Pleureziile

In mod normal cavitatea pleurala contine 2-5 ml de lichid pleural. Lichidul pleural
este produs in principal de catre pleura parietala , la nivelul capilarelor pulmonare
de la acest nivel si este drenat si la nivelul pleurei parietale ( prin drenaj limfatic) si
la nivelul pleurei viscerale.
Astfel excesul de lichid pleural apare fie cand e productie prea mare , fie cand e
drenaj prea scazut, fie cand e transportat lichid din cavitatea abdominal in torace
precum in ascita.
Productie mare:
-Cresterea presiunii in capilare – IC stanga
-Scaderea presiunii coloid osmotice
-Cresterea permeabilitatii capilarelor in infectii ( pneumonie) sau hipersensibilitate
Drenaj scazut:
-Scaderea drenajului din cauza blocajului limfaticelor din cauza tumorilor ( care
apasa cred pe limfatice)
-Scaderea presiunii in spatiul pleural din cauza unei atelectazii -obstructie a bronhiei
 Tipuri de lichid pleural
Transudat:
- IC stang
- Hipoalbuminemie
- Ciroza hepatica
- Sindrom nefrotic

Exudat:
- Procese maligne
- Empiem pleural- puroi
- Hemotorax
- Chylothorax – Limfa
- SI in pneumonii nu??
• Pleurezii bilaterale:
- IC, Pneumonie (dar mai mare cantitate de partea mai afectata) si lupus
• Plurezii unilaterale:
- TBC, trombembolism pulmonar, traumatism
• Pleurezie stanga
- Pancreatita, obstructie distala de duct toracic, Dressler syndrome(apare la 2-3
saptamani post infarct miocardic si produce triada: Left pleural effusion,
pericardial effusion and patchy airspace disease at the left lung base)
• Pleurezie dreapta:
- Patologie hepatica sua ovariana( Meigs Syndrome), artrita reumatoida, obstructie
proximala de duct toracic.
 Semne radiografice:
- Semnul Meniscului
- In decubit dorsal , scd apar normale , dar se produce voalarea
hemitoracelui, depinzand cat de mare e colectia
- In cantitati mari poate produce devierea/impingerea contralaterala a
pratilor mobile (trahee, mediastin,inima)
- Se modifica cu pozitia
- Silueteaza cred
Fluid accumulates in the pleural space.
Irrespective of the nature of fluid, radiologically they will look similar.
Radiological criteria are:
• Density
• In dependent portion
– Costophrenic angle in PA view
– Anterior and posterior portions of gutter in lateral view
– Along sides in lateral decubitus position
– Along posteriorly in supine position, giving diffuse haziness on the side of
effusion
• Silhouette of upper limit of density
– Upper margin high in axilla in PA view
– Upper margin high interiorly and posteriorly in lateral view
• Blunting of costophrenic angle
• Lack of identifiable diaphragm (silhouette sign principle).
Pleural Effusion Massive

• Unilateral
homogenous
density
• Mediastinal shift
to right
• Left
diaphragmatic
and left heart
silhouettes lost
• Left hemithorax
larger
• Labeled and post
tap films below
• Homogenous
density
• Meniscus
maximum in axilla
• Loss of
cardiophrenic
angle
• Loss of
diaphragmatic
and right cardiac
silhouette
Hydropneumothorax
• Air in pleural
cavity
• Lung margin
visible
• Bilateral fluid
level: Any
time you see
a horizontal
fluid level, it
means that
there is air
and fluid in
the pleural
space
Loculated Pleural Effusion
Loculated =
inchistata???
• Homogenous
density
• Loculated
• Loss of
cardiophrenic
angle
• Loss of lateral
portion
of diaphragma
tic silhouette
Massive Pleural Effusion
• Massive opacity
right hemithorax
• No shift of
trachea and
heart
• Smaller right
hemithorax
• Right heart and
diaphragmatic
silhouettes are
not identifiable
• Right
diaphragm not
visible
• Diffuse
haziness
Massive Pleural Effusion
• Unilateral homogenous
density
• Loss of diaphragmatic
and right sided cardiac
silhouettes
• No mediastinal shift
Other findings include:
• Blunting of left
cardiophrenic angle
• LUL gloved finger
density. Sorry I do not
remember the etiology
for this case.
Pleural Effusion
• Massive
• Shift of
mediastinum
Subpulmonic Effusion

• Blunting of
costophrenic
angle
• Medial
displacement of
costophrenic
angle
• "Elevated
diaphragm"
Pleural Effusion- decubit dorsal