Pleural diseasesPleural diseases

Department of faculty and hospital surgery Department of faculty and hospital surgery Tashkent Medical AcademyTashkent Medical Academy

The prevalence of pleural The prevalence of pleural diseasesdiseases

Empyema refers to the common diseases of Empyema refers to the common diseases of the chest. In 30-50% of cases, it complicates the chest. In 30-50% of cases, it complicates the course of acute and chronic pneumonia, the course of acute and chronic pneumonia, 80-90% - of gangrene of the lung, in the 9-80-90% - of gangrene of the lung, in the 9-15% - lung abscess, 6-8% - bronchiectasis 15% - lung abscess, 6-8% - bronchiectasis

At 4-34 patients with acute empyema At 4-34 patients with acute empyema developed after surgical treatment for lung developed after surgical treatment for lung and pleura. In 1.3-3 times more disease in and pleura. In 1.3-3 times more disease in menmen

With the treatment of With the treatment of diseases of the pleura diseases of the pleura

(empyema) began (empyema) began thoracic surgery. thoracic surgery.

The first description of The first description of thoracic surgery belongs thoracic surgery belongs

to Hippocrates, who to Hippocrates, who diagnosed pleural diagnosed pleural

empyema and cured the empyema and cured the sick releasing the pus by sick releasing the pus by

a cut (now it's called - a cut (now it's called - torakostomiya)torakostomiya)

Hippocrates(about 460 years BC)

The clinic as a diagnostic method The clinic as a diagnostic method thoracoscopy was first performed by thoracoscopy was first performed by the Swedish physician, pulmonologist the Swedish physician, pulmonologist Hans Christian Yakobeusom in 1910 Hans Christian Yakobeusom in 1910 with the help of a cystoscope to with the help of a cystoscope to diagnose the state of the pleural cavity diagnose the state of the pleural cavity in patients with tuberculosis. Later in patients with tuberculosis. Later Yakobeus designed optical instrument Yakobeus designed optical instrument called thoracoscope, whereby initially called thoracoscope, whereby initially inspect the pleural cavity, and from inspect the pleural cavity, and from 1910 to 1913, he completed 89 of 1910 to 1913, he completed 89 of thoracoscopy. thoracoscopy.

In 1913 Yakobeus upgraded In 1913 Yakobeus upgraded Thoracoscope, adjoining the Thoracoscope, adjoining the galvanokauter, and began using galvanokauter, and began using thoracoscopy for pleural adhesions thoracoscopy for pleural adhesions perezhiganiya. In 1925, he first perezhiganiya. In 1925, he first performed pleural biopsy in patients performed pleural biopsy in patients with mesothelioma and reported on with mesothelioma and reported on the implementation of 120 the implementation of 120 thoracoscopy in patients with thoracoscopy in patients with pulmonary tuberculosis.pulmonary tuberculosis.

Hans Christian Yakobeus

(1879-1937)

In 1925, PA Herzen In 1925, PA Herzen performed the first in performed the first in

the USSR thoracoscopy the USSR thoracoscopy in chronic pleural in chronic pleural

empyema. empyema. Subsequently, it is most Subsequently, it is most often used in TB for the often used in TB for the

intersection of intersection of adhesions by galvano-adhesions by galvano-

cautery for the cautery for the formation of a formation of a

therapeutic therapeutic pneumothorax.pneumothorax.

Peter A. Herzen (1871-1947)

Sergey Yudin (1891-1954)

Mikhail Davydov

Ivan Greeks (1867-1934)

Boris Petrovsky (1908 - 2004)

Vasit Vakhidovich Vahidov

Shavkat Ibrahimovic Karimov

Nikolai Fedorovich Krotov

Sadik Aliyevich Masumov

Duties of the general practitioner in diseases Duties of the general practitioner in diseases of pleuraof pleura

- Provision of primary health and social care; - Provision of primary health and social care; - Health education (promoting healthy lifestyles); - Health education (promoting healthy lifestyles); - Preventive work (timely detection of early and latent forms of the - Preventive work (timely detection of early and latent forms of the

disease, risk groups); disease, risk groups); - Dynamic monitoring; - Dynamic monitoring; - Emergency assistance in case of emergency and acute conditions; - Emergency assistance in case of emergency and acute conditions; - Timely consultation and hospitalization in the prescribed manner; - Timely consultation and hospitalization in the prescribed manner; - Medical and rehabilitation work in accordance with the qualifying - Medical and rehabilitation work in accordance with the qualifying

characteristic; characteristic; - An examination of temporary disability; - An examination of temporary disability; - The organization of medical and social care and household - The organization of medical and social care and household

together with the bodies of social protection and services of mercy together with the bodies of social protection and services of mercy alone, the elderly, the disabled, the chronically ill; alone, the elderly, the disabled, the chronically ill;

- Maintaining the approved forms of records and reports.- Maintaining the approved forms of records and reports.

Anatomy of the pleuraAnatomy of the pleuraAnatomy of the pleuraAnatomy of the pleura

Anatomy of the parietal pleuraAnatomy of the parietal pleuraAnatomy of the parietal pleuraAnatomy of the parietal pleura

1.Neck part2.Costal part 3.Mediastinal part4.Diaphragmatic

part

Classification of Diseases of Classification of Diseases of the pleurathe pleura

1.1. Empyema Empyema

2.2. Spontaneous Spontaneous pneumothorax pneumothorax

3.3. Injuries of the chest Injuries of the chest

4.4. Clotted hemothorax Clotted hemothorax

5.5. Fibrothorax Fibrothorax

6.6. Tumor of the pleuraTumor of the pleura

Classification of empyemaClassification of empyemaClassification of empyemaClassification of empyemaI. By the origin I. By the origin primary primary secondary secondary II. The clinical course II. The clinical course acute (disease lasts less than 8 weeks) acute (disease lasts less than 8 weeks) chronic (illness lasts more than 8 weeks) chronic (illness lasts more than 8 weeks) III. By the nature of exudate III. By the nature of exudate purulent purulent putrid putrid IV. By the nature of the microflora IV. By the nature of the microflora specific (tuberculosis, fungal) specific (tuberculosis, fungal) nonspecific (staphylococcal, dyplococcal, anaerobic) nonspecific (staphylococcal, dyplococcal, anaerobic) mixed mixed V. By the distribution process V. By the distribution process total and subtotal total and subtotal limited empyema: parietal, basal, interlobarnaya, apical, limited empyema: parietal, basal, interlobarnaya, apical,

mediastinal an multi-chamber mediastinal an multi-chamber VI. Iatrogenic empyemaVI. Iatrogenic empyema

Clinical signs of pleural Clinical signs of pleural empyemaempyema

Cough Cough Sputum Sputum Signs of intoxication Signs of intoxication FeverFever Asymmetry of chest Asymmetry of chest Auscultation reduction or absence of Auscultation reduction or absence of

pulmonary respiration in the affected pulmonary respiration in the affected sideside

EmpyemaEmpyema

EmpyemaEmpyema

radiography computed tomography

EmpyemaEmpyema

Changing the location of the fluid in the pleural Changing the location of the fluid in the pleural cavity according to the position of the patientcavity according to the position of the patient

Puncture of the pleural cavity

Thoracostomy by Seldinger

The location of the needle with respect to the fins during the puncture of the pleural cavity

Thoracostomy with the help of the trocar

Technique of chest draining

The valve is used for drainage of the pleural cavity

Device for drainage of the pleural cavity by Byulau

Thoracostomy by Bobrov

Modern plant for active aspiration of the pleural cavity

The scheme of pleuroevacuator

PleuroevacuatorPleuroevacuator

Methods of rehabilitation of the pleural cavity

Decortication of the lung

As a rule, spontaneous pneumothorax is a complication, not a cause

Spontaneous pneumothoraxSpontaneous pneumothorax

Position of the patient on the operating table

Intubation tube to separate light

Thoracoscopic Thoracoscopic intervention in intervention in spontaneous spontaneous

pneumothoraxpneumothorax

Coagulation of the bull

Ligation of the bull

Suturing of the bull

Partial atypical resection

Diagnostic thoracoscopy

The advantages of VATS intervention Reducing trauma surgery Reduction in pain There is no need to find a patient in the

intensive care unit Early activation of patients Reducing the number of complications

associated with physical inactivity on the part of the surgical wound

Reduction in length of hospital stay Reduction in general terms of disability Reducing the flow of drugs and surgical

material Good cosmetic effect

Pronounced cosmetic effect after thoracoscopic interventions

Radiographic signs of damage to Radiographic signs of damage to the chestthe chest

Partial or complete alveolar infiltrates Partial or complete alveolar infiltrates Mediastinal shift Mediastinal shift Subcutaneous emphysema Subcutaneous emphysema Pneumomediastinum Pneumomediastinum Fractured ribs Fractured ribs Expansion of the shadow of the mediastinum Expansion of the shadow of the mediastinum The disappearance of the contour of the The disappearance of the contour of the

aortic arch aortic arch Mixing of a nasogastric tube to the right Mixing of a nasogastric tube to the right Expansion of cardiac contour Expansion of cardiac contour Presence of gastric bubble and bowel loops in Presence of gastric bubble and bowel loops in

the pleural cavitythe pleural cavity

Clinical signs of damage at Clinical signs of damage at the chestthe chest

1.1. Cyanosis Cyanosis

2.2. The absence of spontaneous The absence of spontaneous breathing breathing

3.3. Subcutaneous emphysema Subcutaneous emphysema

4.4. The presence of abnormal noise in the The presence of abnormal noise in the pleural cavity pleural cavity

5.5. The presence of chest injury The presence of chest injury

6.6. Bulging neck veins Bulging neck veins

7.7. Paradoxical pulseParadoxical pulse

HemothoraHemothoraxx

Tension pneumothoraxTension pneumothorax

Subcutaneous emphysema Subcutaneous emphysema For percussion tympanitis on the For percussion tympanitis on the

affected side affected side Mixing of the trachea in a Mixing of the trachea in a

healthy way healthy way The weakening of the respiratory The weakening of the respiratory

noise noise Unstable hemodynamicsUnstable hemodynamics

Tension pneumothorax

Open pneumothorax

schematic representation of

Treatment of injuries of the Treatment of injuries of the chestchest

1.1. Thoracostomy Thoracostomy

2.2. Surgical treatment Surgical treatment

3.3. Conservative therapyConservative therapy

Indications for drainage of Indications for drainage of the pleural cavitythe pleural cavity

1.1. Pneumothorax Pneumothorax

2.2. Injuries of the chest Injuries of the chest

3.3. HemothoraxHemothorax

Indications for surgical treatment of Indications for surgical treatment of injuries of the chestinjuries of the chest

Cardiac tamponade Cardiac tamponade Large open wound of the chest Large open wound of the chest Signs of damage to the mediastinum Signs of damage to the mediastinum Profuse bleeding continues or pleural cavity Profuse bleeding continues or pleural cavity Massive pnevmoreya on drainage of the Massive pnevmoreya on drainage of the

pleural cavity pleural cavity Damage to the trachea or main bronchus Damage to the trachea or main bronchus Rupture diaphragms, aorta, esophagus Rupture diaphragms, aorta, esophagus Foreign body chestForeign body chest