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Mesothelioma - Exudative Pleural Effusions

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					       Aetiology




Exudative Pleural Effusions
                What is an Exudate?
A cloudy fluid containing proteins and cellular debris which has escaped from
blood vessels and has been deposited in tissues, or on tissue surfaces,
usually as a result of inflammation.
•   Transudative and exudative pleural
    effusions are distinguished by measuring
    the lactate dehydrogenase (LDH) and
    protein levels in the pleural fluid.

•   LDH is an enzyme which is important to
    the production of energy in cells. When
    cells die LDH is released and escapes into
    the blood.

•   Exudative pleural effusions meet at least
    one of the following criteria, whereas
    transudative pleural effusions meet none:
•   1. pleural fluid protein/serum protein >0.5
•   2. pleural fluid LDH/serum LDH >0.6
•   3. pleural fluid LDH more than two-thirds
    normal upper limit for serum
        Causes of Exudative Pleural
                Effusions
Once an exudative pleural effusion has been established from the fluid test,
the causes can be investigated.
    An exudative pleural effusion is not a pathology in itself and is
    always caused by something else such as:
• Parapneumonic causes
• Malignancy (carcinoma, lymphoma, mesothelioma)
• Pulmonary embolism
• Collagen-vascular conditions (rheumatoid arthritis, lupus)
• Tuberculous
• Asbestos exposure
• Trauma
• Postcardiac injury syndrome
• Esophageal perforation
• Radiation pleuritis
• Drug use
• Chylothorax
                    Mesothelioma

•Mesothelial cells are the superficial
cells lining the lungs
•They produce a transudate fluid to
allow smooth movement of the lungs as
they expand and contract whilst
breathing

•Mesothelioma causes pleural thickening that prevents lymphatic
drainage of pleural fluid, causing fluid to build up- A pleural
effusion
•The Most common cause of mesothelioma is inhalation of
asbestos fibres.
•Asbestos fibres are very fine and once they have been inhaled
they cannot be exhaled or coughed out
                     A Few Facts
• Cancer research uk 2009
• 70-80% of people diagnosed with mesothelioma say they have been
  exposed to asbestos at some point in their life
• Mesothelioma can not just affect the pleura but also the pericardium
  and peritoneum.
• Pleural mesothelioma can spread to the pericardium quite easily
  due to the hearts close proximity to the pleural lining.
• National Macmillan Mesothelioma Resource Centre 2008
• In the United Kingdom almost 2000 people a year are diagnosed
  with mesothelioma
• Mesothelioma has a latency period meaning it can take from 15 to
  45 years for asbestos to mesothelioma to occur and show any
  symptoms at all.
                              REFERENCES
Goldberg, Persky and White (2009) ‘Mesothelioma Centre’ [Online rescource] available at:
    http://www.mesotheliomacenter.org/about/pleural-mesothelioma.php accessed 28/12/2009

Daniel L. Miller (2009) ‘Extrapleural Pneumonectomy’ CTSnet [online rescourse] Available at:
    http://www.ctsnet.org/sections/clinicalresources/thoracic/expert_tech-7.html accessed 2812/2009

Jeffrey Rubins (2009) ‘pleural effusion’ eMedicine [online rescource] Available at:
      http://emedicine.medscape.com/article/299959-overview accessed: 28/12/2009

National Macmillan Mesothelioma Resource Centre 2008 ‘mesothelioma uk’ [online rescource] available at
     http://www.mesothelioma.uk.com/index.php?pageno=18 accessed 28/12/2009

Cancer research UK 2009 ‘mesothelioma’ [online rescource] available at
    http://www.cancerhelp.org.uk/type/mesothelioma/index.htm accessed:28/12/2009

Victor L Roggli, thomas A Sporn and tim d ovry (2004) ‘pathology of asbestos associated disease’ 2nd Edition,
     springer, New York.

Harvey I Pass, Nicholas J Vogelzang Michele Carbone (2005) ‘Malignant mesothelioma- advances in
    pathogenesis, diagnosis and translational therapies’ Springer, New York

				
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