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The Pleura • A mesothelial surface lining the lungs and mediastinum • Mesothelial cells designed for fluid absorption • Hallmark of disease is the effusion
Transudate (low protein) cardiac failure hypoproteinaemia Exudate (high protein) pneumonia TB connective tissue disease malignancy (primary or metastatic) Pleural Effusion
Purulent Effusion Full of acute inflammatory cells • Empyema • Can become chronic
Pneumothorax Air in pleural space • Trauma • Rupture of bulla
Pleural Neoplasia • Primary • benign (rare) • malignant mesothelioma • Secondary • common (adenocarcinomas - lung, GIT, ovary)
Pleural biopsy - mesothelioma • Mixed spindle cell (mesenchymal) and epithelial differentiation
Differential diagnosis of malignant effusions….. • Cytology, biopsy • Difficult • Immunohistochemistry for lineage specific antigens may help • Medicolegal importance