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PLEURAL SPACE
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Parietal pleura Visceral pleura
cover the inner surface envelope all surfaces
of the thoracic cavity,
of the lungs, including
including the
diaphragm, and ribs. the interlobar fissures.
At the Hilum
where pulmonary vessels, bronchi, and nerves
enter the lung tissue, the parietal pleura is
continuous with the visceral pleura.
PLEURAL EFFUSION
PLEURAL SPACE
INTERCOSTAL BRONCHIAL
MICROVESSELS MICROVESSELS
VEIN VEIN
ARTERY ARTERY
?
LYMPHATICS TO
MEDIASTINAL
NODES
PLEURAL FLUID
STOMA
PLEURAL SPACE
STARLING’S LOW :
L: Filtration coefficient
A: Surface area
Cap: Capillary
Pl: Pleural
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PLEURAL FLUID FORMATION AND ABSORTION
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PLEURAL FLUID FORMATION AND ABSORTION
PLEURAL SPACE
INTERCOSTAL BRONCHIAL
MICROVESSELS MICROVESSELS
VEIN VEIN
ARTERY ARTERY
?
LYMPHATICS TO
MEDIASTINAL
NODES
PLEURAL FLUID
STOMA
PLEURAL SPACE
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PLEURAL EFFUSION
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PLEURAL EFFUSION
DIAGNOSTIC THORACENTESIS
CONTRAINDICATIONS
• Bleeding tendency
• Thrombocytopenia (decrease platelets less
25000 u3/dl )
• Prolonged PT or PTT greater than twice
normal,
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Color of Fluid
Color of Fluid Suggested Diagnosis
Pale yellow (straw) Transudate, some exudates
Red (bloody) Malignancy or embolism or TB
Turbid Infected effusion
Pus Empyema
White (milky) Chylothorax or cholesterol
effusion
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Transudates vs Exudates
LIGHT’S CRITERIA*
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Causes of Transudates and Exudates
Tronsudote Exudate
• Transudate < 1000 but 20% > 1000 and rarely >
10,000/mm3
• Exudate > 1000/mm3
• Limited value (unless > 50,000/mm3
emphyema)
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PLEURAL EFFUSION
PF LYMPHOCYTE-PREDOMINANT EXUDATES (>80%)
Causes
TB
Lymphoma
`Chronic lymphocytic leukaemia
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PLEURAL EFFUSION
BIOCHEMISTY
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PLEURAL EFFUSION
The mechanism responsible for pleural fluid low
glucose include;
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PLEURAL EFFUSION
BIOCHEMISTY
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PLEURAL EFFUSION
The mechanism responsible for pleural fluid acidosis
(pH <7.30) include;
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PLEURAL EFFUSION
DIAGNOSES ASSOCIATED WITH PLEURAL FLUID
ACIDOSIS (pH <7.30) AND LOW GLUCOSE
CONCENTRATION (PF/SERUM <0.5)
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PLEURAL EFFUSION
CYTOLOGY
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PLEURAL EFFUSION
Yes No
Diagnostic Fluid thickness > Observe
thoracentesis 10mm
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PLEURAL EFFUSION
SUMMARY
Diagnostic
thoracentesis
Exudate Transudate