Causes And Management Of Pleural Fibrosis
The development of pleural diffuse pleural fibrosis. pleural fibrosis follows severe pleural space inflammation diffuse pleural fibrosis which is typically associated with an exudative pleural effusion. The response of the mesothelial cell to injury and its ability, along with the basement membrane, to maintain its integrity, is vital in determining whether there is normal healing or pleural fibrosis. The formation of a fibrinous intrapleural matrix is critical to the development of pleural fibrosis.
This matrix is the result of disordered fibrin turnover, whereby fibrin formation is up-regulated and fibrin dissolution is down-regulated. Cytokines, such as TGF- and TNF-, facilitate the fibrin matrix formation. A complete understanding of the pathogenesis of pleural fibrosis and why abnormal pleural space remodeling occurs in some and not in others, remains unknown. Clinically significant pleural fibrosis requires involvement of the visceral pleura. Isolated parietal pleural fibrosis, as with asbestos pleural plaques, does not cause restriction or respiratory impairment.
Related links:
Benign pleural diseases
The causes of visceral pleural fibrosis include asbestos-associated diffuse pleural thickening, coronary bypass graft surgery, pleural infection (including tuberculous pleurisy), drug-induced pleuritis, rheumatoid pleurisy, uraemic pleurisy, and haemothorax. Systemic and intrapleural corticosteroids administered during the initial presentation of rheumatoid pleurisy in small series may decrease the incidence of pleural fibrosis. Several randomised control trials using corticosteroids in tuberculous pleurisy have not shown efficacy in reducing residual pleural fibrosis. Decortication is effective in treating symptomatic patients regardless of the cause of pleural fibrosis as long as chronicity has been documented and significant underlying parenchymal disease has been excluded.
Malignant Diffuse Pleural mesothelioma
Diagnostic procedure consists mainly of the image processing with computed tomography (CT), magnetic resonance imaging (MRI) and emission tomography (PET) position, and the tests in the laboratory and in the analysis. Thoractomy, which means a cut through the chest wall, the pleura (membranes, wallpapered, lungs and chest cavity) and pleural fibrosis biopsy evidence.
But in general, the prognosis (response to treatment) is not well in the spread of malignant pleural mesothelioma. The surgery in phase I can help. It is found during the later stages of the cancer, the survival rate is four months to twelve months. Radiation therapy and chemotherapy apparently not the survival rate of businesses grow. The reality is that there is currently no effective treatment. The research is on the lookout for new methods for the efficient management and medications.
Diffuse Pleural Thickening
Diffuse pleural thickening may result from exudative pleural effusions secondary to asbestos exposure, but other causes of pleural disease may also cause thickening (e.g. haemothorax, connective tissue diseases, tuberculosis, chest surgery, drugs such as methysergide and parapneumonic effusions).
Loud et al., 1985). It has also been defined on CT scanning as a continuous sheet more than 5 cm wide, more than 8 cm in craniocaudal extent, and more than 3 mm thick (Lynch et al., 1989). Diffuse pleural thickening may be difficult to differentiate from multiple pleural plaques, but the following may assist (Fletcher., 1970):
CT is more sensitive and specific for the detection of diffuse pleural thickening than chest radiography. Diffuse pleural thickening may result in impaired lung function in the absence of parenchymal fibrosis, producing a restrictive ventilatory defect with a decrease in lung volumes and preserved gas transfer. With severe pleural restriction, the KCO may be increased (Al Jarad et al., 1991, Yates et al., 1996).
