DISEASES OF PLEURA

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DISEASES OF PLEURA
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Clinical features -1- cough dry or
productive2-Haemoptysis3-Chest
pain4-Dyspnea5-Pleural effusion6-Anorexia
loss of weight7-Clubbing of the
fingers8-Hoarseness of the voice (recurrent
LN)9-Dysphagia involvement of the
esophagus10-Hormonal syndromes ..ectopic ACTH ,
ADH, hypercalcaemia ,carcinoid syndrome
Diagnosis Clinical , sputum cytology Chest
X-ray ,CT chest .. Bronchoscopy ,BAL
,bronchial brush biopsy FNAC.or Trucut
biopsy , pleural fluid aspiration cytology
Diagnostic Thoracoscopy mediastinoscopy TNM
classification for staging
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Signs of inoperability -1-Bloody pleural
effusion .positive for malignant cells2-Horners
syndrome .3-Vocal cord paralysis4-Phrenic nerve
palsy(elevated hemi diaphragm)5-SVC obstruction
6-Distant metastasis 7-If during surgery ,the
tumor locally spreading or cannot be remover
technically or fixed to the PA or to the heart
,it is technically irresectable
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Treatment 1-Surgery more than 50of the
patients have distant metastases at the time of
diagnosis .50 Iresectable per
operatively15-20 resectability rate Surgery
..segmentecomy , lobectomy . pneumectomy
2-Radiotherapy Pre
operative or post operative
Chemo therapy vincristine or adriamycin
Bleomycin for malignant
effusion
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Differential diagnosis of a solitary lung
lesion (COIN LESION) 1-Hydatid cyst
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Primary benign lesion 2-Tuberculoma
5-primary
malignancy of the lung 3-Angiomatous malformation
(AV fistula) 6-metastatic tumors
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Pulmonary Echinococcosis (Hydatid Cyst)
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Hydatid disease of the lung is caused by the
.small. tape worm (Echinococcus Granulosus)
Hydatid cyst means cyst full of water .It has a
life cycle between dogs sheep .Parasites in the
elementary tract of the dog shed ova that
excreted in the dog faeces , contaminated the
food of the sheep in which hydatid cyst will
develops in the viscera . Including the lung
.Infected sheep when slaughtered and its entrails
are eaten by dogs , the life cycle is completed
.When a human being hands or food become
contaminated with canine fecal material
containing ova which will be ingested .The
parasitic larva burrow through the gastric mucosa
and are carried to the liver in the portal venous
circulation where most of them filtered out to
form hydatid cyst of the liver , some escape the
liver lodge in the lung to form one or more
hydatid cyst which grows slowly or rapidly over
years .
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The cyst consists of a germinal layer cyst
fluid containing broad capsule scoleses . A
cellular white hyaline layers are laid down
outside the cyst so that the cyst is enclosed by
a laminated cyst membrane .As the cyst enlarged ,
it usually reaches the pleural surface .
Compression of the lung tissues produces a thin
fibrous layer of atelectatic lung tissue around
the cyst (capsule , pericyst or adventia)
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Clinical Manifestation
A-Asymptomatic Any smooth homogenous opacity of
uniform density with clear cut border and little
or no reaction around it on a chest X-Ray is a
hydatid cyst unless proved the other wise
. B-Cough haemoptysis due to rupture of the
cyst , or it can lead to severe dyspnea , or
asphyxia ,or a hyper sensitivity reaction , If
the cyst get infected ,it will lead to formation
of lung abscess or bronchiectatic changes .
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Radiological Findings

• 1-Smooth homogenous opacity (Intact H.C).
• 2-Partial rupture (peri-vesicular
  pneumocyst).
• 3-Complete rupture (Water lilly sign)
  .
• 4-Formation of lung abscess(Air fluid level) .
• 5-Completely coughed out cyst(empty cavity )
• 6-Rupture into the pleura (hydropneumothorax)

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Treatment
Surgical A-Inoculation means to remove it
intact. B-Aspiration evacuation technique
C-Wedge resection or excision of the cyst with
adjacent lung tissue. D-Segmentectomy
,Lobectomy or Pneumonectomy (rare ).