*according to content of fluid we can divide pleural effusion to 2 main types

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1 Pleural lesion and lesion of the Done by: Upper respiratory tract Saef Bassam ma'adat **Lets start with pleural lesion there is a little differet between pleural effustion and empyema accumulation of fluid in the pleural space = pleural effusion accumulation of fluid in peritoneal space = Ascites but accumulation of pus and inflammatory cell in the pleural cavity = empyema *according to content of fluid we can divide pleural effusion to 2 main types 1-transudate pleural effusion : contain proteins less than 2.9mg/dl without inflammatory cells 2-exudative pleural effusion : contain proteins more than 2.9mg/dl with inflammatory cells The purpose of knowing this is to identify the cause of effusion --transudate comes from congestive heart failure mainly --but exudate comes from more than one reason like : * pleuritis from pneumonia infection can lead to exudative pleural effusion *from cancer (specially here we can find RBC in pleural space ;cause malignant tumor here lead to hemorrhage) ""remember this"" we will differentiate between it and hemothorax later *other causes Pulmonary infarction Viral pleuritis SLE, rheumatoid arthritis Uremia Previous thoracic surgery

2 pneumothorax air enters the pleural cavity << collapsing of the lung there are many types of pneumothorax according to its cause **spontaneous pneumothorax: idiopathic or primary pneumothorax,no specific cause,,the disease suddenly appear (usually in healthy, young patient) so here we dont know the cause >>we call it spontaneous ** secondary pneumothorax: clearly it's caused due to certain diseases lung diseaes like emphysema,tb can lead to sec pneumothorax Also trauma and tumor important causing of sec pneumothorax other causes like lung abscess Fractured rib (here the air is coming from outside not from airway "" not from air we inhaled''") tension pneumothorax \one-way valve shock it s a life threatening condition! whats happen here?? the air is coming and enter the pleural space but can not get out from pleural space cause valve forming to close the repture site so the air can not get out the air still inside and that will compress the major BV located in mediastinum so shifting the medaistinum toward the opposite side why thats life threating?? cause the air compress the BV that will prevent the blood from returning to the heart )shock)

3 from this pic the air coming from lung and filling the pleural cavity that lead to collapsing of the affected lung,,and the mediastinum will shift toward normal lung in the opposite side in the X-ray the black color means there is air entering the lung and the white color mean that's a tissue *so in normal X-ray in the lung you must see the black color making the shape of the lung *If you observe scattered white area<< thats mean there is of fibrosis in the lung *in pneumothorax you able to find black color compress the the small white area this small white area (collapsed lung) and the black area (air in the pleural cavity) note: keep in your mind that's there is no mediastinal shifting in the case of non tension pneumothorax (the air enter and leave the pleural cavity""open pneumothorax"")

4 **hemothorax (rec min14 ) collection of the blood in the pleural space on the first lecture we have talked about pleural exudate ( we might have malignant here that lead to hemorrhage) so we should differntate between hemothorax and bloodly pleural exudate --hemothorax: accumulation of (blood only) in the pleural space --bloodly pleural exudate : accumulation of blood and fluid in the pleural space and thats a sign of malignancy **Chylothorax another type of pleural effusion;; It results from lymph formed in the digestive system called chyle accumulating in the pleural cavity due to either disruption or obstruction of the thoracic duct so here accumulation of lymphatic fluid in the pleural space these lymphatic fluid composed mainly of lipids thats comes from digestive tract that s all about benign disease of the pleura now malignant disease of the pleura Mesothelioma rare malignant tumor with very rare ability to metastasis,, develops from the thin layer of the mesothelium that covers many of the internal organs The most common area affected is the lining of the lungs and chest wall."" Pleura"" mainly in pleura but it can occur in any site of body contain mesothelial linning like pericardiaum or peritoneum Main risk factor for mesothelioma >> Asbestos a man who working in a Special mines he will at risk of exposure to asbestos

5 if that man stop working after the asbestos enter his lung,, does that reduce the risk of forming mesothelioma?? No,,becasue once asbestos enter the lung it can not get out its not like smoking ( cession of smoking reduce risk of any disease related to the smoke) its take years from exposure to asbestos and developing mesothelioma Q:: Is there any relation between smooking and mesothelioma?? NO ;;;Conversely, smoking maybe important to protect us from mesothelioma ;) Now LESIONS OF THE UPPER RESPIRATORY TRACT **common cold by rhinovirus:: (rec min23) is a viral infectious disease of the upper respiratory tract that primarily affects the nose,,, Signs and symptoms may begin less than two days following exposure They include coughing, sore throat, runny nose, sneezing, headache, and fever,, People usually recover in seven to ten day -dont give antibiotic here,, the mainly treatment just to allevate symptoms acute pharungitis --mainly by β-hemolytic streptococcal Pharyngitis is inflammation of the pharynx, which is in the back of the throat. It s most often referred to simply as sore throat. Pharyngitis can also cause scratchiness in the throat and difficulty swallowing may be complicate to more serious event like Rheumatic fever --whats RF Rheumatic fever (RF) is an inflammatory disease that can involve the heart, joints, skin, and brain. The disease typically develops two to four weeks after a streptococcal throat infection --Thats happen by cross linked AB antibody instead of attacking bacteria it will attack the heart << RF or attack the kidney << Glomerulonephritis Acute bacterial epiglottitis

6 infection by H.influenzae that lead to edema in the epiglottis << obstruction of the air way <<so in this case it's a life threatening condition Croup or laryngotracheobronchitis viral infection mainly by parainfluenzae;;; in this case when a baby breath >> A strange voice will sound(inspiratory stridor) and the parent will Concerned about their child;; but that sound nothing it just inflammation in the larynx from croup infection Nasopharyngeal Carcinoma: -one of the most common cancer in the URT -its a SCC in the nasopharynx mainly in old age and related to the EBV infection infection to the EBV will increase the risk of developing nasopharyngeal carcinoma because chinese people exposure to the EBV more than rest nation<< they will develop that cancer as we said its a SCC so there are 3 mainly types -keratinizing squamous cell carcinoma, (well differentiated) - nonkeratinizing squamous cell carcinoma,(less differentiated) -undifferentiated carcinoma/lymphoepitheliomas lymphoepitheliomas <<its composed of 2 types of cell --epithelial cell and lymphocytes why lymphocytes??? because that tumor mainly comes from EBV infecton so we must find lymphocytes **the mainly cured by radiotherapy Laryngeal tumors (rec min 34 ) Vocal cord nodules (benign tumor) squamous cell epithelial in the true vocal fold here in vocal cord nodules just elevation of the epithelial the main risk factor >> smoking

7 in histological section we find normal epithelial these cells just elevated from its position in long term this will affect the quality of voice Laryngeal papilloma: it's not only mas,, its a mass with finger like projection squamous papilloma in vocal cord Recurrent respiratory papillomatosis (RRP) papillomatosis mean than more than one papilloma >>more than one mass with finger like projection reccurent: means exclusion of it lead to arise it again resoiratory : in respiratory system papillomatous : more than one papilloma mainly in childern comes from HSV infection,, but how HSV reach the children although its a sexual transmitted before birth from maternal infected to its baby this benign tumor will dissapear after puberity

8 Malignant tumor of the larynx Carcinoma of the Larynx: mainly SCC,, risk factor like smoking (most common) alcohol HPV 20% asbestos the main signs of this tumor it's a"" hoarseness of voice"" less quality of voice 3 main types according to its position glottic tumors: arise from vocal cord,,, 60% to 75%, 90%,,the most common,,,less metastasis cause less LN here very important sign here hoarseness (the patient is come to you with a hoarseness in his voice so in diagnosis that lead to find glottic tumer) << good prognosis supraglottic:above the vocal cord,,, 25% to 40% more LN here so more risk for metastasis << less prognosis subglottic 5% below vocal cord No hoarseness in voice here so there is no sign of disease that lead to very bad prognosis rhinitis irritation and inflammation of the mucous membrane inside the nose,, The inflammation.is caused by viruses, bacteria, irritants or allergens at long term it maybe prognosis to Nasal Polyps

9 as we know polyps its just elevation of normal epithelial layer and maybe we find eosinophile here Sinonasal (Schneiderian) Papilloma tumor with finger like projection from one mass(papilloma) mainly 3 types --surface papilloma --inverted papilloma(papilloma goes inside toward CT) --cylindrical papilloma our lecture has ended best of luck