胸膜疾病英文版pptpleural disea

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1、RespiratoryMedicineRuiZheng（郑锐），M.D.,Ph.D.SHENGJINGHOSPITALCHINAMEDICALUNIVERSITY•Male,70yearoldwithan80-pack-yearhistoryofsmokingandahistoryofcoronaryheartdisease.•Hewassufferedfromincreasingshortnessofbreathfor1week.Andhealsohadchestpainontherightsidethatworsenswithdeepinspiration.Hewasafebrile.•

2、Chestexaminationrevealeddullnesstopercussion,theabsenceoffremitus,anddiminishedbreathsoundsontherightside.Nodistendedneckveins,noperipheraledemawasobserved.ThechestradiographwasshowedaspicturePleuralDiseasesPleuraleffusionPleuralSpace•VisceralPleura–attachedtolungs.•ParietalPleura–attachedtochestwa

3、ll.•Pleuralspace–5-15mLoffluidsecretedbythepleuralcells.–Minimizesfrictionasthetwopleuralsurfacesglideovereachotherduringinspirationandexpiration.Let’sreviewRibcageLungPleuralSpaceVisceralPleuraParietalPleuraPleuraleffusiontransportParietalPleuraPleuralSpaceVisceralPleurahydrostaticpressure-5cmH2Oh

4、ydrostaticpressure+30cmH2O+11cmH2Ooncoticpressureoncoticpressure+8cmH2Ooncoticpressure+34cmH2O+34cmH2O(30+5+8)-34=9cmH2O34-(11+5+8)=10cmH2ODevelopmentofPleuralEffusion•pulmonarycapillaryhydrostaticpressure(CHF,constrictivepericarditis)transudate•plasmaoncoticpressure(hypoalbuminemia,livercirrhosis)

5、•pleuralmembranepermeabilityexudate(pneumonia,TB,CTD，malignancy,PE)•lymphaticobstruction(malignancy)•trauma(esophagus,thoracicductrupture)Symptom•Dyspnea(mostcommon)•Mild,non-productivecough•Severecoughwithsputumorblood–Pneumoniavs.bronchiallesion•Constantchestpain–Cancerousinvasionofchestwall•Pleu

6、riticchestpain–PEvs.inflammatorypleuraleffusionPhysicalExamination•MediastinalshiftawayfromtheeffusionDecreasedtactilefremitus•Dullnesstopercussion•Decreasedbreathsounds•PleuralfrictionrubChestX-Ray•FluidinX-rayseenasadense,whiteshadowwithaconcaveupperedge(fluidlevel)anteriorrib(<4,2-4,>2)Ultrasono

7、graphy•UltrasonographicguidanceisindicatedifdifficultyisencounteredinobtainingpleuralfluidoriftheeffusionissmalltoperformthoracentesisThoracentesis•Aneedleisinsertedintothechestwalltoremovethecollectionoffl