The Pleura

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The Pleura
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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

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Pleural Effusion

• Transudate (low protein)
• cardiac failure
• hypoproteinaemia

• Exudate (high protein)
• pneumonia
• TB
• connective tissue disease
• malignancy (primary or metastatic)

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Purulent Effusion

• Full of acute inflammatory cells
• Empyema
• Can become chronic

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Pneumothorax

• Air in pleural space
• Trauma
• Rupture of bulla

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Large bullae
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Pleural Neoplasia

• Primary
• benign (rare)
• malignant mesothelioma
• Secondary
• common (adenocarcinomas - lung, GIT, ovary)

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Mesothelioma
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Pleural biopsy - mesothelioma

• Mixed spindle cell (mesenchymal) and epithelial
  differentiation

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Metastases in Pleura
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Differential diagnosis of malignant effusions..

• Cytology, biopsy
• Difficult
• Immunohistochemistry for lineage specific
  antigens may help
• Medicolegal importance