Derrame Pleural

Descripción General

Definición

El derrame pleural es una acumulación excesiva de líquido dentro de la cavidad pleural (entre la pleura Pleura The pleura is a serous membrane that lines the walls of the thoracic cavity and the surface of the lungs. This structure of mesodermal origin covers both lungs, the mediastinum, the thoracic surface of the diaphragm, and the inner part of the thoracic cage. The pleura is divided into a visceral pleura and parietal pleura. Pleura: Anatomy parietal Parietal One of a pair of irregularly shaped quadrilateral bones situated between the frontal bone and occipital bone, which together form the sides of the cranium. Skull: Anatomy y visceral).

Clasificación

Los LOS Neisseria criterios de Light se utilizan para categorizar los LOS Neisseria derrames y para guiar los LOS Neisseria estudios posteriores.

Un derrame se clasifica como exudativo si se cumple alguno de estos 3 criterios:

• Relación proteínas del líquido pleural:proteínas séricas > 0,5
• Relación LDH LDH Osteosarcoma del líquido pleural: LDH LDH Osteosarcoma sérica > 0,6
• LDH LDH Osteosarcoma en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum líquido pleural > dos-tercios del límite superior de la normalidad para la LDH LDH Osteosarcoma sérica

Si no se cumplen estos 3 criterios, el derrame pleural se considera transudativo.

Etiología

• Causas comunes de transudado:
  • Insuficiencia cardíaca
  • Cirrosis hepática
  • Hipoalbuminemia
  • Síndrome nefrótico
• Causas comunes de exudado:
  • Neumonía
  • TB TB Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis complex bacteria. The bacteria usually attack the lungs but can also damage other parts of the body. Approximately 30% of people around the world are infected with this pathogen, with the majority harboring a latent infection. Tuberculosis spreads through the air when a person with active pulmonary infection coughs or sneezes. Tuberculosis
  • Tumor Tumor Inflammation maligno (frecuentemente un cáncer de pulmón primario)
  • Enfermedades del tejido conectivo
  • Pancreatitis Pancreatitis Inflammation of the pancreas. Pancreatitis is classified as acute unless there are computed tomographic or endoscopic retrograde cholangiopancreatographic findings of chronic pancreatitis. The two most common forms of acute pancreatitis are alcoholic pancreatitis and gallstone pancreatitis. Acute Pancreatitis
  • Hemotórax
  • Quilotórax (acumulación de líquido linfático)
  • Derrame pleural benigno por asbesto
• Transudativo o exudativo: embolia pulmonar

Fisiopatología

Los LOS Neisseria derrames pleurales representan una alteración entre la producción de líquido pleural y la reabsorción linfática.

Fisiología normal

El líquido pleural es un producto de las fuerzas de Starling dentro del lecho capilar de la pleura Pleura The pleura is a serous membrane that lines the walls of the thoracic cavity and the surface of the lungs. This structure of mesodermal origin covers both lungs, the mediastinum, the thoracic surface of the diaphragm, and the inner part of the thoracic cage. The pleura is divided into a visceral pleura and parietal pleura. Pleura: Anatomy parietal Parietal One of a pair of irregularly shaped quadrilateral bones situated between the frontal bone and occipital bone, which together form the sides of the cranium. Skull: Anatomy y es absorbido por los LOS Neisseria vasos linfáticos de las superficies diafragmática y mediastínica de la pleura Pleura The pleura is a serous membrane that lines the walls of the thoracic cavity and the surface of the lungs. This structure of mesodermal origin covers both lungs, the mediastinum, the thoracic surface of the diaphragm, and the inner part of the thoracic cage. The pleura is divided into a visceral pleura and parietal pleura. Pleura: Anatomy parietal Parietal One of a pair of irregularly shaped quadrilateral bones situated between the frontal bone and occipital bone, which together form the sides of the cranium. Skull: Anatomy.

• La tasa media normal de producción y absorción del líquido pleural es de 0,2 mL/kg/hora.
• Todo el volumen de líquido pleural suele reemplazarse en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum 1 hora.
• Los LOS Neisseria vasos linfáticos pueden manejar un flujo de hasta aproximadamente 20 veces más que la tasa de producción normal → la reabsorción linfática tiene una gran capacidad de reserva

Derrames transudativos

Un derrame pleural transudativo puede ser el resultado de una mayor entrada de líquido en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el espacio pleural debido a:

• ↑ Presión hidrostática en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la vasculatura (e.g., insuficiencia cardíaca)
• ↓ Fuerzas oncóticas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el plasma Plasma The residual portion of blood that is left after removal of blood cells by centrifugation without prior blood coagulation. Transfusion Products (e.g., hipoalbuminemia)
• Movimiento de líquido ascítico a través del diafragma (e.g., hidrotórax hepático)

Derrames exudativos

Un derrame pleural exudativo puede ser el resultado de:

• ↑ Permeabilidad capilar → ↑ niveles pleurales de:
  • Proteínas
  • Células
  • Otros contenidos plasmáticos (según la etiología)
• Deterioro del drenaje linfático por:
  • Infiltración por tumor Tumor Inflammation maligno u obstrucción de los LOS Neisseria vasos linfáticos
  • Procesos inflamatorios
  • Compresión mecánica de los LOS Neisseria vasos linfáticos
  • ↑ Presión venosa sistémica de manera aguda.

Presentación Clínica

Síntomas

Algunos derrames pleurales pueden ser asintomáticos. Los LOS Neisseria síntomas pueden variar y pueden depender de la gravedad y la causa del derrame.

• Disnea (más común)
• Dolor Dolor Inflammation torácico pleurítico:
  • El dolor Dolor Inflammation empeora con la inspiración profunda.
  • Indica inflamación pleural
• Fiebre
• Tos TOS Thoracic outlet syndrome (TOS) is a broad term used for a spectrum of syndromes related to the general region of the thoracic outlet, which involves the compression or irritation of elements of the brachial plexus, subclavian artery, or subclavian vein. Thoracic Outlet Syndrome

Examen clínico de los LOS Neisseria pulmones

• Inspección:
  • Expansión torácica asimétrica (expansión reducida en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el lado del derrame)
  • Llenado de los LOS Neisseria espacios intercostales
• Palpación:
  • ↓ o ausencia de frémito táctil
  • Desviación traqueal:
    • La tráquea se desplaza hacia el lado opuesto del derrame.
    • Se ve VE Ventilation: Mechanics of Breathing en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum derrames grandes y severos
• Auscultación:
  • Sonidos respiratorios ↓ o inaudibles en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el derrame
  • Ruidos respiratorios bronquiales, broncofonía y egofonía:
    • Se escucha sobre las partes del pulmón directamente por encima del derrame
    • Debido a la consolidación del pulmón en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum esa zona
  • Fricción pleural
• Percusión:
  • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el caso de un derrame > 300 mL, la exploración del tórax también presentará matidez a la percusión.
  • La matidez del borde superior sigue una curva que asciende lateralmente y que tiene su ápice en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la línea axilar media (línea Ellis-Damoiseau).

Indicios de una etiología subyacente

Los LOS Neisseria derrames paraneumónicos (adyacentes a una neumonía) pueden presentarse con signos de sepsis Sepsis Systemic inflammatory response syndrome with a proven or suspected infectious etiology. When sepsis is associated with organ dysfunction distant from the site of infection, it is called severe sepsis. When sepsis is accompanied by hypotension despite adequate fluid infusion, it is called septic shock. Sepsis and Septic Shock o shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock séptico.

• Fiebre
• Taquicardia
• Hipotensión

Los LOS Neisseria derrames transudativos pueden estar asociados a:

• Aumento de peso
• Edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema periférico
• Ingurgitación yugular

Los LOS Neisseria derrames malignos pueden estar asociados a:

• Pérdida de peso
• Saciedad temprana
• Sudoración nocturna

Diagnóstico

Imagenología

Los LOS Neisseria derrames pleurales suelen detectarse fácilmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria estudios de imagen.

Radiografía de tórax:

• Mejor prueba inicial
• Hallazgos:
  • Embotamiento anormal de los LOS Neisseria ángulos costodiafragmáticos
  • Líquido dentro de las fisuras horizontales u oblicuas
  • Algunos derrames pueden mostrar un menisco
  • Derrames masivos
    • Opacificación completa de un hemitórax
    • Desviación de la tráquea en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum sentido contrario al AL Amyloidosis lado afectado
    • Desplazamiento del mediastino
• Radiografías en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum decúbito lateral
  • Más sensibles
  • Pueden demostrar la estratificación del líquido (derrame pleural de flujo libre)

TC de tórax:

• Puede detectar pequeñas cantidades de líquido pleural
• Capaz de evaluar todo el parénquima pulmonar y el mediastino en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum busca de posibles etiologías

Ultrasonido:

• Alta sensibilidad para el diagnóstico de derrames pleurales
• Puede detectar pequeñas cantidades de líquido pleural que pueden pasar desapercibidas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un examen radiológico
• A menudo se utiliza para visualizar el derrame para la realización de la toracocentesis o el drenaje pleural

Consideraciones imagenológicas

Algunos hallazgos imagenológicos pueden ayudar a reducir la lista de posibles causas del derrame pleural.

• Derrames pleurales bilaterales:
  • Se observan con mayor frecuencia en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum estados de sobrecarga de volumen (e.g., insuficiencia cardíaca)
  • El diagnóstico diferencial debe incluir también tumor Tumor Inflammation maligno, lupus y pericarditis Pericarditis Pericarditis is an inflammation of the pericardium, often with fluid accumulation. It can be caused by infection (often viral), myocardial infarction, drugs, malignancies, metabolic disorders, autoimmune disorders, or trauma. Acute, subacute, and chronic forms exist. Pericarditis constrictiva.
• Pueden producirse derrames masivos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum:
  • Tumores malignos
  • Derrame paraneumónico complicado o empiema
  • TB TB Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis complex bacteria. The bacteria usually attack the lungs but can also damage other parts of the body. Approximately 30% of people around the world are infected with this pathogen, with the majority harboring a latent infection. Tuberculosis spreads through the air when a person with active pulmonary infection coughs or sneezes. Tuberculosis
• Derrames localizados:
  • Causados por adherencias entre superficies pleurales contiguas
  • Más comúnmente asociados a estados inflamatorios significativos (e.g., empiema, hemotórax, TB TB Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis complex bacteria. The bacteria usually attack the lungs but can also damage other parts of the body. Approximately 30% of people around the world are infected with this pathogen, with the majority harboring a latent infection. Tuberculosis spreads through the air when a person with active pulmonary infection coughs or sneezes. Tuberculosis)

Análisis del líquido pleural

Una vez que se encuentra un derrame pleural, el siguiente paso es tomar una muestra del líquido pleural realizando una toracocentesis.

Las investigaciones de rutina incluyen:

• Envío del líquido pleural para:
  • Cultivos y microscopía
    • Bacterias
    • Bacilos ácido-alcohol resistentes
    • Hongos
  • Citología
  • Recuento celular con diferencial
  • pH pH The quantitative measurement of the acidity or basicity of a solution. Acid-Base Balance
  • LDH LDH Osteosarcoma
  • Proteínas
  • Albúmina
  • Glucosa
• Estudios del suero a solicitar para los LOS Neisseria criterios de Light:
  • LDH LDH Osteosarcoma
  • Proteína
  • Albúmina

Las investigaciones adicionales incluyen (basadas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la sospecha clínica):

• Amilasa → pancreatitis Pancreatitis Inflammation of the pancreas. Pancreatitis is classified as acute unless there are computed tomographic or endoscopic retrograde cholangiopancreatographic findings of chronic pancreatitis. The two most common forms of acute pancreatitis are alcoholic pancreatitis and gallstone pancreatitis. Acute Pancreatitis, ruptura esofágica
• Triglicéridos → quilotórax
• Factor reumatoide y anticuerpos antinucleares → trastornos autoinmunes
• Frotis de bacilos ácido-alcohol resistentes y adenosina desaminasa → TB TB Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis complex bacteria. The bacteria usually attack the lungs but can also damage other parts of the body. Approximately 30% of people around the world are infected with this pathogen, with the majority harboring a latent infection. Tuberculosis spreads through the air when a person with active pulmonary infection coughs or sneezes. Tuberculosis

Procedimientos avanzados

Si los LOS Neisseria antecedentes, la exploración física, el diagnóstico imagenológico y el análisis del líquido pleural no revelan un diagnóstico y el paciente tiene síntomas preocupantes (e.g., pérdida de peso, fiebre persistente), se puede considerar lo siguiente:

• Broncoscopia: puede ayudar a diagnosticar un tumor Tumor Inflammation maligno asociado o causas infecciosas
• Biopsia pleural:
  • Puede realizarse si hay sospecha clínica de malignidad o TB TB Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis complex bacteria. The bacteria usually attack the lungs but can also damage other parts of the body. Approximately 30% of people around the world are infected with this pathogen, with the majority harboring a latent infection. Tuberculosis spreads through the air when a person with active pulmonary infection coughs or sneezes. Tuberculosis
  • Opciones:
    • Biopsia percutánea con aguja
    • Cirugía toracoscópica asistida por vídeo (VATS, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés)

Formas Especiales de Derrame Pleural

Quilotórax

• Líquido linfático en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la cavidad pleural
• Etiología:
  • Traumatismos (e.g., postoperatorios)
  • Tumor Tumor Inflammation maligno
  • Anomalías congénitas
• El análisis del líquido pleural revelará:
  • Líquido turbio y lechoso
  • Exudado
  • Predominio linfocítico
  • Altas concentraciones de lípidos

Derrame paraneumónico

• Líquido pleural exudativo y neutrofílico asociado a una neumonía
• Clasificación:
  • No complicado
    • No hay invasión bacteriana de la pleura Pleura The pleura is a serous membrane that lines the walls of the thoracic cavity and the surface of the lungs. This structure of mesodermal origin covers both lungs, the mediastinum, the thoracic surface of the diaphragm, and the inner part of the thoracic cage. The pleura is divided into a visceral pleura and parietal pleura. Pleura: Anatomy
    • Se resuelve con el tratamiento de la neumonía
  • Complicado
    • Invasión bacteriana de la pleura Pleura The pleura is a serous membrane that lines the walls of the thoracic cavity and the surface of the lungs. This structure of mesodermal origin covers both lungs, the mediastinum, the thoracic surface of the diaphragm, and the inner part of the thoracic cage. The pleura is divided into a visceral pleura and parietal pleura. Pleura: Anatomy
    • Las bacterias se eliminan rápidamente del espacio pleural → los LOS Neisseria cultivos suelen ser negativos
  • Empiema
    • Infección bacteriana de la pleura Pleura The pleura is a serous membrane that lines the walls of the thoracic cavity and the surface of the lungs. This structure of mesodermal origin covers both lungs, the mediastinum, the thoracic surface of the diaphragm, and the inner part of the thoracic cage. The pleura is divided into a visceral pleura and parietal pleura. Pleura: Anatomy
    • El líquido pleural será espeso, viscoso y opaco (pus).
    • Puede provocar el depósito de fibrina y la restricción del movimiento pulmonar

Hemotórax

• Acumulación de sangre en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la cavidad pleural
• Etiología:
  • Traumática
  • No traumática:
    • Tumor Tumor Inflammation maligno
    • Coagulopatía
    • Enfermedad vascular o del tejido conectivo
• El análisis pleural revelará:
  • Sangre franca
  • ↑ Recuento de eritrocitos

Tratamiento

Tratamiento inicial

Los LOS Neisseria pacientes asintomáticos no suelen requerir tratamiento y muchos tendrán una reabsorción espontánea del derrame. Sin embargo, en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria pacientes sintomáticos se debe hacer lo siguiente:

• Evaluar las vías respiratorias, la respiración y la circulación.
• Proporcionar oxígeno suplementario.
• Drenaje urgente si hay:
  • Dificultad respiratoria severa o insuficiencia respiratoria
  • Evidencia de shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock obstructivo

Intervenciones

• Toracocentesis:
  • Aspiración con aguja del líquido pleural
  • Diagnóstica y terapéutica
  • Puede repetirse si hay reacumulación
• Colocación de drenaje pleural:
  • Colocación de un tubo quirúrgico en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el espacio pleural
  • Crítico en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el empiema y el hemotórax
• Catéter pleural permanente:
  • Catéter que hace HACE Altitude Sickness un túnel en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el espacio pleural
  • Permite el drenaje intermitente del líquido pleural
  • Se utiliza en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum derrames pleurales refractarios (que requieren toracocentesis frecuentes por recidiva, como en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el caso de un tumor Tumor Inflammation maligno)
• Pleurodesis:
  • Obliteración del espacio pleural mediante la inducción de inflamación y fibrosis Fibrosis Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. Bronchiolitis Obliterans
  • Puede realizarse con productos químicos (e.g., talco) o con abrasión manual
  • Se utiliza para los LOS Neisseria derrames pleurales refractarios
• Pleurectomía y decorticación:
  • Opción quirúrgica si fallan todas las medidas anteriores
  • Se utiliza como último recurso en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum casos avanzados

Tratamiento de la causa subyacente

El tratamiento de los LOS Neisseria derrames pleurales depende de encontrar y tratar la etiología subyacente.

• Derrame paraneumónico y empiema:
  • Antibióticos
  • Toracocentesis o drenaje pleural
• Derrame pleural maligno:
  • Tratamiento adecuado del tumor Tumor Inflammation maligno primario
    • Quimioterapia
    • Radiación
  • Puede requerir un drenaje frecuente o una intervención avanzada (e.g., pleurodesis, catéter pleural)
• Hemotórax:
  • Colocación del drenaje pleural
  • Identificar y detener la fuente de la hemorragia:
    • Exploración quirúrgica
    • Radiología intervencionista
  • Transfusión de sangre, según sea necesario
• Derrames transudativos:
  • Insuficiencia cardíaca: diuresis
  • Hidrotórax hepático:
    • Diuresis
    • Derivación portosistémica transyugular
  • Insuficiencia renal con sobrecarga de líquidos: hemodiálisis

Complicaciones

Complicaciones de los LOS Neisseria derrames pleurales

• Insuficiencia respiratoria:
  • Empeoramiento de la hipoxia
  • Dificultad respiratoria
• Derrames pleurales localizados:
  • Compartimentación de un derrame pleural en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum espacios más pequeños por capas fibrosas
  • Clásicamente, se ve VE Ventilation: Mechanics of Breathing en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el empiema, el hemotórax y TB TB Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis complex bacteria. The bacteria usually attack the lungs but can also damage other parts of the body. Approximately 30% of people around the world are infected with this pathogen, with the majority harboring a latent infection. Tuberculosis spreads through the air when a person with active pulmonary infection coughs or sneezes. Tuberculosis
  • Tratados con agentes fibrinolíticos intrapleurales
• Atrapamiento pulmonar:
  • Pulmón incapaz de expandirse debido a la formación de una cáscara pleural en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la pleura Pleura The pleura is a serous membrane that lines the walls of the thoracic cavity and the surface of the lungs. This structure of mesodermal origin covers both lungs, the mediastinum, the thoracic surface of the diaphragm, and the inner part of the thoracic cage. The pleura is divided into a visceral pleura and parietal pleura. Pleura: Anatomy visceral
  • Secundaria a una inflamación pleural activa, una infección o un tumor Tumor Inflammation maligno
• Shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock:
  • Shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock obstructivo: efecto compresivo mediastínico que provoca una alteración del gasto cardíaco
  • Shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock séptico: resultado de una infección que provoca inestabilidad hemodinámica y disfunción de órganos diana
  • Shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock hemorrágico: se observa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el hemotórax traumático

Complicaciones de la toracocentesis

• Neumotórax
• Lesión vascular → hemotórax
• Edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema pulmonar de reexpansión