Wall Pleura Diseases 胸壁胸膜损伤课件.pptVIP

Thoracic Wall, Pleura Diseases Beijing Lung Cancer Center,CUMS EMPYEMA Definition An infected effusive process within the pleura space 希波克拉底是第一个采用引流术治疗Empyema的人 Cause Infection 1, Bacteria infection 2, TB infection 3, Peculiar infection Others 1, post-operation 2, Blood infection Acute Empyema Clinical Manifestation High Fever chest pain shortness of breath Cough… Physical Examination Unilaterally decreased breath sounds decreased breath movement Mediastinal excursion… Laboratory Finding WBC↗ a shift to left X-ray opacification shadow, fluid level… CT Scan: 超声检查 Treatment Supportive improving immunity Antibiotic based on sensitive test Drainage: Key point penetration underwater-seal closed tube drainage ( Lowest position ) surgery: VATS胸膜固定术 Chronic Empyema Uncured acute empyema last for more than 3 month Later diagnosis No good result from Acute empyema The second infection TB infection Clinical Manifestation Fever Malnutrition Systemically toxic Weakness Shortness of breath… Physical Examination Unilaterally decreased breath sounds Chest wall collapsing Mediastinal excursion X-ray and CT Finding Thicken of pleura Narrowing of inter-rib space Fluid level… Treatment Nutrition support Antibiotic Drainage Surgery debridement, thoracoplasty … Key: to protectrestore lung function Complications Bronchopleural fistula Pericardial extension Mediastinal abscess Metastatic abscesses… MalignantPleuralMesothelioma Benign Mesothelioma Localized 分化良好乳头状间皮瘤 Well differentiated papillary mesothelioma 腺瘤样瘤 Adenomatoid tumor 多囊性间皮瘤 Multicystic mesothelioma Almost symptomless Surgery achieves good prognosis Malignant MesotheliomaRelationship to Asbestos Exposure A causative relationship between asbestos and malignant mesothelioma was not recognized until 1960, when J Wagner observed an unusually high incidence of mesothelioma among asbe