pleural effusion

[SUMAN-SAJAN]

Is crackle (crepitation) a feature of pleural effusion?

What is melanoptysis?

What is parapneumonic effusion ?

[kehi garnuchha]

PARAPNEUMONIC EFFUSION

Simple parapneumonic effusion is defined as pleural effusion associated with lung infection, ie, pneumonia.These effusions result from the spread of inflammation and infection to the pleura. Much less commonly, infections in other adjacent areas, eg, retropharyngeal, vertebral, abdominal, and retroperitoneal spaces may spread to the pleura resulting in the development of effusion.

Early in the course of parapneumonic effusion, the pleura becomes inflamed; subsequent leakage of proteins, fluid, and leukocytes into the pleural space forms the effusion. At the time of formation, the pleural effusion is usually sterile with a low leukocyte count. With time, bacteria invade the fluid, resulting in empyema, which is defined as the presence of grossly purulent fluid in the pleural cavity. The development of pleural empyema is determined by a balance between host resistance, bacterial virulence, and timing of presentation for medical treatment

[SPRimal]

PATHOPHYSIOLOGY OF PARAPNEUMONIC EFFUSION

IT is important to understand the pathophysiology of parapneumonic effusions. It is to prevent the complications associated with the organization of the effusion that determine how we manage parapneumonic effusions. It is not true that an uncomplicated effusion is any more difficult to sterilize than a pneumonia. Antibiotic penetration of the pleural space is very good.

An effusion evolves in three phase. The initial phase is the accumulation of a small, sterile effusion caused by the infection contiguous to the pleural space. Fortunately, many parapneumonic effusions do not progress beyond this stage and resolve as the pneumonia resolves.

The second stage occurs if bacteria and polymorphs enter the pleural fluid. The inflammatory response causes fibrin to be deposited along the visceral and parietal pleura that can lead to loculation. Associated with this inflammation, the LDH rises while the pH and glucose fall.

If the fluid is not drained, the third stage will occur. Fibroblasts move in organizing the fluid into a pleural peel, making removal of fluid by a needle impossible. This pleural fluid will encase or trap the lung permanently impairing its ability to function. If the effusion is still infected, it will act as an abscess. It then can drain through the chest wall, or disastrously into a bronchus forming a life threatening broncho-pleural fistula.

If an effusion is noticed with a pneumonia, a lateral decubitus should be ordered as soon as possible. If it forms a layer greater than 10 ml in depth, a thoracentesis should be done on an urgent basis before the fluid has a chance to organize. The fluid should always be sent for glucose, LDH, total protein, pH, cell count, culture and gram stain. The pH can be obtained by sending the fluid to the lab in an arterial blood kit. If clinically warranted, fluid can be sent for amylase, TB, fungus and cytology.

[Khushboo]

Melanoptysis:
The term "Melanoptysis" is derived from the Greek adjective melas, meaning black, and the noun ptysma, meaning spit.

One of the subjectively most worrying, but harmless, symptoms of Coal Worker's Pneumoconiosis (CWP) is melanoptysis ("Black Phtisis"). Black phtisis, the expectoration of large amounts of black-stained sputum, is a result of the liquefaction of a progressive massive fibrosis (PMF)

Black sputum is produced when cavitation of progressive massive fibrosis occurs due to mycobacterial and anaerobic bacterial infections (67%) or ischaemic necrosis. It was due to diffuse melanoma cell infiltration of the lungs, with secondary pigment deposition in macrophages and in bronchial epithelial cells. The blackish or greyish sputum suggests cavitation of conglomerated masses; the acinar shadows in gravity dependent areas together with cavitary pneumoconiosis, make us suspect an insufficiency of bronchial clearing. Bronchoscopy confirms the diagnosis by showing the airway blocked by dark shadows.

[SUMAN-SAJAN]

Thanks sp, khusboo and kehi garnucha for ur reply.

[nibinhawnlync]

How i may contact admin this site? I have a question.iijiivei

[kehi garnuchha]

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[cocojambo]

A parapneumonic effusion is a type of pleural effusion that arises as a result of a pneumonia. There are three types of parapneumonic effusions: uncomplicated effusions, complicated effusions, and empyema. Uncomplicated effusions generally respond well to appropriate antibiotic treatment. Complicated parapneumonic effusions respond more variably: many resolve with antibiotics but may benefit from early pleural fluid drainage.

Pleural Effusions is the accumulation of excess fluids in the pleural cavity, which inhibits the normal expansion/contraction of the lungs and can impair breathing. Normally, very small amounts of fluids are present around the pleural spaces and are generally not detectable. The Pleura is a Sac which houses the lungs, and consists of a thin membrane called the 'mesothelium.' The mesothelioma is a vital part of the lungs because it enables them to expand and contract when breathing by secreting a fluid. This fluid is located in the lungs and inside of the rib cage. The official definition of pleural effusions is that it occurs when the rate of fluid formation exceeds the rate of fluid absorption, resulting in excess fluids clogging up the lungs and causing pulmonary signs and symptoms. Normal human beings have the capacity of 20-25ml of fluids in each pleural space. Fluids enter the pleural space via the capillaries in the parietal pleura or through the peritoneal cavity through small holes in the diaphragm.