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Pathology - Pleural effusion
Definition: An accumulation of surplus fluid within the pleural cavity.
Epidemiology
• Ubiquitous.
Aetiology
• Left ventricular insufficiency. • Pneumonia. • Pulmonary embolism. • Neoplasm. • Systemic autoimmune disorders (e.g. lupus, rheumatoid arthritis).
Pathogenesis
• Augmented pulmonary venous congestion (left ventricular failure), pleural inflammation (pneumonia, pulmonary embolism, autoimmune illness), pleural infiltration (malignancy).
Presentation
• Minor effusions may be asymptomatic (though they may be detectable on imaging). • Significant effusions induce dyspnea. Macroscopy • Fluid is observed in the pleural cavity. • The fluid may be straw-colored, hemorrhagic, or purulent.
Cytopathology
Cytological analysis of pleural fluid under benign conditions reveals mesothelial cells and varying quantities of inflammatory cells, contingent upon the underlying etiology. Malignant pleural fluid may comprise malignant cells exhibiting enlarged pleomorphic nuclei. Prognosis: Parapneumonic effusions and those resulting from pulmonary emboli disappear with treatment. Pleural effusion resulting from left ventricular failure typically indicates advanced disease and a grim prognosis. Pleural effusion resulting from malignancy is generally attributable to metastatic illness, thereby indicating a very unfavorable prognosis.
Definition: An accumulation of surplus fluid within the pleural cavity.
Epidemiology
• Ubiquitous.
Aetiology
• Left ventricular insufficiency. • Pneumonia. • Pulmonary embolism. • Neoplasm. • Systemic autoimmune disorders (e.g. lupus, rheumatoid arthritis).
Pathogenesis
• Augmented pulmonary venous congestion (left ventricular failure), pleural inflammation (pneumonia, pulmonary embolism, autoimmune illness), pleural infiltration (malignancy).
Presentation
• Minor effusions may be asymptomatic (though they may be detectable on imaging). • Significant effusions induce dyspnea. Macroscopy • Fluid is observed in the pleural cavity. • The fluid may be straw-colored, hemorrhagic, or purulent.
Cytopathology
Cytological analysis of pleural fluid under benign conditions reveals mesothelial cells and varying quantities of inflammatory cells, contingent upon the underlying etiology. Malignant pleural fluid may comprise malignant cells exhibiting enlarged pleomorphic nuclei. Prognosis: Parapneumonic effusions and those resulting from pulmonary emboli disappear with treatment. Pleural effusion resulting from left ventricular failure typically indicates advanced disease and a grim prognosis. Pleural effusion resulting from malignancy is generally attributable to metastatic illness, thereby indicating a very unfavorable prognosis.
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