{"id":3162,"date":"2016-07-01T05:15:43","date_gmt":"2016-07-01T08:15:43","guid":{"rendered":"http:\/\/planetabiologia.com\/?p=3162"},"modified":"2022-11-20T23:29:10","modified_gmt":"2022-11-20T23:29:10","slug":"o-que-e-derrame-pleural","status":"publish","type":"post","link":"https:\/\/planetabiologia.com\/o-que-e-derrame-pleural\/","title":{"rendered":"O que \u00e9 Derrame Pleural"},"content":{"rendered":"<p style=\"text-align: left;\"><strong>Opacidade homog\u00eanea<\/strong> em base de hemit\u00f3rax esquerdo, sem estrutura a\u00e9rea dentro, <strong>sugerindo acometimento pleural. Derrame pleural \u00e0 esquerda.<\/strong><\/p>\n<p style=\"text-align: left;\">Obstru\u00e7\u00e3o dos seios costofr\u00eanico e cardiofr\u00eanico esquerdo. Imagem a\u00e9rea sugestiva de bulha gasosa do est\u00f4mago, definindo o diafragma acima dela. Aorta e \u00e1rea card\u00edaca normais<\/p>\n<p>Veja antes uma aula sobre as <a href=\"https:\/\/planetabiologia.com\/pleura-pulmonar\/\">fun\u00e7\u00f5es e anatomia da pleura<\/a>.<\/p>\n<p style=\"text-align: left;\">\u2022 <strong>Derrame Pleural \u00e0 esq<\/strong>. Opacidade homog\u00eanea no 2\/3 inferiores do hemit\u00f3rax direito, levemente curva lateralmente. Mediastino discretamente desviado para esquerda, bot\u00e3o a\u00f3rtico mais \u00e0 esquerda que o habitual. <a href=\"\/traqueia\/\"><strong>Traqueia<\/strong><\/a> sem desvios. Quanto mais l\u00edquido existe em um derrame, maior o colabamento de tecido pulmonar, determinando a chamada <strong>atelectasia passiva<\/strong>, que voc\u00ea geralmente n\u00e3o v\u00ea na radiografia. H\u00e1 um aumento volum\u00e9trico do <a href=\"\/pulmao\/\"><strong>pulm\u00e3o<\/strong><\/a> esquerdo, na tentativa de compensar o acometimento do pulm\u00e3o direito.<\/p>\n<p style=\"text-align: left;\">\u2022 Opacificacao em 2\/3 do HTD, desvio de mediastino<\/p>\n<p style=\"text-align: left;\">\u2022 H\u00e1 um n\u00edvel hidroa\u00e9reo que caracteriza um <strong>derrame pleural com ar associado (<u>hidropneumot\u00f3rax<\/u>).<\/strong><\/p>\n<p style=\"text-align: left;\">\u2022 \u00a0N\u00e3o h\u00e1 a \u201ccurva\u201d das imagens anteriores, pois aqui existem duas subst\u00e2ncias com densidades diferentes (ar e l\u00edquido).<\/p>\n<p style=\"text-align: left;\">\u2022\u00a0 Opacidade em 1\/3 inferior do HTD<\/p>\n<p style=\"text-align: left;\">\u2022\u00a0 Seios costofr\u00eanico e cardiofr\u00eanico direitos obstru\u00eddos.<\/p>\n<p style=\"text-align: left;\">\u2022\u00a0 A c\u00fapula direita aparenta estar mais alta que a esquerda. Uma hepatomegalia ou uma eventra\u00e7\u00e3o diafragm\u00e1tica poderiam dar imagem semelhante, sendo at\u00e9 mais frequentes.<\/p>\n<p style=\"text-align: left;\">\u2022 Essa \u00e9 uma forma at\u00edpica de derrame pleural conhecida como <strong>derrame pleural sub-pulmonar<\/strong>, na qual o l\u00edquido se acumula na base do hemit\u00f3rax.<\/p>\n<p style=\"text-align: left;\">\u2022 <strong>o dec\u00fabito lateral direito com raio horizontal do mesmo paciente<\/strong> (derrame pleural subpulmonar dir.). Faixa de l\u00edquido no espa\u00e7o pleural, dando esta opacidade. O derrame sub-pulmonar \u00e9 mais f\u00e1cil de ser visto no lado esquerdo, quando observa-se uma dist\u00e2ncia aumentada entre a base do pulm\u00e3o e a bolha gasosa do est\u00f4mago. sempre pedir o dec\u00fabito lateral diante da suspeita desse tipo de derrame. (havendo eleva\u00e7\u00e3o de c\u00fapula +sintomatologia fazer esse Rx)<\/p>\n<p style=\"text-align: left;\">\u2022 <strong>Opacidade no 1\/3 superior do pulm\u00e3o direito<\/strong>, com uma estrutura aerada dentro.<\/p>\n<p style=\"text-align: left;\">\u2022 <strong>C\u00fapula direita mais alta que a esquerda<\/strong>, mas com seio costofr\u00eanico livre. No dec\u00fabito lateral (a foto est\u00e1 tremida e desfocada), observa-se que aparece um l\u00edquido no espa\u00e7o pleural. <strong>Este \u00e9 um caso de TB com derrame sub-pulmonar associado<\/strong><\/p>\n<p style=\"text-align: left;\">\u2022 Cardiomegalia<\/p>\n<p style=\"text-align: left;\">\u2022 <strong>Derrame Pleural Intercissural (fissura horizontal), Pseudo TU de Pulmao, TU Evanescente.<\/strong><\/p>\n<p style=\"text-align: left;\">\u2022 Imagem nodular em 1\/3M, se continua com a cisura horizontal.<\/p>\n<p style=\"text-align: left;\">\u2022 \u00c1rea card\u00edaca aumentada com a ponta do ventr\u00edculo arredondada.<\/p>\n<p style=\"text-align: left;\">\u2022 Ingurgitamento dos vasos hilares<\/p>\n<p style=\"text-align: left;\">\u2022 cardiomegalia com essa imagem nodular arredondada na topografia da cisura.se continua com a cisura, no trajeto da cisura)<\/p>\n<p style=\"text-align: left;\">\u2022 N\u00e3o sendo derrame \u00e9 n\u00f3dulo. Teste terapeutico, repete Rx<\/p>\n<p style=\"text-align: left;\">\u2022 Retifica\u00e7\u00e3o da c\u00fapula direita. Opacidade no ter\u00e7o m\u00e9dio do pulm\u00e3o direito, <strong>hilos congestos.<\/strong><\/p>\n<p style=\"text-align: left;\">\u2022 <strong>Pneumot\u00e9rax hipertensivo esq. <\/strong>Desvio de mediastino e traqu\u00e9ia para direita. Imagem transparente no pulm\u00e3o esquerdo, sem estrutura vascular, sugerindo pneumot\u00f3rax. Opacifica\u00e7\u00e3o mais medial, peri-hilar, estendendo-se at\u00e9 o diafragma, correspondendo ao pulm\u00e3o esquerdo colabado. H\u00e1 ainda uma pneumatocele (rotura de alv\u00e9olos, ver seta), secund\u00e1ria a uma infec\u00e7\u00e3o pulmonar bacteriana estreptoc\u00f3cica, com necrose subseq\u00fcente. H\u00e1 ainda um aumento da circula\u00e7\u00e3o pulmonar no lado direito<\/p>\n<p style=\"text-align: left;\">\u2022 2 opacidades no 1\/3M<\/p>\n<p style=\"text-align: left;\">\u2022 Derrame pleural bilateral<\/p>\n<p style=\"text-align: left;\">\u2022 Cardiomegalia ou derrame peric\u00e1rdico<\/p>\n<p style=\"text-align: left;\">\u2022 Duas opacidades biconvexas,<\/p>\n<p style=\"text-align: left;\">\u2022 uma em topografia de cisura horizontal,<\/p>\n<p style=\"text-align: left;\">\u2022 outra em topografia de cisura obl\u00edqua (ver setas).<\/p>\n<p style=\"text-align: left;\">\u2022 Derrame septado (ou pseudo-tumor de pulm\u00e3o ou tumor evanescente), alem de derrame livre, associado a um quadro de ICC.<\/p>\n<p style=\"text-align: left;\">\u2022 A maior caracter\u00edstica de um derrame septado \u00e9: opacidade el\u00edpitica, biconvexa, em proje\u00e7ao, topografia de cisura obl\u00edqua ou horizontal. Se acompanhado de derrame livre +cardiomegalia= ICC<\/p>\n<p style=\"text-align: left;\">\u2022 Empiema septado \u00e9 redondo<\/p>\n<p style=\"text-align: left;\">\u2022 Mais um caso de <strong>derrame pleural encistado<\/strong> (o mesmo que septado). Observar a reflex\u00e3o da pleura visceral. Provavelmente este paciente teve alguma sequela passada ou em curso que justifique essa ader\u00eancia da pleura, a qual se reflete e \u201cencista\u201d o derrame. Lembrar sempre: opacidade dentro do t\u00f3rax <u>homog\u00eanea<\/u> (da cor do f\u00edgado), at\u00e9 que se prove o contr\u00e1rio \u00e9 <strong>PLEURAL<\/strong>.<\/p>\n<p style=\"text-align: left;\">\u2022 Patologia plural \u00e9 homog\u00eanea, e se tem reflec\u00e7ao&#8230;.<\/p>\n<p style=\"text-align: left;\">\u2022 Na imagem, observam-se algumas bolhas de ar (mais escuras, algumas maiores, outras menores) que tanto podem ser bolhas de enfisema como c\u00e2maras de pneumot\u00f3rax septado (mais raras). Tamb\u00e9m s\u00e3o conhecidas como <strong><em>blebs<\/em> <\/strong>de pneumot\u00f3rax espont\u00e2neo. A linha sinalizada pela seta representa <a href=\"\/alveolos-pulmonares\/\"><strong>alv\u00e9olos<\/strong><\/a> colabados pela bolha em crescimento, como ocorre no derrame pleural (atelectasia passiva). Isso n\u00e3o \u00e9 \u201cparede de bolha&#8221;.<\/p>\n<ul style=\"text-align: left;\">\n<li style=\"text-align: justify;\">O que \u00e9 Derrame Pleural &#8211; \u00c1gua no pulm\u00e3o<\/li>\n<\/ul>\n<h3 style=\"text-align: left;\"><strong>Fun\u00e7\u00e3o Pleural<\/strong><\/h3>\n<ul>\n<li style=\"text-align: left;\">Prote\u00e7\u00e3o pulmonar;<\/li>\n<li style=\"text-align: left;\">Diminuir o atrito entre par\u00eanquima pulmonar e caixa tor\u00e1cica;<\/li>\n<li style=\"text-align: left;\">Tra\u00e7\u00e3o do par\u00eanquima pulmonar na inspira\u00e7\u00e3o<\/li>\n<\/ul>\n<h3 style=\"text-align: left;\"><strong>Estrutura pleural:<\/strong><\/h3>\n<ul>\n<li style=\"text-align: left;\">C\u00e9lula mesotelial com vilosidades;<\/li>\n<li style=\"text-align: left;\">\u00c1cido Hialur\u00f4nico;<\/li>\n<li style=\"text-align: left;\">Pleura parietal sensibilidade dolorosa;<\/li>\n<li style=\"text-align: left;\">12ml de l\u00edquido pleural (0.16 \u2013 0.36ml\/kg);<\/li>\n<li style=\"text-align: left;\">Cavidade virtual com press\u00e3o negativa\u00a0 (-6 cmH2O);<\/li>\n<li style=\"text-align: left;\">Estomas linf\u00e1ticas com membrana cribriforme (pleura parietal);<\/li>\n<li style=\"text-align: left;\">Comunica\u00e7\u00e3o pleuro-peritoneal (raras);<\/li>\n<\/ul>\n<h3 style=\"text-align: left;\"><strong>Anatomia e Fisiologia da Cavidade Pleural:<\/strong><\/h3>\n<h3 style=\"text-align: left;\"><strong>L\u00edquido Pleural:<\/strong><\/h3>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 12 ml por hemit\u00f3rax;<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Fluxo de 0.5ml\/h;<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 2 a 3 g\/dl de prote\u00edna (pode aumentar quando o derrame for por congest\u00e3o pulmonar);<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Poucas c\u00e9lulas (maioria macr\u00f3fagos, raras hem\u00e1ceas e linf\u00f3citos);<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Circula\u00e7\u00e3o sist\u00eamica, pleura parietal (membrana semi-perme\u00e1vel intercelular),cavidade pleural, estomas linf\u00e1ticos (0.01ml\/kg\/h, ou at\u00e9 0.28ml\/kg\/h)<\/p>\n<h3 style=\"text-align: left;\"><strong>Causas da forma\u00e7\u00e3o do Derrame Pleural:<\/strong><\/h3>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <strong>1= <\/strong>Aumento da press\u00e3o hidrost\u00e1tica capilar pulmonar (ICE);<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <strong>2=<\/strong> Diminui\u00e7\u00e3o da press\u00e3o onc\u00f3tica do sangue\u00a0 ( cirrose hep\u00e1tica);<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <strong>3= <\/strong>Aumento da permeabilidade capilar, ou por les\u00e3o estrutural ou libera\u00e7\u00e3o de mediadores qu\u00edmicos (DP parapneum\u00f4nico,TEP, Tb, neoplasia);<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <strong>4= <\/strong>Bloqueio linf\u00e1tico ou ruptura de ducto linf\u00e1tico (linfoma de mediastino,).<\/p>\n<h3 style=\"text-align: left;\"><strong>Quadro Cl\u00ednico:<\/strong><\/h3>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Depende da velocidade de forma\u00e7\u00e3o do derrame, da presen\u00e7a ou n\u00e3o de inflama\u00e7\u00e3o pleural e da doen\u00e7a de base.<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <strong>Hist\u00f3ria Cl\u00ednica:<\/strong> dor tor\u00e1cica, dispn\u00e9ia e tosse seca.<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <strong>Exame F\u00edsico:<\/strong> &#8211; Diminui\u00e7\u00e3o de elasticidade e expansibilidade no hemit\u00f3rax afetado;<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 &#8211; Fr\u00eamito t\u00f3raco-vocal diminu\u00eddo ou ausente;<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 &#8211; Atrito pleural;<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 &#8211; Submacicez \u00e0 percuss\u00e3o;<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 &#8211; Diminui\u00e7\u00e3o ou aus\u00eancia de murm\u00fario vesicular;<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 &#8211; Sopro pleur\u00edtico<\/p>\n<h3 style=\"text-align: left;\"><strong>Investiga\u00e7\u00e3o diagn\u00f3stica:<\/strong><\/h3>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Hist\u00f3ria;<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Exame cl\u00ednico;<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Radiografia de t\u00f3rax;<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ultrassonografia;<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Tomografia;<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Toracocentese diagn\u00f3stica;<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Bi\u00f3psia pleural com agulha de Cope;<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Video-toracoscopia e Toracotomia.<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Investiga\u00e7\u00e3o Diagn\u00f3stica:<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <strong>Rx de t\u00f3rax:<\/strong><\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Investiga\u00e7\u00e3o Diagn\u00f3stica:<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <strong>Rx de t\u00f3rax:<\/strong><\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Investiga\u00e7\u00e3o Diagn\u00f3stica:<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <strong>Rx de t\u00f3rax:<\/strong><\/p>\n<p style=\"text-align: left;\"><strong>Toracocentese Diagn\u00f3stica:<\/strong><\/p>\n<ul style=\"text-align: left;\">\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Glicose;<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 LDH;<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Prote\u00ednas totais;<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 ADA;<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 pH;<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Gram e cultura para germes comuns;<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pesquisa e cultura para BAAR;<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Citologia total e diferencial;<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Citologia onc\u00f3tica.<\/li>\n<li>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 O que \u00e9 Derrame Pleural &#8211; \u00c1gua no pulm\u00e3o<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Transudatos<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 L\u00edmpidos<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Amarelo claro<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 N\u00e3o coagulam<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Bilaterais<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Exsudatos<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Hemorr\u00e1gicos<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 5-10.000 hem\u00e1ceas\/mm3 ou VG &lt; 1%= acidente de pun\u00e7\u00e3o<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 &gt;100.000 hem\u00e1ceas\/mm3 ou VG &gt; 1% = neo, trauma ou embolia<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 VG &gt; 50% do VG s\u00e9rico = hemot\u00f3rax<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Turvos<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Purulentos<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Frequentemente coagulam (fribinog\u00eanio)<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Quilot\u00f3rax e pseudoquilot\u00f3rax = branco-leitosos<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Unilaterais<\/li>\n<li>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Outros Testes para Exsudatos:<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Citol\u00f3gico total e diferencial:<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Citol\u00f3gico &gt; 10.000 leuc\u00f3citos:<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Empiema;<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Predom\u00ednio neutr\u00f3filos:<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Parapneum\u00f4nico;<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 TEP;<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Processos abdominais;<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 TB (7% casos);<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Neoplasia (20% casos);<\/li>\n<li>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Citol\u00f3gico total e diferencial:<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Predom\u00ednio linf\u00f3citos:<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Neoplasia;<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 TB;<\/li>\n<li>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Se linf\u00f3citos &gt; 90%:<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 TB;<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Linfoma.<\/li>\n<li>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Adenosina deaminase (ADA ) &gt; 40 U\/l:<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 TB (90%):<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Empiema (60%);<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Derrame parapneum\u00f4nico complicado (30%);<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Neoplasia (linfomas e adenocarcinomas)<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 AR e LES<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Bi\u00f3psia pleural:<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Indicada para exsudatos sem diagn\u00f3stico, quando se suspeitar de TB ou neoplasia;<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 A TB apresenta sensib. 80% na histologia e 56% na cultura, diagn\u00f3stico em 90% dos casos;<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Neoplasia: citologia \u00e9 superior \u00e0 bi\u00f3psia para o diagn\u00f3stico de malignidade;<\/li>\n<li>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0V\u00eddeo-toracoscopia:<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u2191 na sensibilidade para o diagn\u00f3stico de neoplasia (&gt; 90%):<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Identifica\u00e7\u00e3o das \u00e1reas de espessamento e\/ou nodularidade;<\/li>\n<li><\/li>\n<\/ul>\n<p style=\"text-align: left;\"><strong>Tuberculose pleural<\/strong><\/p>\n<ul style=\"text-align: left;\">\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 80 mil casos novos\/ano (Brasil)<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Formas<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Prim\u00e1ria<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Reativa\u00e7\u00e3o<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Patogenia<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Contiguidade de foco caseoso do par\u00eanquima<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ruptura de Linfonodos mediastinais<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dissemina\u00e7\u00e3o linf\u00e1tica ou hematog\u00eanica<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 J Bras Pneumol 2006, 72<\/li>\n<\/ul>\n<p style=\"text-align: left;\"><strong>Tuberculose pleural<\/strong><\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Manifesta\u00e7\u00e3o cl\u00ednica<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Aguda<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 cr\u00f4nica<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Caracter\u00edsticas do l\u00edquido<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Amarelo citrino ou turvo<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Prote\u00edna &gt; 4,5 mg\/dl<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 a 6.000 c\u00e9lulas com predom\u00ednio linf\u00f3citos<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 &lt; 15 dias = predom\u00ednio neutr\u00f3filos<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Cels mesoteliais &lt; 5%<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Culturas<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Cultura l\u00edquido pleural: 10-35%<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Cultura bi\u00f3psia pleural: 39-65%<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 ADA (&gt;40)<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Sensibilidade e especificidade 90-100%<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Bi\u00f3psia e cultura fragmento<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Sensibilidade 87%<\/p>\n<h3 style=\"text-align: left;\"><strong>Tuberculose pleural<\/strong><\/h3>\n<ul style=\"text-align: left;\">\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Tratamento<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Melhora cl\u00ednica em 15 dias<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 RIP 6 meses<\/li>\n<\/ul>\n<h3 style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <strong>Derrame pleural parapneum\u00f4nico (DPP)<\/strong><\/h3>\n<ul style=\"text-align: left;\">\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 140.000 a\u00a0 210.000 casos\/ano internados (Brasil)<\/li>\n<li>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 40% dos pacientes com pneumonia;<\/li>\n<\/ul>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dor ventilat\u00f3rio-dependente intensa;<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Unilateral de pequeno a moderado volume;<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Fases: exsudato est\u00e9ril, fase fibrino purulenta, organiza\u00e7\u00e3o (empiema);<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 pH &lt; 7.2, glicose&lt; 40, LDH &gt; 1000, leucocitose (predom\u00ednio de neutr\u00f3filos);<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Abordagem do Derrame Pleural Parapneum\u00f4nico (DPP):<\/p>\n<h2 style=\"text-align: left;\">O que \u00e9 Derrame Pleural &#8211; \u00c1gua no pulm\u00e3o &#8211; Derrames<\/h2>\n<p style=\"text-align: left;\"><strong>Derrame Pleural Neopl\u00e1sico &#8211;\u00a0Conduta<\/strong><\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Uni ou bilaterais, volume vari\u00e1vel;<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Neoplasia pulmonar (43%), mama (23%), linfomas (8%), ov\u00e1rio, TGI (est\u00f4mago), n\u00e3o identificado (5-10%);<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Exsudato amarelo-citrino ou sero-hem\u00e1tico, leucocitose com predom\u00ednio de linf\u00f3citos, riqueza de c\u00e9lulas mesoteliais;<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Glicose e pH (quanto mais baixos, pior progn\u00f3stico), CEA (95% especificidade para AdenoCa).<\/p>\n<p style=\"text-align: left;\"><strong>Derrame pleural p\u00f3s inj\u00faria card\u00edaca (S\u00edndrome de Dressler).<\/strong><\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ap\u00f3s IAM, cirrurgias card\u00edacas, procedimentos hemodin\u00e2micos;<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Derrames pequenos e geralmente \u00e0 esquerda;<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Exsudato com aumento de neutr\u00f3filos e eosin\u00f3filos (ap\u00f3s 30 dias predominam linf\u00f3citos e diminui LDH);<\/p>\n<p style=\"text-align: left;\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Abordagem: grande maioria melhora espontaneamente, toracocentese, cortic\u00f3ides em baixas doses.<\/p>\n<p>Voc\u00ea quer publicar um artigo, um post, ou algo qualquer texto relacionado a ci\u00eancias, educa\u00e7\u00e3o ou biologia? O que voc\u00ea acha de publicar aqui? Se voc\u00ea encontrou algo indevido nos textos e nas imagens deixe nos coment\u00e1rios que assim que puder vou analisar.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Opacidade homog\u00eanea em base de hemit\u00f3rax esquerdo, sem estrutura a\u00e9rea dentro, sugerindo acometimento pleural. Derrame pleural \u00e0 esquerda. Obstru\u00e7\u00e3o dos seios costofr\u00eanico e cardiofr\u00eanico esquerdo. Imagem a\u00e9rea sugestiva de bulha gasosa do est\u00f4mago, definindo o diafragma acima dela. Aorta e \u00e1rea card\u00edaca normais Veja antes uma aula sobre as fun\u00e7\u00f5es e anatomia da pleura. \u2022 &hellip;<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[41],"tags":[56],"_links":{"self":[{"href":"https:\/\/planetabiologia.com\/wp-json\/wp\/v2\/posts\/3162"}],"collection":[{"href":"https:\/\/planetabiologia.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/planetabiologia.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/planetabiologia.com\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/planetabiologia.com\/wp-json\/wp\/v2\/comments?post=3162"}],"version-history":[{"count":2,"href":"https:\/\/planetabiologia.com\/wp-json\/wp\/v2\/posts\/3162\/revisions"}],"predecessor-version":[{"id":14837,"href":"https:\/\/planetabiologia.com\/wp-json\/wp\/v2\/posts\/3162\/revisions\/14837"}],"wp:attachment":[{"href":"https:\/\/planetabiologia.com\/wp-json\/wp\/v2\/media?parent=3162"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/planetabiologia.com\/wp-json\/wp\/v2\/categories?post=3162"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/planetabiologia.com\/wp-json\/wp\/v2\/tags?post=3162"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}