Pleural Diseases

by Jeremy Brown, PhD

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    The subject of this lecture is pleural disease, by which we mean pleural effusions which can be transudates or exudates or infective in origin. In addition, we’ll talk about pneumothorax which is air in the pleural space and pleural thickening. Mesothelioma which is a primary cancer of the pleura is actually discussed in the lung oncology lecture. There are a couple of important basic concepts about pleural disease. The first is that there are no divisions in the normal pleural space. That means that when you have a pneumothorax with air in the pleural space, it will rise to the top, whereas if you have pleural fluid, then it will sink to the bottom and pleural effusions are best detected at the base of the lungs. However, if you get an infection in the pleural space or a hemothorax that is blood in the pleural space or a surgeon has done some pleural surgery, then you get adhesions forming between the visceral and the parietal pleura. And that can cause loculations of the pleural space divisions, and that will make the X-ray appearances of pleural fluid or pneumothorax quite different. The other basic concept of pleural space is under negative pressure, and this keeps the lungs inflated. That means that when you get a pneumothorax, the lung will collapse. Pleural disease is actually readily detectable normally by clinical examination. The stethoscope will quite easily pick up a difference when somebody has a pneumothorax or pleural effusion between the affected side and the normal side. And percussion will readily pick up somebody with a large pleural effusion. The best test is actually a pleural ultrasound, and that is the most efficient way of assessing for pleural fluid and for divisions in the pleural space and is also affected by identifying whether...

    About the Lecture

    The lecture Pleural Diseases by Jeremy Brown, PhD is from the course Respiratory Medicine (Pulmonology): Advanced. It contains the following chapters:

    • Pleural disease
    • Transudates vs. exudates
    • Unilateral pleural effusions
    • Pleural tap
    • Pleural biopsy
    • Pneumothorax
    • Tension pneumothorax
    • Empyema
    • Pleural thickening
    • Asbestos exposure and pleural disease

    Quiz for lecture

    Test your knowledge with our quiz for lecture Pleural Diseases.

    1. The normal pleural space has divisions due to connections between the visceral and parietal pleura.
    2. A small pneumothorax is best detected at the top of the chest.
    3. A small pleural effusion is best detected at the bottom of the chest.
    4. Significant pleural disease should be picked up by a good examination of the chest.
    1. Rheumatoid arthritis
    2. Congestive cardiac failure
    3. Constrictive pericaridits
    4. Nephrotic syndrome
    1. Echocardiogram
    2. Bronchoscopy
    3. CT guided biopsy of the pleura
    4. Pleural cytology
    1. Pulmonary embolus
    2. Marfan’s syndrome
    3. Bullous lung disease
    4. Smoking
    1. Rapid insertion of a cannula into the second intercostal space in the midclavicular line
    2. Controlled oxygen between with an FiO2 of 24 to 28%
    3. Immediate intubation and ventilation
    4. Treatment with cardiac inotropes
    1. Pleural fluid content of 40 g / L, culture negative with normal pH and no loculations seen on the ultrasound
    2. Pleural fluid pH of < 7.2
    3. Pleural loculations visible on pleural ultrasound
    4. Culture of Streptococcus milleri from the pleural fluid

    Author of lecture Pleural Diseases

     Jeremy Brown, PhD

    Jeremy Brown, PhD

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