胸膜疾病英文版Respiratory Medicine.pptVIP

Unclosure pneumothorax Open Pneumothorax Air enters pleural cavity via outside A free communication between the exterior and the pleural space as through an open wound Tension pneumothorax a piece of tissue forms a one-way valve that allows air to enter the pleural cavity but not to escape, overpressure can build up with every breath Bronchoscope Haemoptysis Suspect airway obstruction Diagnosis 3 steps 1. to determine pleural effusion existing or not 2. to determine transudate or Exudate 3. to find the causes of pleural effusion Transudate Exudate Apperance light yellow yellow, purulent Specific gravity 1.018 1.018 Coagulability unable able Revalta test negative positive Protein content 30g/L 30g/L ΘP. To serum 0.5 0.5 LDH 200 I U/ L 200 I U / L Θ P. To s 0.6 0.6 Cell count 100×10 6/ L 500×10 6 / L Differential cell Lymphocyte Different diagnosis Light’s Criteria Pleural fluid is exudate if one or more: Pleural fluid protein:serum protein 0.5 Pleural fluid LDH:serum LDH 0.6 Pleural fluid LDH 2/3 upper limit ln serum LDH Transudate Hepatic hydrothorax. Nephritic syndrome. Congestive heart failure. Hypoproteinemia. Exudate Cell count – Neutrophil predominate acute process (pneumonia, PE) - Lymphocytic predominate chronic process (Cancer, TB,) Culture/stain- infected fluid Glucose- low level (60mg/dl)(pneumonia, CA) Cytolo