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Pleural Space
Visceral Pleura
Parietal Pleura
Parietal Pleura
Pleural Space
Visceral Pleura
Think Again - - -
Back
Liver Failure
• Pneumonia
-inflammation of the lung structures,
specifically the alveoli and bronchioles
• WBCs accumulate in response to
infection and inflammation leading to
empyema
Atelectasis
• Atelectasis is an incomplete expansion of the lung which
leads to collapse of the alveoli
• Increased negative intrapleural pressure can lead to the
collection of fluid in the portion of the lung which is not
expanding
• This can cause an effusion by fluid leaking out of the
lung and into the chest cavity
• Atelectasis typically leads to small pleural effusions not
requiring surgical intervention
Cancer
• Impaired lymphatic drainage of the pleural space due to
obstruction by a tumor
• Typically due to the interference with the visceral pleura
(which absorbs pleural fluid)
• A tumor can obstruct pulmonary veins, preventing fluid
from being reabsorbed into the bloodstream
• A tumor can perforate the thoracic duct
• Shedding of malignant cells into the pleural space,
decreasing reabsorption of pleural fluid back into the
lymphatic system (Brubacher & Holmes Gobel, 2003, p. 1)
Trauma
• Pus
• Yellow, cloudy, and foul odor
• Most likely due to pneumonia, lung
abscess, infected chest wounds
• Has a pH > 7.2
(Drummond Hayes, 2001, p. 33)
Chyle
• Milky fluid
• Consists of lymph and fat
• Chyle leaks from the thoracic duct
-due to lymphatic obstruction
(tumor) or trauma
• High triglyceride levels found in fluid
analysis
Hemothorax
• Blood
• Usually results from chest injury
• A blood vessel ruptures into the pleural space or
a bulging area into the aorta (aortic aneurysm)
leaks blood into the pleural space
• Can occur as a result of bleeding from the ribs,
chest wall, pleura, and the lung
Let’s review
• Which is NOT a type of fluid that may
cause a pleural effusion?
-empyema
-chylothorax
-pneumothorax
-hemothorax
This is a fluid that may cause a
Pleural Effusion
• Empyema (pus),
Chylothorax (chyle), and
hemothorax (blood) are all
fluids that may result in a
pleural effusion.
Correct, this is not a fluid!
• Pneumothorax is a
collection of air in the
pleural cavity.
Signs and symptoms
• Dyspnea
• Cough, usually non-productive
• Pleuritic chest pain
• Chest pressure
• Hypoxemia
• Decreased breath sounds on the affected side
• Some people may exhibit no symptoms!
Diagnosis
• Chest radiograph (x-ray)
-able to distinguish >200ml of fluid
• Chest ultrasound
-locates small amounts or isolated loculated
pockets of fluid
-able to give precise position of accumulation
• Computed Tomography (CT) scan
-Differentiates between fluid collection, lung
abcess, or tumor
Diagnosis
Fluid analysis confirms a pleural effusion
Normal pleural fluid has the following characteristics:
• clear ultrafiltrate of plasma
• pH 7.60-7.64
• protein content less than 2% (1-2 g/dL)
• fewer than 1000 WBCs per cubic millimeter
• glucose content similar to that of plasma
• lactate dehydrogenase (LDH) level less than 50% of plasma and
sodium
• potassium and calcium concentration similar to that of the interstitial
fluid
(Abrahamian, 2005, p. 2 of 28)
Non-surgical
Treatment Options
• Thoracentesis
• tPA
• Chemical Pleurodesis
• Pleurx catheter
Thoracentesis
• A needle is inserted into
the chest wall to
remove the collection of
fluid
• 50-100ml of fluid is sent
for analysis
• Determines the type of
fluid (transudate or
exudate)
Picture used with permission (Allibone, 2006, p. 60)
Thoracentesis
In chest wall
where fluid is
accumulating
• Thoracentesis
• tPA
• Chemical Pleurodesis
• Pleurx Catheter
Think again!
Good Job!
• Chemical Pleurodesis
• This creates
inflammation and
subsequent fusion of
the parietal and
visceral pleura
• Anti-inflammatories
will counteract this
reaction.
Congratulations!
dy Rejret, RN,
Ka
BSN