Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:57

1186 Pleural Tumors Pneumothorax

follow-up

■Most follow-up is directed at the specific disease

■Benign fibrous mesothelioma, because of late recurrences, should

have annual Chest X-ray

complications and prognosis

■Malignant mesothelioma:

➣Median Survival:

Stage I (resectable without LN involvement): 22 months

Stage II (resectable with LN involvement): 17 months

Stage III (unresectable): 11 months

■Benign Fibrous Mesothelioma:

➣90% cure; 10% recurrence (may occur late)

■Primary Effusion Lymphoma:

➣Survival: 4–6 months

■Metastatic Pleural Disease

➣Mean survival with positive cytology=3 months

➣Effusion decreases with chemotherapy in 40% of breast and 35%

of small cell cancers

PNEUMOTHORAX

MESHELL D. JOHNSON, MD

history & physical

History

■Spontaneous pneumothorax (ptx)

■Primary – no underlying lung disease

➣Incidence 18 /100,000 in men, 6/100,000 in women

➣Usually tall, thin males 10–30 years old; uncommon over 40;

4:1 male predominance; cigarette smoking increases rate

■Secondary – history of underlying COPD, emphysema, cystic fibrosis,

status asthmaticus, PCP, necrotizing pneumonias, sarcoidosis, IPF,

EG, LAM, tuberous sclerosis, connective tissue disease, Marfan’s,

Ehlers-Danlos, cancer, thoracic endometriosis

➣Incidence 6/100,000 in men, 2/100,000 in women; in COPD, inci-

dence is 26/100,000

➣Peak incidence 60–65 years of age

■Traumatic ptx – penetrating or blunt chest injury (rib fracture, bron-

chial rupture, esophageal injury)

■Iatrogenic ptx – transthoracic needle aspiration, central line, thora-

centesis, pleural biopsy, positive pressure ventilation