577:
548:. Thus, pleural fluid is produced and reabsorbed continuously. The composition and volume is regulated by mesothelial cells in the pleura. In a normal 70 kg human, a few milliliters of pleural fluid is always present within the intrapleural space. Larger quantities of fluid can accumulate in the pleural space only when the rate of production exceeds the rate of reabsorption. Normally, the rate of reabsorption increases as a physiological response to accumulating fluid, with the reabsorption rate increasing up to 40 times the normal rate before significant amounts of fluid accumulate within the pleural space. Thus, a profound increase in the production of pleural fluid—or some blocking of the reabsorbing lymphatic system—is required for fluid to accumulate in the pleural space.
40:
807:. If lymphocytes predominate and mesothelial cells are rare, this is suggestive of tuberculosis. Mesothelial cells may also be decreased in cases of rheumatoid pleuritis or post-pleurodesis pleuritis. Eosinophils are often seen if a patient has recently undergone prior pleural fluid tap. Their significance is limited.
559:
According to the viscous flow model, the intra pleural pressure gradient drives a downward viscous flow of pleural fluid along the flat surfaces of ribs.The capillary equilibrium model states that the high negative apical pleural pressure leads to a basal-to-apical gradient at the mediastinal pleural
759:
tools for determining the causes of this abnormal accumulation. Even the gross appearance, color, clarity and odor can be useful tools in diagnosis. The presence of heart failure, infection or malignancy within the pleural cavity are the most common causes that can be identified using this approach.
822:
Chemistry studies may be performed including pH, pleural fluid:serum protein ratio, LDH ratio, specific gravity, cholesterol and bilirubin levels. These studies may help clarify the etiology of a pleural effusion (exudative vs transudative). Amylase may be elevated in pleural effusions related to
460:
begin to invaginate into these canals, creating a pair of enlarging cavities that encroach into the surrounding somites and further displace the transverse septum caudally — namely the pleural cavities. The mesothelia pushed out by the developing lungs arise from the splanchnopleure, and become the
625:
Pleural effusions are classified as exudative (high protein) or transudative (low protein). Exudative pleural effusions are generally caused by infections such as pneumonia (parapneumonic pleural effusion), malignancy, granulomatous disease such as tuberculosis or coccidioidomycosis, collagen
560:
surface, leading to a fluid flow directed up towards the apex (helped by the beating heart and ventilation in lungs).Thus the recirculation of fluid occurs. Finally there is a traverse flow from margins to flat portion of ribs completes the fluid circulation.
802:
Microscopy may show resident cells (mesothelial cells, inflammatory cells) of either benign or malignant etiology. Evaluation by a cytopathologist is then performed and a morphologic diagnosis can be made. Neutrophils are numerous in
329:, which also innervates the lungs and bronchi. The parietal pleurae however, like their blood supplies, receive nerve supplies from different sources. The costal pleurae (including the portion that bulges above the
830:
in origin. If severe symptoms persist, more invasive techniques may be required. In spite of the lack of knowledge of the cause of the effusion, treatment may be required to relieve the most common symptom,
244:, the left and right lungs are completely separated by the mediastinum, and there is no communication between their pleural cavities. Therefore, in cases of a unilateral
145:
755:
of the fluid, as well as clinical microscopy, microbiology, chemical studies, tumor markers, pH determination and other more esoteric tests are required as
626:
vascular diseases, and other inflammatory states. Transudative pleural effusions occur in congestive heart failure (CHF), cirrhosis or nephrotic syndrome.
823:
gastric/esophageal perforations, pancreatitis or malignancy. Pleural effusions are classified as exudative (high protein) or transudative (low protein).
769:
Clear straw-colored: If transudative, no further analysis needed. If exudative, additional studies needed to determine cause (cytology, culture, biopsy).
556:
The hydrostatic equilibrium model, viscous flow model and capillary equilibrium model are the three hypothesised models of circulation of pleural fluid.
401:. The dehiscence of these two layers creates a fluid-filled cavity on each side, and with the ventral infolding and the subsequent midline fusion of the
516:
during breathing. The pleural cavity transmits movements of the ribs muscles to the lungs, particularly during heavy breathing. During inhalation the
512:
of the pleural fluid also leads to close apposition of the lung surfaces with the chest wall. This relationship allows for greater inflation of the
869:
524:. This causes the expansion of the chest wall, that increases the volume of the lungs. A negative pressure is thus created and inhalation occurs.
1266:"Air leak pattern shown by digital chest drainage system predict prolonged air leakage after pulmonary resection for patients with lung cancer"
1129:
Casha, Aaron R.; Caruana-Gauci, Roberto; Manche, Alexander; Gauci, Marilyn; Chetcuti, Stanley; Bertolaccini, Luca; Scarci, Marco (April 2017).
576:
109:
633:) results probably from increased capillary permeability due to cytokine or inflammatory mediator release from the platelet-rich thrombi.
1505:
1264:
Shintani, Yasushi; Funaki, Soichiro; Ose, Naoko; Kawamura, Tomohiro; Kanzaki, Ryu; Minami, Masato; Okumura, Meinoshin (June 2018).
1197:
536:
produced by the serous membrane covering normal pleurae. Most fluid is produced by the exudation in parietal circulation (
413:
during the fourth week, with the splanchnopleure on the inner cavity wall and the somatopleure on the outer cavity wall.
216:, by just the film of pleural fluid in the pleural cavity. The visceral pleura follows the fissures of the lung and the
1461:
1413:
1113:
1380:
956:
915:
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Pink to red/bloody: Traumatic tap, malignancy, pulmonary infarction, intestinal infarction, pancreatitis, trauma.
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end of the intraembryonic coeloms fuse early to form a single cavity, which rotates invertedly and apparently
1498:
307:
140:
517:
465:; while the other mesothelial surfaces of the pleural cavities arise from the somatopleure, and become the
370:
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278:. The parietal pleura receives its blood supply from whatever structures underlying it, which can be
133:
1575:
472:
The tissue separating the newly formed pleural cavities from the pericardial cavity are known as the
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1436:
De Mais, Daniel. ASCP Quick
Compendium of Clinical Pathology, 2nd. Ed. ASCP Press, Chicago, 2009.
505:
433:
345:. The mediastinal pleurae and central portions of the diaphragmatic pleurae are innervated by the
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has become the mainstay of invasive procedures as closed pleural biopsy has fallen into disuse.
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The pleural cavity, with its associated pleurae, aids optimal functioning of the lungs during
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Thin fluid-filled space between the two pulmonary pleurae (visceral and parietal) of each lung
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If malignant cells are present, a pathologist may perform additional studies including
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Porcel, J.M.; R.W. Light (July 2008). "Pleural effusions due to pulmonary embolism".
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In spite of all the diagnostic tests available today, many pleural effusions remain
1373:
Color Atlas of Body Fluids: an illustrated field guide based on proficiency testing
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Absorption occurs into lymphatic vessels at the level of the diaphragmatic pleura.
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994:"Mechanisms controlling the volume of pleural fluid and extravascular lung water"
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can form when fluid builds up in the pleural cavity (labelled as pleural space).
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248:, the contralateral lung will remain functioning normally unless there is a
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Lai-Fook, Stephen J. (April 2004). "Pleural mechanics and fluid exchange".
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Cloudy, purulent, turbid: Infection, empyema, pancreatitis, malignancy.
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and allows the pleurae to slide effortlessly against each other during
333:) and the periphery of the diaphragmatic pleurae are innervated by the
264:
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and eventually collapse the contralateral cardiopulmonary circulation.
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is maintained in the pleural cavity to enable lubrication between the
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1131:"Pleural pressure theory revisited: a role for capillary equilibrium"
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Anchovy-paste (or 'chocolate sauce'): Ruptured amoebic liver abscess.
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480:. The transverse septum and the displaced somites fuse to form the
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Localized pleural fluid effusion noted during pulmonary embolism (
500:. The pleural cavity also contains pleural fluid, which acts as a
947:(3. ed.). Philadelphia, Pa.: Churchill Livingstone. p.
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449:
417:
390:
253:
229:
198:
1104:
Vander's human physiology : the mechanisms of body function
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Green-white, turbid: Rheumatoid arthritis with pleural effusion.
1408:(1st ed.). Philadelphia, Pennsylvania: Saunders Elsevier.
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in front of the thorax, and is later encroached by the growing
378:
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The serous membrane that covers the surface of the lung is the
1128:
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Green-brown: Biliary disease, bowel perforation with ascites.
283:
241:
80:
1100:
Widmaier, Eric P.; Raff, Hershel; Strang, Kevin T. (2006).
190:
1043:"Physiology and pathophysiology of pleural fluid turnover"
1263:
910:(3rd ed.). New York: McGraw-Hill. pp. 643–644.
787:
Milky or green, metallic sheen: Pseudochylous effusion.
270:
of the underlying lung, which have input from both the
263:
The visceral pleura receives its blood supply from the
1108:(10th ed.). Boston, Massachusetts: McGraw-Hill.
594:
A pathologic collection of pleural fluid is called a
1366:
1364:
1362:
373:, each lateral mesoderm splits into two layers. The
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Milky-white or yellow and bloody: Chylous effusion.
220:structures. The parietal pleura is attached to the
1101:
1099:
940:
1359:
973:
1600:
1404:Shidham, Vinod B.; Atkinson, Barbara F. (2007).
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866:: a fluid accumulation within the pleural space.
86:cavum pleurae, cavum pleurale, cavitas pleuralis
1403:
860:: a collection of air within the pleural cavity
444:, separated from the pericardial cavity by the
885:, medical diagnostic test for a punctured lung
212:and is separated from the outer membrane, the
1499:
1188:Boron, Walter F.; Boulpaep, Emile L. (2015).
814:to determine the etiology of the malignancy.
790:Viscous (hemorrhagic or clear): Mesothelioma.
751:When accumulation of pleural fluid is noted,
436:portions of the coeloms fuse later below the
551:
52:of the pleural sac that surrounds each lung.
476:, which later become the side walls of the
1506:
1492:
991:
252:, which may shift the mediastinum and the
38:
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1406:Cytopathologic diagnosis of serous fluids
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615:Decreased plasma colloid osmotic pressure
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853:Diseases of the pleural cavity include:
621:Increased negative intrapleural pressure
575:
566:
456:. During the fifth week, the developing
1370:
905:
321:The visceral pleurae are innervated by
189:of the pleural sac that surrounds each
14:
1601:
1040:
938:
896:
1487:
1456:. Lippincott Williams & Wilkins.
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1325:Current Opinion in Pulmonary Medicine
979:
353:. Only the parietal pleurae contain
341:, which branches off from the T1-T12
817:
872:: abnormal growths on the pleurae.
763:
618:Increased capillary venous pressure
571:
24:
835:, as this can be quite disabling.
25:
1620:
1471:
527:
349:. which branches off the C3-C5
1430:
1397:
1375:. Northfield, Ill.: CAP Press.
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1371:Galagan, Katherine A. (2006).
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992:Miserocchi, G. (2009-12-01).
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1337:10.1097/MCP.0b013e3282fcea3c
1060:10.1183/09031936.02.00062102
1047:European Respiratory Journal
1041:Zocchi, L. (December 2002).
906:Saladin, Kenneth S. (2011).
235:
7:
1270:Journal of Thoracic Disease
1135:Journal of Thoracic Disease
998:European Respiratory Review
939:Larsen, William J. (2001).
876:
491:
474:pericardiopleural membranes
409:anterolaterally around the
393:layer joins the underlying
228:, and to the inside of the
224:, the upper surface of the
10:
1625:
1450:Light, Richard W. (2007).
1443:
1235:10.1152/physrev.00026.2003
846:
842:
587:
482:pleuroperitoneal membranes
454:pericardioperitoneal canal
440:vein to become the larger
377:layer joins the overlying
44:The pleural cavity is the
1543:
1522:
1011:10.1183/09059180.00002709
753:cytopathologic evaluation
552:Pleural fluid circulation
369:During the third week of
296:inferior phrenic arteries
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1283:10.21037/jtd.2018.05.150
1148:10.21037/jtd.2017.03.112
649:Congestive heart failure
738:(or Boerhaave syndrome)
201:, and also to create a
798:Microscopic appearance
747:Pleural fluid analysis
585:
544:and reabsorbed by the
520:contract, as does the
407:intraembryonic coeloms
153:Anatomical terminology
1588:Suprapleural membrane
1223:Physiological Reviews
1190:Fisiologia medica (2)
670:Pulmonary atelectasis
579:
567:Clinical significance
518:external intercostals
506:respiratory movements
276:bronchial circulation
69:Intraembryonic coelom
812:immunohistochemistry
726:Autoimmune disorders
716:Pulmonary infarction
695:Obstructive uropathy
538:intercostal arteries
355:somatosensory nerves
343:thoracic spinal cord
314:branches), or their
308:anterior intercostal
250:tension pneumothorax
195:serous pleural fluid
193:. A small amount of
1583:Endothoracic fascia
1478:Photo of dissection
680:Peritoneal dialysis
532:Pleural fluid is a
478:fibrous pericardium
357:and are capable of
337:from the enclosing
304:pericardiacophrenic
1576:Costodiaphragmatic
1563:Pulmonary ligament
1192:. Elsevier Mosby.
736:Ruptured esophagus
721:Pulmonary embolism
685:Pulmonary embolism
665:Nephrotic syndrome
586:
430:pericardial cavity
405:, forms a pair of
335:intercostal nerves
179:intrapleural space
134:H3.05.03.0.00013
1596:
1595:
1199:978-85-352-6851-5
818:Chemical analysis
744:
743:
655:Hepatic cirrhosis
642:Exudative causes
446:transverse septum
442:peritoneal cavity
323:splanchnic nerves
300:internal thoracic
203:pressure gradient
167:
166:
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16:(Redirected from
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1571:Costomediastinal
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1276:(6): 3714–3721.
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864:Pleural effusion
764:Gross appearance
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596:pleural effusion
590:Pleural effusion
582:pleural effusion
572:Pleural effusion
546:lymphatic system
467:parietal pleurae
463:visceral pleurae
426:primordial heart
327:pulmonary plexus
292:superior phrenic
218:root of the lung
159:edit on Wikidata
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399:splanchnopleure
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210:visceral pleura
183:potential space
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528:Pleural fluid
525:
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371:embryogenesis
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351:cervical cord
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982:, p. 1.
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858:Pneumothorax
852:
837:Thoracoscopy
825:
821:
809:
801:
750:
731:Pancreatitis
628:
624:
612:permeability
593:
562:
558:
555:
534:serous fluid
531:
495:
481:
473:
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397:to form the
387:somatopleure
385:to form the
368:
320:
262:
246:pneumothorax
239:
207:
185:between the
178:
174:
170:
168:
110:A07.1.01.001
85:
48:between the
1530:Mediastinum
605:obstruction
452:called the
365:Development
316:anastomosis
288:intercostal
268:capillaries
265:parenchymal
256:, kink the
222:mediastinum
75:Identifiers
1424:1239350014
980:Light 2007
890:References
828:idiopathic
757:diagnostic
703:Malignancy
639:Transudate
608:Increased
389:; and the
1567:Recesses
1292:2072-1439
1243:0031-9333
1208:949753083
1157:2072-1439
1079:0903-1936
1070:2434/9438
1020:0905-9180
967:902010725
926:780984149
883:Coin test
708:Infection
610:capillary
603:Lymphatic
542:bulk flow
522:diaphragm
502:lubricant
498:breathing
486:diaphragm
458:lung buds
438:umbilical
325:from the
282:from the
272:pulmonary
236:Structure
226:diaphragm
199:membranes
64:Precursor
1603:Category
1391:78070199
1353:44337698
1345:18520269
1310:30069369
1251:15044678
1175:28523153
1087:12503717
1028:20956149
877:See also
675:Myxedema
492:Function
422:descends
411:gut tube
395:endoderm
383:ectoderm
339:rib cage
280:branched
274:and the
1523:General
1444:Sources
1301:6051872
1166:5418293
843:Disease
833:dyspnea
514:alveoli
450:foregut
428:as the
418:cranial
391:ventral
379:somites
298:), the
254:trachea
230:ribcage
187:pleurae
181:is the
98:D035422
58:Details
50:pleurae
18:Pleural
1609:Pleura
1516:thorax
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712:Trauma
651:(CHF)
540:) via
434:caudal
432:. The
375:dorsal
242:humans
1349:S2CID
284:aorta
177:, or
157:[
81:Latin
1458:ISBN
1420:OCLC
1410:ISBN
1387:OCLC
1377:ISBN
1341:PMID
1306:PMID
1288:ISSN
1247:PMID
1239:ISSN
1204:OCLC
1194:ISBN
1171:PMID
1153:ISSN
1110:ISBN
1083:PMID
1075:ISSN
1024:PMID
1016:ISSN
963:OCLC
953:ISBN
922:OCLC
912:ISBN
416:The
381:and
310:and
294:and
191:lung
169:The
146:9740
122:3316
105:TA98
93:MeSH
1333:doi
1296:PMC
1278:doi
1231:doi
1161:PMC
1143:doi
1065:hdl
1055:doi
1006:doi
949:138
240:In
141:FMA
117:TA2
1605::
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