Pleural diseases

Bolesti pleure predstavljaju veliki broj patologija koje zahvaćaju pleuru, pleuralni prostor i pleuralnu tekućinu. Ove bolesti su česte te se procjenjuje da godišnje pogađaju oko 3000 na milijun osoba. S obzirom na veliki broj stanja koja mogu uzrokovati simptomatologiju na pleuri u i pleuralnom prostoru, važno je sistemski pristupati dijagnostici. Pleura je serozna plućna ovojnica koja se sastoji od dva lista, visceralne i parijetalne pleure. Između ta dva lista nalazi se pleuralna šupljina koja normalno sadrži oko 0,26 mL/kg pleuralne tekućine. Najčešća patologija pleure je pleuralni izljev, koji nastaje zbog narušenog balansa u proizvodnji i reapsorpciji pleuralne tekućine. Najčešći uzroci su pneumonije, kongestivno zatajenje srca i malignitet. Pleuralni izljevi klasificiraju se na transudate i eksudate prema Light-ovim kriterijima. Dijagnoza se postavlja radiološki, rendgenskim snimkama i ultrazvukom, a ključna je i analiza pleuralne tekućine dobivena torakocentezom. U slučajevima nejasne etiologije, dostupne su i invazivnije dijagnostičke metode poput biopsija. Liječenje je fokusirano na terapiju podlježećeg uzroka. Druga najčešća patologija pleure je pneumotoraks, koji može nastati spontano, traumatski ili ijatrogeno. Dijagnoza se postavlja rendgenskom snimkom ili UZV-om. Liječenje se planira prvenstveno prema kliničkoj slici, a uključuje oksigenoterapiju, iglenu aspiraciju i postavljanje torakalnog drena. Od malignih bolesti pleure najčešće se javljaju metastaze, posebno tumora pluća i dojke. Najvažniji primarni tumor pleure je maligni mezoteliom, koji se povezuje s dugotrajnom izloženošću azbestu. Razlikujemo tri histološka tipa mezotelioma: epiteloidni, sarkomatoidni i bifazični. Dijagnozu je nužno histološki potvrditi iz uzorka tkiva dobivenog biopsijom, dok se za određivanje stadija koristi CT. Mezoteliom je neizlječiva bolest pa je skrb fokusirana na palijativnu njegu. Liječenje obuhvaća kemoterapiju, imunoterapiju, radioterapiju i kirurško liječenje.Pleural diseases represent a number of pathologies that involve the pleura, pleural space and pleural liquid. These diseases are common and it is estimated that they affect around 3000 in a million persons yearly. Considering the number of conditions that can cause symptoms involving the pleura and pleural space, it’s important to have a systemic approach in diagnosis. Pleura is a serous lung membrane, made up of two layers, visceral and parietal pleura. Between them is the pleural space which normally contains around 0,26 mL/kg of pleural liquid. Most common pathology of the pleura are pleural effusions, which happens due to an imbalance in formation and reabsorption of pleural liquid. Common causes include pneumonia, congestive heart failure and malignancy. They can be divided in transudates and exudates based on the Light’s criteria. The diagnosis is made with chest radiography and ultrasound, but the most important part is the analysis of the pleural liquid obtained by thoracocentesis. In case the etiology in unclear, invasive diagnostic methods are available, such as pleural biopsy. Treatment is focused on the underlying cause. The second most common pathology is pneumothorax, which can occur spontaneously or be caused by trauma or iatrogenically. Diagnosis is set with an x-ray image or with ultrasound. Treatment is planed based on the clinical presentation and it involves oxygen therapy, needle aspiration and chest drain insertion. Most common malignant diseases of the pleura are metastases, especially those from lung and breast cancers. Malignant pleural mesothelioma is the most important primary pleural tumour and is associated with long-term asbestos exposure. There are three histological variants of the mesothelioma: epithelioid, sarcomatoid and biphasic. It’s necessary to confirm the diagnosis histologically from the tissue sample obtained by biopsy, while CT is used for staging. Mesothelioma is an incurable disease so the focus is on palliative care. Treatment includes chemotherapy, immunotherapy, radiotherapy and surgical interventions