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Old 01-13-2012
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Stethoscope Pleural Friction Rub and PE

Rapid review says on page 293 edition 3, that one of the clinical findings of PULMONARY THROMBOEMBOLUS is Pleural friction rub. Other sources confirm, but i do not understand..

I thought Pleural rub occurs due to an inflamatory process, but if an embolus is sudden, for ex- saddle embolus, then how can it cause an inflamatory process leading to friction rub? Am i missing something, i feel like something is going right over my head, any help would be much appreciated.

Thank you!
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Old 01-13-2012
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29 views and no one knows the answer?

I would appreciate any help, even a lead so i can figure it out.. what am i missing? thanks so much guys, my test is in 3 weeks
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Old 01-13-2012
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Ok since you're asking for a lead this is what I was thinking but I believe I am way off topic here .. possibly incorrect ? lol .. Here goes -

Since its a pulmonary embolism, it will lead to hypoxic ischemia. The cell will have no oxygen, no atp, and it will undergo coagulative necrosis. The NA/K/ATP-ase pump would shut down causing efflux of Na+ along with water .. this would lead to hypovolemia in the tissues. I'm guessing the fluid from the pleural cavity leaks out as a result of the necrotic damage ?

Now IDK if any of this makes sense lol
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Old 01-13-2012
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Thanks hope2pass.. I appreciate your effort.. and what you say makes sense. Its kinda comforting to know someone else is just as confused as me! Lol, which makes me feel less stupid . This is my 2nd time re-reading rapid review and i just caught this, and was wondering how after doing UW 2xs and RR and FA almost 5 times did i miss this point?

Thanks so much!
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No problem.

I think if you listen to goljan audio - Cell Injury (part 1) .. he talks about pulmonary embolism in it .. somewhere half way through the audio. Give it a try. I dont quite remember exactly what he said in it though lol I havent heard the audios yet but tried listening to that one lol
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Old 01-14-2012
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Pleural friction rub is due to hemorrhagic infarction that occurs due to decrease in perfusion in small vessels due to embolus in the pulmonary artery, this causes wedge shaped pulmonary infarct leading to loss of lubrication of pleura leading to this rub.... this also occurs in pneumonia when the pleura is inflamed, this is inspiratory as well as expiratory sound!!!
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Old 01-15-2012
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Disturbance of hemodynamics will cause the inflammation of pleura, causing pleuritic pain, fever, effusion...

http://www.askthedoctor.com/topics-a...-embolism.html

Hope this helps.
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thank you so much guys, the explanations really cleared things up!
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Old 01-16-2012
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Quote:
Originally Posted by doctorFH View Post
Pleural friction rub is due to hemorrhagic infarction that occurs due to decrease in perfusion in small vessels due to embolus in the pulmonary artery, this causes wedge shaped pulmonary infarct leading to loss of lubrication of pleura leading to this rub.... this also occurs in pneumonia when the pleura is inflamed, this is inspiratory as well as expiratory sound!!!
so the embolus causes less fluid than usual in the pleural space and leads to the friction rub?
I thought it would be embolism --> transudate/exudate into interpleural space --> friction rub --> pleuritis chest pain, as in pneumonia, cancer, collagen vascular disease...
Could you all explain? thanks.
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