Question

Case Study –Fibrothorax Lori was 43 years old when her pulmonary problems started. She got extremely ill and was forced to take a week off of work. During this time her body temperature was 41oC and she experienced severe dyspnea (had to stop for breath after walking for 100 yards). She was coughing and producing large amounts of rust colored sputum. She was diagnosed with lobar pneumonia with pleural empyema. She was treated with antibiotic and the infection was controlled. After she returned to work she was still experiencing moderate dyspnea. To determine the reason for the lingering symptoms she underwent several pulmonary function tests. Blood gas measurements and ventilatory function measurements yielded the following: PaO2 75 mmHg PaCO2 50 mmHg Residual Volume (RV) 2250 ml Forced Vital Capacity (FVC) 2680 ml Force Expiratory Volume (FEV1) 2420 ml It was determined that the pleural exudates had organized into fibrothorax. Her doctor suggested that a decortication surgery might be indicated. She is consulting with her family to decide if she wants to undergo this procedure.

1. What is dyspnea? Why is Lori experiencing this symptom?

2. What is lobar pneumonia? How does it compare to lobular or interstitial pneumonia?

3. What is pleural empyema? How does it relate to the infection she suffered from?

4. Do these blood gas results tell you anything about Loris pulmonary function?

5. Do these ventilatory function measurements tell you anything about her disease? Is she suffering from a restrictive or an obstructive disorder?

6. Do you think she should have the surgery? Why?

Answer 1

1. What is dyspnea? Why is Lori experiencing this symptom?

Dyspnoea refers to shortness of breath or difficult or laboured breathing.

Causes of Dyspnoea in Lori are due to the following 3 causes :

a) Lori had an episode of lobar pneumonia which is an infection of the lung tissue. The body's immune response causes inflammation which inturn cause the alveoli to fill up with fluids. The air sac(alveoli) become fluid filled and becoome less elastic. Since the gas exchange surface (alveoli) is compromised, it results in hypoxia and hence the feeling of breathlessness i.e Dyspnoea.

b) When the infection from the lung parenchyma spreads to the pleural fluid it results in pleural empyema (pus in pleural fluid). This causes increase in the quatity of fluid as well as its thickening which inturn restricts the movement of the lng and hence th dyspnoe.

c) Fibrothorax : The fibrothorax which can also be called an a defective healing following the pleural empyema episode, causes contraction of the involved hemithorax and reduced mobility of the lung and thoracic cage. This results in the feeling of Dyspnoea and shortness of breath.

2. What is lobar pneumonia? How does it compare to lobular or interstitial pneumonia

Lobar pnemonia : Affects an entire lobe or lung,

Lobar pnemonia lobular pneumonia interstitial pneumonia   

Affects an entire lobe or lung, patchy foci of consolidation (pus) mesh-like walls of the alveoli,affects in many alveoli which are scattered areas surrounding the alveoli.   in one or more lobes of one or more
lung

Xray - Dense consolidation X-ray - Patchy opacity X-Ray - Septal thickening, Diffuse hazy opacities

Microbiology - mostly streptococcus, Wide variety of bacteria Viruses, Mycoplasms, Atypical   pneumoniae, Klebsiella pnemoniae (mycoplasms, chlamydia,

legionella Staph, pseudomonas

3. What is pleural empyema? How does it relate to the infection she suffered from?

Pleural empyema is the collection of pus in the pleural cavity. In case of Lori, Pneumonia caused increase in inflammatory process and thereby increase in production of pleural fluid. Due tp progress of the disease, the microorganism can coloize the plueral fluid and causes empyema i.e pus.