Layer Of Pleura Research Articles

Pleural Effusion Classification Based on Chest X-Ray Images using Convolutional Neural Network

Pleural effusion is a respiratory infection characterized by a buildup of fluid between the two layers of pleura, which causes specific symptoms such as chest pain and shortness of breath. In Indonesia, pleural effusion cases alone account for 2.7% of other respiratory infections, with an estimated number of sufferers in general at more than 3000 people per 1 million population annually. Pleural effusion is a severe case and can cause death if not treated immediately. Based on a study, as many as 15% of 104 patients diagnosed with pleural effusion died within 30 days. In this paper, we present a model that can detect pleural effusion based on chest x-ray images automatically using a Machine Learning algorithm. The machine learning algorithm used is Convolutional Neural Network (CNN), with the dataset used from ChestX-ray14. The number of data used was 2500 in the form of x-ray images, based on two different classes, x-ray with pleural effusion and x-ray with normal condition. The evaluation result shows that the CNN model can classify data with an accuracy of 95% of the test set data; thus, we hope it can be an alternative to assist medical diagnosis in pleural effusion detection.

Chemical pleurodesis for malignant pleural effusion: which agent is perfect?

BackgroundPleurodesis is defined as symphysis between two layers of pleura to prevent recurrence of effusion, and it is the best available treatment for recurrent effusions of incurable malignancies. An ideal agent must be highly effective, safe, inexpensive, and readily available which is yet to be identified.The aim of this study was to assess our results of medical pleurodesis, using 3 different chemical agents: bleomycin ampoules, doxycycline capsules, povidone–iodine solution, through two different routes, chest tube and small bore indwelling catheter.Over a period of 5 years, 104 patients with malignant recurrent pleural effusion underwent pleurodesis at our university hospital, using 3 different agents and two routes of delivery.ResultsFifty patients were male, patients’ age ranged from 22 to 74 years (57.55 ± 9.02). Fifty-nine patients (56.7%) had right-sided effusion, 61 patients (58.7%) had massive effusion. All patients were dyspneic. The rout of effusion drainage and sclerosing agent instillation was chest tube in 64 patients (61.5%) and small indwelling catheter in 40 patients. Forty-three patients received bleomycin, 36 patients received doxycycline, and 25 patients received povidone–iodine. The total success rate was 78.8%.ConclusionPleurodesis is a safe acceptable palliative procedure for malignant pleural effusion with not yet definite ideal agent or rout. Hence, the availability and the expense of agent are important.

Analysis of pleural fluid: Differentiating transudate from exudate

Introduction: Pleural fluid is defined as the fluid that is found between the two layers of pleura, (i.e. the parietal and visceral pleura) the membranes which line the cavity and surround the lungs. Normally, 10-20ml of pleural fluid, similar in composition to plasma but lower in protein ( over the layers of pleura, facilitating the movement between lungs and chest wall. The pleural fluid enters the systemic capillaries in the parietal pleura and exits via the parietal pleural stoma and lymphatics. (1) Pleural fluid accumulates when too much fluid enters or too little fluid exits the pleural cavity. Pleural fluid analysis is used to diagnose the cause of accumulation of pleural fluid in the chest cavity (Pleural effusion). Pleural effusion may be Transudative or Exudative. Analysis is done in three broad spectrums (1) Biochemical analysis (2) Microbiological analysis (3) Clinical pathology or cytology analysis. Materials and Methods: Pleural fluid is obtained by Thoracocentesis. Thoracocentesis or pleural tap is an invasive procedure to remove fluid or air from the pleural space for diagnostic or therapeutic purposes. The fluid obtained is sent for analysis. Pleural fluid analysis is a group of tests used to diagnose the cause of fluid build-up such as CHF, Cirrhosis, Infection etc. Result: Study shows that pleural effusions are common among 40-60 years of age group with a slight male predominance. The present study suggests that exudative effusions are more common than transudative effusions with a percentage of 61%. Conclusion: Pleural fluid analysis helps in diagnosing the etiology of the effusion based on the appearance and biochemical parameters. The common etiology for pleural effusion reported in India is Tuberculosis. WHO statistics shows India accounted for 27% of the total new infections in 2017, which is the highest among the top 30 high TB burden countries in the world. Keywords: Exudative, Pleural fluid, Transudative, Thoracocentesis.

Comparative evaluation of effects of intrapleural block with adjuvants on analgesia and pulmonary function after intercostal drainage: A pilot study

BackgroundInter-costal chest drain (ICD) used for varied thoracic pathologies causes continuous pain and irritation of the pleura, which limits respiratory efforts and impairs ventilatory function. Intrapleural block deposits local anaesthetic between the layers of pleura and may improve ventilatory function especially in non surgical patients. MethodsTwenty eight ASA I-III patients treated with ICD, who could perform incentive spirometry, were included for study. They were randomized to ‘Group C’ (control group); ‘Group B’ (Bupivacaine); ‘Group M’ (Bupivacaine+Morphine) and ‘Group D’ (Bupivacaine+Dexmedetomidine). The drugs were administered via the ICD itself and clamped thereafter for 15min. The success of the block was assessed by time for first analgesic demand, maximum inspiratory volume generated and Numerical Rating Scale score for pain; by patients. ResultsEffective analgesia was observed in Group B, M and D. Addition of an adjuvant significantly prolonged time for rescue analgesic demand. Patients who received local anaesthetic alone or with an adjuvant had significantly improved maximal inspiratory volume and required lesser rescue analgesics. No significant complications were observed in any group. Pain relief in post-surgical patients using intraplural block is masked by systemic analgesics. However its application in patients with ICD for non surgical indications was explored in this study and was found to improve patient comfort and ventilation. ConclusionIntra-pleural blockade is safe and effective in relieving the constant pleural irritation and pain of ICD, thus enabling the patient to improve ventilatory effort and faster recovery of respiratory function.

Azygos lobe presenting as right para-tracheal shadow.

CASE SUMMARY Fifty-seven years old male patient, non-addict, unemployed, was referred to Pulmonary Medicine OPD by anesthesiologist, in view of right paratracheal shadow, detected as an incidental finding during routine preanesthetic check up. The patient was posted for left malleolar bursa excision surgery. The patient did not have any respiratory complains, when he visited Pulmonary Medicine OPD. The patient had undergone angiography 7 months ago which did not reveal any abnormality. He was operated for fracture neck femur 13 years ago. On examination the patient was afebrile, with a pulse rate of 80 beats per minute, regular, and had blood pressure of 140/90 mmHg, respiratory rate of 20/min. Rest of general examination and respiratory system examination did not reveal any abnormality. Breath sounds were equal on both sides. INVESTIGATIONS Hb: 9.6 gm%, WBC: 11,000, N: 70, L: 20, E: 03, M: 05, ESR: 79, Platelets: 2,80000, BUN: 18 mg, Serum creatinine: 1.0 mg/dl, Total proteins: 7.5 gm/dl Albumin: 3.6 gm/dl, Globulin: 3.9 gm/dl, Total Bilirubin: 0.6 mg/dl, Direct Bilirubin: 0.2 mg/dl, SGPT: 13 IU, SGOT: 19 IU, Alkaline phosphatase: 77 KA, FBS: 93 mg%, PLBS: 155 mg%, Spirometry was within normal limits. CXR: Right paratracheal shadow HRCT Chest: Figure 1a and bFigure 1: (a) CXR: Right paratracheal shadow. (b) CT thorax imageQUESTIONS What is the diagnosis? Q1. Enlarged thymus Q2. Substernal goitre Q3. Pleural Bands Q4. Azygos lobe ANSWER Right azygos lobe HRCT chest: Right azygos lobe DISCUSSION An azygos lobe is a rare anomaly of lung and the incidence of the same varies from 0.4% to 1%.[1]. Azygos lobe was first mentioned by Wrisberg in1778 from anatomical studies, described as “Lobus Wrisbergi.” An azygos lobe is formed when a precursor of the azygos vein fails to migrate over the apex of the lung during fetal life, instead of course through the lung dragging lung with it, the parietal and visceral pleura [Figure 2]. The four layers of pleura are known as “Azygos Fissure.” Since there is no corresponding alteration in segmental architecture, “Lobe” is a misnomer.[1] Embryologically, a part of upper lobe of the right lung may come to lie medial to the azygos vein. This part is called the azygos lobe. In this condition, the azygos vein is suspended from the wall of the thorax by a fold of parietal pleura (mesoazygous).[2] It is commonly seen in males and has also been reported on the left side.[3] An azygos lobe is not susceptible to disease.[1] However, multiple authors have reported spontaneous pneumothorax associated within the azyos lobe in adult and pediatric patients.[456] Clinically, the knowledge of azygos lobe anatomy is important during thoracic surgical approaches.[3]Figure 2: Formation of an azygos lobe

Intrathoracic rib: radiographic features of two cases

Two cases of intrathoracic rib are presented. In one of these the anomalous rib was not supernumerary, and the investing layers of pleura caused the rib to appear abnormally dense. The relevant literature is briefly reviewed.

Inflammatory Pseudotumor of the Lung

The first case of an inflammatory pseudotumor of the lung recorded at the University of Missouri Medical Center, Columbia, Mo., affords the opportunity to introduce this entity into the radiological literature. This relatively rare condition should not be confused with the so-called “pseudotumor of the lung” which consists of fluid loculated between layers of pleura. Report of a Case An 8-year-old white girl was first seen at the University of Missouri Medical Center on June 30, 1959, for treatment of cardiac failure. An admission chest film showed a greatly enlarged heart and diffuse pulmonary edema (Fig. 1). The patient improved on medical therapy and at subsequent cardiac catheterization, a diagnosis of interventricular septal defect was made. On April 5, 1960, through a median sternotomy, under open heart technic with the heart-lung bypass, the intraventricular septal defect was closed. The patient did well, and roentgenograms obtained July 15, 1960, showed marked decrease in cardiac size and clearing...

The Incidence and Significance of Apical Lesions in Pulmonary Tuberculosis: A Pathologic and Roentgenologic Study

ALTHOUGH the various phases of pulmonary tuberculosis, including its pathologic and roentgenologic aspects, have for many years been favorite subjects of investigation, scarring at the apex of one or both lungs such as is so often present in lungs examined at necropsy, has received relatively little attention in the literature. That the lesion is tuberculous scarcely can be doubted, for Opie (1) observed evidence of tuberculosis in many cases, and Baldwin (2), Petroff (3), and Gardner (4) have stated that living bacilli of tuberculosis have been found in the lesion. Examination for this lesion has been a routine procedure in the Department of Pathologic Anatomy of the Mayo Clinic for several years. The lesion is almost always at the extreme apex of one or both lungs (Fig. 1). It is seen as a whitish, opaque scar that stands out in contrast to the normal color of the apical visceral pleura surrounding the lesion. The portion of the apex covered by the scar varies considerably. It may be found, in minimal cases, as just a slight puckering and opacity or whitening of the visceral pleura. In extreme cases, the scarring may cover the entire apex, forming a cap. There are also many variations as to the shape it may take. It is interesting to note that it is never found where the rib has encroached on the lung. The thickness of the scar probably varies more than the surface extent. On sectioning the lesion, the thickness will vary from 1 mm. to 8 or 10 mm. (Fig. 2). No evidence of a similar lesion of the parietal apical pleura adjoining this has been found except in cases in which adhesions joined the two layers of pleura at the point of scarring. Such adhesions were found in very few of the cases studied. On palpation of this area of the apex with the finger tips, the definite resistance of the scar compared to the surrounding normal apical pleura can at once be appreciated. In the less severely affected cases, the parenchyma of the lung directly beneath the scar is uninvolved; occasionally one will find an emphysematous cavity 2 or 3 mm. in diameter or multiple smaller ones. On examining these apical scars with the aid of the microscope one sees a picture of complete fibrosis (Fig. 3). In many of the sections the connective tissue has become hyalinized. As a rule, there is no evidence of proliferation of blood vessels. In many of the sections in which there has been a general anthracosis of the lung, coal pigment will be found deposited in clumps between the connective tissue fibrils. Evidence that silicon might be interspersed with the coal dust is lacking when these areas are viewed through a polarizing microscope. Tubercle formation, giant and epitheloid cells are seldom seen. The lesion is manifested roentgenographically as an opacity at the extreme apex of the lung (Fig. 4), its density varying considerably according to the extent of the scarring.

The Behavior of the Arterioles and Capillaries of the Lung.

In order to study the pulmonary circulation by direct observation and under physiological conditions, a method has been devised which permits a direct view of the vessels of the lung with the chest closed.Under amytal anesthesia the chest wall of the cat is so prepared that only a layer of pleura remains to keep the chest wall intact. This window of the pleura is planned so that it will lie directly over the extreme edge of the right lower lobe of the lung, in the axillary line. An abdominal incision is made which allows approach to the diaphragm immediately opposite the window in the outer wall. A similar window is then prepared by dissecting the muscle fibers from the diaphram and leaving the pleural layer intact. By means of this window a beam of light is thrown through the lung at sufficient intensity to permit direct observation of the pulmonary vessels with a microscope at the outer window. By employing this method it has been possible to observe the smaller arteries and veins and the capillaries un...

Diaphragmatic Hernia, Non-Traumatic

THE definition of diaphragmatic hernia requires the protrusion of abdominal viscera through a congenital or acquired opening in the diaphragm into the thorax. A true hernia requires the presence of a sac composed of a layer of peritoneum within and a layer of pleura without. A false hernia has no hernial sac, the abdominal viscera lying free within the thoracic cavity. These visceral protrusions occur either when there is deficient development with congenital weakness of the muscular layer of the diaphragm, and a weak spot exists through which the abdominal contents can force themselves, or when any one of the existing foramina is congenitally wide or at some time later in life becomes so. Diaphragmatic hernia has been recognized for many years. Stehelinus, in 1724, reported a case in which postmortem examination showed that the stomach had passed through the diaphragm into the thorax. However, a cross-reference to the writings of Clauder, in 1661, seemed to indicate that he had preceded Stehelinus in the...

ON THE DIAGNOSIS OF TUMORS OF THE ANTERIOR MEDIASTINUM.

Read in the Section on Practice of Medicine and Materia Medica, of Am. Med. Association, May, 1884. It would be difficult to find in the adult human body a region of less intrinsic interest than that space between spaces known to the anatomists as the Anterior Mediastinum. It is narrow and of little depth; at its superior part a small interval is left between the two layers of pleura which bound it; behind the second piece of the sternum, the pleuræ of opposite sides come into contact and it amounts merely to a thin septum; while lower down it is inclined to the left, and widened out into an angular space of some breadth by the recedence of the margin of the left pleura from the sternum (Quain). It is bounded in front by the triangularis sterni muscle, behind by the pericardium, laterally by the reflected borders of the costal