胸膜疾病英文版pleural-disease.ppt

Male, 70 year old with an 80-pack-year history of smoking and a history of coronary heart disease. He was suffered from increasing shortness of breath for 1 week. And he also had chest pain on the right side that worsens with deep inspiration. He was afebrile. Chest examination revealed dullness to percussion, the absence of fremitus, and diminished breath sounds on the right side. No distended neck veins, no peripheral edema was observed. The chest radiograph was showed as picture Pleural effusion Pleural Space Visceral Pleura – attached to lungs. Parietal Pleura – attached to chest wall. Pleural space 5-15 mL of fluid secreted by the pleural cells. Minimizes friction as the two pleural surfaces glide over each other during inspiration and expiration. Pleural fluid analysis Appearance, Specific gravity, Protein content, Cell counts, Glucose, LDH , Adenisine deaminase (ADA), Gram stain and culture, Cytologic examination, etc. What shall we do next? The pleural fluid test result: total cells: 570×106/L, lymphocyte 59%, protein 36g/L, Rivalta test(+), serum protein 62g/L,what kind of pleural effusion was it? diagnostic thoracentesis Exudate Definition  Sources –Visceral pleura –Ruptured esophagus –Chest wall defect –Gas-forming organisms Classification of Pneumothorax Spontaneous –Primary –Secondary ?COPD ?Infection ?Neoplasm ?Catamenial ?Miscellaneous ?Traumatic –Blunt –Penetrating ?Iatrogenic –Inadvertent –Diagnostic –Therapeutic Primary Spontaneous Pneumothorax Pt. with unknown lung disease.? a rupture of a bulla in the lung. Most often tall, thin men between 20 and 40 years old. Secondary Spontaneous Pneumothorax occurs in pt. with known lung disease most often COPD? Other lung diseases commonly assoc. with Tuberculosis Pneumonia Asthma cystic fibrosis lung cancer Often severe life threatening Closure pneumothorax Air enters the