Target for Nurses & Paramedics , *Simplifying*

1. PLEURAL DISEASES
M.Thulasiraman.,RN,RM & RT
Institute of Critical Care Medicine,
Royal Care Super Speciality Hospital.

2. ANATOMY
• The pleura is the serous membrane that covers
the lung parenchyma (visceral pleura) , the
mediastinum, the diaphragm, and the rib cage
(parietal pleura).
• visceral pleura: blood supply from low- pressure
pulmonary circulation, and has no sensory
nerves
• parietal pleura: from the systemic circulation
and contains sensory nerves

3. ANATOMY OF PLURA

4. PHYSIOLOGY
The two layers of the pleura are separated
by a virtual cavity, which is lubricated by 5 to
10 mL of fluid, facilitates lung expansion,
and helps maintain lung inflation by coupling
the lungs with the chest wall.

5. CLASSIFICATION

6. PLEURAL EFFUSION
Pleural effusion, sometimes referred to as “water on the
lungs,” is the build-up of excess fluid between the layers of the pleura
outside the lungs. The pleura are thin membranes that line the lungs
and the inside of the chest cavity and act to lubricate and facilitate
breathing.

8. ETIOLOGY
• Congestive heart failure
• Cirrhosis
• Peritoneal dialysis
• Nephrotic syndrome
• Superior vena cava obstruction
• Myxedema
• Pulmonary thromboemboli
Transudative Pleural Effusions

9. • Infectious diseases
Tuberculosis, Bacterial infections, Fungal,
Viral, Parasitic
• Neoplasms
• Pulmonary thromboembolization
• Gastrointestinal disease
Pancreatitis, Esophageal perforation,
Intra-abdominal abscesses
• Collagen vascular diseases
Rheumatoid arthritis, Lupus erythematosus
ETIOLOGY
Exudative Pleural Effusions

10. • Drug-induced pleural disease
Nitrofurantoin, Amiodarone
• Asbestos exposure
• Chylothorax
• Hemothorax
• Postsurgical
• Sarcoidosis
• Uremic pleuritis
• Yellow nail syndrome
ETIOLOGY

11. LIGHT'S CRITERIA

12. CLINICAL MANIFESTATION

13. INVESTIGATIONS

14. x-ray

15. Ultrasound image of the left hemithorax
USG

16. Computed tomography: Bilateral pleural effusions
are present as a result of pneumonia
CT Scan

17. PLEURAL EFFUSION.: A, Blood-stained pleural aspirate. This patient
had pleural metastases from carcinoma of the breast.
B, Chylous pleural effusion. This patient had bronchial carcinoma that
had invaded and obstructed the thoracic duct.
C, Pleural transudate. This pale effusion is typically found in patients
with heart failure or other causes of generalized edema.

18. EMPYEMA

19. EMPYEMA
• Is pus in the pleural space
Etiology:
• Empyema is always secondary to infection
in a neighbouring structure, usually the
lung. The principal infections liable to
produce empyema are the bacterial
pneumonias and TB.

20. • Pathophysiology:
parapneumonic pleural effusion
exudative stage
↓
fibropurulent stage
↓
organization stage

21. Clinical Features
Symptoms:
• Pyrexia, usually high and remittent
• Rigors, sweating, malaise and weight loss
• Pleural pain
• Breathlessness
• Cough and sputum usually because of
underlying lung disease;
• Copious purulent sputum (bronchopleural
fistula)

22. Signs:
• Clinical signs of fluid in the pleural space
• Intercostal tenderness

23. Treatment
• Antibiotics OR anti tubercular drugs
• Intercostal tube drainage
• Decortication if gross thickening of the
visceral pleura has developed and is
preventing re-expansion of the lung

24. THANKS