Pleural Effusions

pleural SHOCK

The patient developed vasomotor collapse puncture the pleura. Inadequate local anesthesia can be a predisposing factor. Emergency measures include resuscitatory injection of adrenaline, parenteral steroids, and intravenous fluids. Pleural shock can be fatal if not recognized in time.

bleeding in the pleural cavity of the vessels Pleural surface. Bleeding is suspected, when the atmospheric liquid becomes progressively blood-stained. In sever cases, hypovolemic shock can occur. When bleeding is visible, it is advisable to stop the process. The entry of air during aspiration inadvertently becomes a simple pleural effusion in hydropenumothorax. Rarely subcutaneous emphysema and air embolism can develop.

pulmonary edema occurs in some cases of chronic effusion when the lung expands with the removal of fluids. Slow aspiration and limiting the volume of fluid aspirated in one sitting to 1 liter helps to reduce these complications. Start pulmonary edema marked a troublesome cough with frothy sputum. Auscultation revealed the presence of rales. Start pulmonary edema is a sign to stop aspiration. Further management in the same way as for acute pulmonary edema. Pleural effusion, which is part of a general edema, deleted when the underlying condition is treated. If respiratory embarrassment, paracentesis is needed only for diagnostic purposes.

of tuberculous pleural effusion
Among the known causes of pleural effusion in Africa and Asian subjects, tuberculosis remains the top popisa.Pleura may be directly involved in the process of tuberculosis. In most cases it extends from the core focus of pulmonary and spills are almost always on the side of lung lesions. Sometimes a subpleural caseous focus can rupture in the pleural cavity or the pleura may be the seat of miliary lesions. In most cases of classic adolescent pleural effusion is tuberculosis postprimary phenomenon, but rarely get to primary tuberkuloze.Izljev can develop suddenly or insidiously. Most cases are strongly positive tuberculin test.Fluid the exudate. The cells were mainly lymphocytes. Tubercule bacilli is difficult to prove in a serous effusion. Culture and animal vaccines can be positive. In tuberculous empyema, the organisms are easily demonstrable. A needle biopsy is useful, but it is not necessary in the ordinary case.
Board : The standard antituberculosis treatment is started. Pleural aspiration was done electively. Repeated aspiration May be required to pleural cavity dry. Respiratory physiotherapy is essential to restore function immediately. The use of corticosteroids (prednisolone 15-20 mg / day) helps in hastening recovery and prevention of pleural thickening.

empyema

A collection of pus in the pleural cavity is called empyema. Pus may be free in the pleural space or loculated. Empyema May result from enlargement of the underlying lung infection, or it can complicate the chest thoracentesis or generalized pyemia. Pneumonia, lung abscess, bronchiectasis, tuberculous cavities, hepatopulmonary Amoebiasis, bronchogenic carcinoma, osteomyelitis of the rib, and fungal infections are a common cause of actinomycosis. Thoracic and upper abdominal surgery can lead to empyema. Common bacterial flora are Streptococcus, Staphylococcus, Pneumococcus, Pseudomonas, Klebsiella, H.influenzae, anaerobes, M. tuberculosis and actinomycetes.

Clinical features : all ages can be affected, but children suffer more. The beginning is marked by high fever, pleuritis or dull chest pain and dry cough. Physical signs of pleural effusion may be evident. Unlike in the simple pleural effusion, chest wall becomes edematous (broncho-pleural fistula). In this case, postural cough is a troublesome symptom, and there are pyopneumothorax.Gnoj can work its way out and point to the chest. This is called empyema necessitans. Left-sided empyema can pulsate due to the transfer pulse of the heart "pulsating empyema."

Radiologically, the results resemble those of pleural effusion. Demonstration of pus in the pleural cavity aspiration confirmed dijagnozu.Uzročnik organism can be identified by examination of pus. Clinically, a lung abscess may resemble or encysted empyema pyopneumothorax these two conditions must be differentiated. Fever, toxemia, and digital clubbing appear in both. And mediastinal shift to the opposite side of the stone and dullness to percussion in favor of empyema. Special radiological techniques May be required to differentiate them. The loculated pyopneumothorax, air liquid interphase can hurt anatomical boundaries lobe, whereas lung abscess is limited interlobar fissures.

empyema complications include severe toxemia, cachexia, anemia, pulmonary fibrosis, pleural fibrosis, metastatic brain abscesses and long-term cases, secondary amiloidoza.Ukupna mortality is 10-11 %.

treatment : After identifying the body of infection, antimicrobial treatment is pokrenut.Tekućine must be removed by aspiration, and this measure is essential to relieve fever and toxemia. When pus is too thick to be aspirated. or if the re-accumulates quickly, the water drainage pipe must be installed after the resection of the ribs. The distance from the pleural space and a full re-expansion of the lung may take several weeks. Although antibiotics are used to locally instilled in the pleural cavity of appropriate systemic chemotherapy, this measure does not matter. Thick pus which is difficult to be aspirated liquid by instillation of proteolytic enzymes such as streptokinase and streptodornase. In most cases, chemotherapy and surgical drainage adequate clear empyema. Rarely intractable empyema can be surgically excised.