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dr. SABRINA ERMAYANTI, Sp.P(K), FISR
Bagian Pulmonologi dan Kedokteran Respiraasi FK Unand/RSM Djamil Padang
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ANATOMI RONGGA PLEURA
Pleural cavity
Potential space 2-10 m -4 s/d -11 ppm
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Normal Pleural Physiology
Miserocchi G. Eur Respir J 1997;219-225
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Visceral Pleura Parietal Pleura Pleural Space
35 29
29 29
6 0
Starling’s hypothesis of transcapillary exchange
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Produksi cairan pleura : 0,01 mL/Kg/hr atau 15 mL/hr
Absorbsi mll pemb. limfe : 0,20 mL/Kg/hr
NORMAL
Tek. hidrostatik Tek. onkotik
EFUSI PLEURA
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Efusi pleura Penumpukan cairan yang abnormal dalam rongga pleura akibat peningkatan produksi cairan dan/atau berkurangnya absorbsi oleh kelenjar limfe
DEFINISI
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MEKANISME PENYAKIT
Permiabilitas membran pleura Inflamasi, keganasan, emboli paru
tek. onkotik Hipoalbumin ec SN atau SH
Permiabilitas kapiler Trauma, keganasan, inflamasi, infeksi, infark paru, hipersensitivitas obat, uremia, pankreatitis
tek. hidrostatik CHF, SVCS
Tek. intra pleura Trapped lung
aliran limfe Keganasan, infeksi
Cairan intraperitoneal Hidrotorak hepatik, SH, dialisis peritoneal
Perpindahan cairan Edema paru
Tek. Onkotik cairan pleura menetap
Efusi pleura
ETIOLOGI
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Ggn keseimbangan tek. onkotik dan tek. hidrostatik
Transudat
Proses inflamasi pleura
&/atau drainase limfatik Eksudat
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EKSUDAT TRANSUDAT
Parapneumonia effusi CHF
EFUSI PLEURA GANAS Sirosis hepatis
Tuberkulosis Atelektasis
Emboli paru Hipoalbumin Penyakit kolagen (RA, SLE) Sindroma nefrotik
Pankreatitis Dialisis peritoneal
Trauma Myxedema
Sindroma trauma postcardiac Perikarditis konstriktiva
Meigs syndrome Urinotoraks
Uremia Kebocoran cairan Serebrospinal
Cylothorax Fistula duropleural
Infeksi jamur Migrasi ekstravaskuler dr kateter vena sentral
ETIOLOGI
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GEJALA UTAMA
Sesak napas makin lama makin meningkat
Meningkat dengan aktivitas
Suka tidur pada sisi yang sakit
GEJALA KLINIS
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Inspeksi : cembung,
pergerakan tertinggal
Palpasi : fremitus <
Perkusi : redup/pekak
Auskultasi : Suara napas melemah/menghilang
PEMERIKSAAN FISIK
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PEMERIKSAAN PENUNJANG
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Pungsi percobaan cairan +/- Analisa cairan pleura eksudat/transudat Sitologi cairan pleura etiologi Kultur dan sensitiviti kuman banal BTA langsung cairan pleura ADA cairan pleura Chylomicron, TG Chylothorax
PEMERIKSAAN PENUNJANG
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JENIS CAIRAN PLEURA
Makroskopis
Serous
Hemorragis
Purulen
Sero- hemorragis
Sero- purulen
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JENIS CAIRAN PLEURA
Mikroskopis
Transudat
Eksudat
Kriteria Light
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Protein cairan pleura : protein serum > 0,5 LDH cairan pleura : LDH serum > 0,6 LDH cairan pleura > 2/3 batas atas LDH
serum normal
KRITERIA LIGHT
Eksudat
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EFUSI PLEURA GANAS (EPG)
akumulasi sejumlah cairan eksudat di rongga pleura, disertai adanya sel-sel ganas atau jaringan tumor (ERS)
Kondisi dimana kanker akumulasi sejumlah cairan dirongga pleura (NCI Dictionary)
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Primer Pleura Mesotelioma
Sekun der
Paru Ca bronkogenik
Organ lain Tumor metastase ke paru
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EPG
Masif produktif Demam meriang << Sering usia tua kecuali
tumor mediastinum Faktor risiko (+) Hemorragis >> Ada bukti keganasan Sitologi cairan pleura bisa ditemukan sel ganas
Efusi pleura TB
Perlahan Demam tinggi >> Usia muda
Kontak TB (+) Serous BTA sputum +/- Sitologi cairan pleura efusi pleura limfositik >>
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Algorithm for
evaluation
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Gejala Tanda Pemeriksaan penunjang
EFUSI PLEURA MASIF
Tatalaksana
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