胸膜疾病英文版pptpleural_disease.ppt

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1、RespiratoryMedicineRuiZheng（郑锐），M.D.,Ph.D.SHENGJINGHOSPITALCHINAMEDICALUNIVERSITYMale,70yearoldwithan80-pack-yearhistoryofsmokingandahistoryofcoronaryheartdisease.Hewassufferedfromincreasingshortnessofbreathfor1week.Andhealsohadchestpainontherightsidethatw

2、orsenswithdeepinspiration.Hewasafebrile.Chestexaminationrevealeddullnesstopercussion,theabsenceoffremitus,anddiminishedbreathsoundsontherightside.Nodistendedneckveins,noperipheraledemawasobserved.ThechestradiographwasshowedaspicturePleuralDiseasesPleuralef

3、fusionPleuralSpaceVisceralPleura–attachedtolungs.ParietalPleura–attachedtochestwall.Pleuralspace5-15mLoffluidsecretedbythepleuralcells.Minimizesfrictionasthetwopleuralsurfacesglideovereachotherduringinspirationandexpiration.Let’sreviewLungRibcageVisceralPl

4、euraParietalPleuraPleuralSpaceParietalPleuraPleuralSpaceVisceralPleurahydrostaticpressure+30cmH2Ooncoticpressure+34cmH2O(30+5+8)-34=9cmH2O-5cmH2Ooncoticpressure+8cmH2Ohydrostaticpressure+11cmH2Ooncoticpressure+34cmH2O34-(11+5+8)=10cmH2OPleuraleffusiontrans

5、portDevelopmentofPleuralEffusionpulmonarycapillaryhydrostaticpressure(CHF,constrictivepericarditis)transudateplasmaoncoticpressure(hypoalbuminemia,livercirrhosis)pleuralmembranepermeabilityexudate(pneumonia,TB,CTD，malignancy,PE)lymphaticobstruction(maligna

6、ncy)trauma(esophagus,thoracicductrupture)SymptomDyspnea(mostcommon)Mild,non-productivecoughSeverecoughwithsputumorbloodPneumoniavs.bronchiallesionConstantchestpainCancerousinvasionofchestwallPleuriticchestpainPEvs.inflammatorypleuraleffusionPhysicalExamina

7、tionMediastinalshiftawayfromtheeffusionDecreasedtactilefremitusDullnesstopercussionDecreasedbreathsoundsPleuralfrictionrubChestX-RayFluidinX-rayseenasadense,whiteshadowwithaconcaveupperedge(fluidlevel)anteriorrib(<4,2-4,>2)UltrasonographyUltrasonographicgu

8、idanceisindicatedifdifficultyisencounteredinobtainingpleuralfluidoriftheeffusionissmalltoperformthoracentesisThoracentesisAneedleisinsertedintothechestwalltoremovethecollectionoffluidDeterminesthetypeoffluid(