aspiration or tube thoracostomy placement ($4^{\text{th}}\text{--}5^{\text{th}}$ intercostal space along the mid-axillary line).

  • Secondary Spontaneous Pneumothorax:

  • Always requires formal chest tube placement paired with direct treatment of the primary underlying lung pathology.

  • Tension Pneumothorax:

  • Immediate emergency intervention: Emergency needle decompression ($2^{\text{nd}}$ intercostal space along the midclavicular line) using a large-bore needle, followed immediately by formal chest tube placement.

  • Traumatic Pneumothorax:

  • Standard chest tube drainage in combination with management of concurrent traumatic injuries.

  • Recurrent Pneumothorax:

  • Definitive prevention: Pleurodesis or surgical intervention (Video-Assisted Thoracoscopic Surgery [VATS] with thoracoscopic blebectomy/resection).

1. سوال: پلور چیست؟
   جواب: پلور یک غشای نازک و دو لایه‌ای است که ریه‌ها را پوشش می‌دهد و فضای قفسه سینه را خط می‌کشد.

2. سوال: پلور پاریتال چه وظیفه‌ای دارد؟
   جواب: پلور پاریتال سطح داخلی دیواره قفسه سینه، دیافراگم و مدیاستین را خط می‌کشد و حساس به درد است.

3. سوال: پلور ویسسرال چیست؟
   جواب: پلور ویسسرال سطح خارجی ریه‌ها را پوشش می‌دهد و حساسیت کمتری به درد دارد.

4. سوال: حفره پلور چیست؟
   جواب: حفره پلور فضای پتانسیلی است که بین پلورپاریتال و پلور ویسسرال قرار دارد و حاوی مقداری مایع است که اصطکاک را کاهش می‌دهد.

5. سوال: پلوریت (پلو رایت) چیست؟
   جواب: پلوریت التهاب پلور پاریتال است که با درد قفسه سینه تند و موضعی مشخص می‌شود.

6. سوال: احتشاء پلور (پلورال افیوژن) چه حالتی است؟
   جواب: احتشاء پلور تجمع غیر طبیعی مایع در فضای پلور است که می‌تواند ترانسوداتیو یا اگزوداتیو باشد.

7. سوال: ترانسوداتها چه نوع مایعاتی هستند؟
   جواب: ترانسوداتها میوه‌هایی هستند که به دلیل عدم تعادل فشار هیدرواستاتیک و اونکوتیک ایجاد می‌شوند.

8. سوال: اگزوداتها چه هستند؟
   جواب: اگزوداتها مایعاتی هستند که ناشی از فرآیندهای التهابی محلی هستند که نفوذپذیری غشای پلور را افزایش می‌دهند.

9. سوال: X-ray قفسه سینه چه کاربردی دارد؟
   جواب: می‌تواند احتشاء پلور را از طریق زوایای کستوفریک بلانت یا سطح مایع نشان دهد.

10. سوال: scan CT چه کم