A 35-year-old man has had increasing dyspnea for the past 24 hours. A chest radiograph shows large, bilateral pleural effusions. Thoracentesis yields 500 mL of slightly cloudy yellow fluid from the right pleural cavity. Cytologic examination of the fluid shows many neutrophils, but no lymphocytes or RBCs. Which of the following mechanisms contributes most to the pleural fluid accumulation?
Exudation of fluid from venules and capillaries is a key component of the acute inflammatory process. Several mechanisms of increased vascular permeability have been proposed, including formation of interendothelial gaps by contraction of endothelium. This contraction can be caused by mediators such as histamine and leukotrienes. The vessels then become more "leaky," and the fluid leaves the intravascular space to accumulate extravascularly, forming effusions in body cavities or edema within tissues. Arteriolar vasoconstriction is a transient response to injury that helps diminish blood loss. Platelets adhere to damaged endothelium and promote hemostasis. Lymphatic obstruction results in the accumulation of protein-rich lymph and lymphocytes, producing a chylous effusion within a body cavity. After neutrophils reach the site of tissue injury outside of the vascular space, they release lysosomal enzymes that promote liquefaction.
Arteriolar vasoconstriction
Endothelial contraction
Inhibition of platelet adherence
Lymphatic obstruction
Inflammation & Repair