1、Diagnosis of Pleural Effusions1Chest Radiograph Pleural Fluid as the Only Abnormality With Primary Disease in the Chest Bilateral Effusions Diseases Below the Diaphragm Interstitial Lung Disease Pulmonary Nodules21. Pleural Fluid as the Only Abnormality With Primary Disease in the Chest infections t
2、uberculous and viral pleurisy malignancy cancer, non-Hodgkins lymphoma, and leukemia pulmonary embolism drug-induced lung disease benign asbestos pleural effusion (BAPE) lymphatic abnormalities chylothorax and yellow nail syndrome uremic pleurisy constrictive pericarditis hypothyroidism32.Bilateral
3、Effusions transudative effusions congestive heart failure nephrotic syndrome hypoalbuminemia peritoneal dialysis constrictive pericarditis exudative effusions malignancy (extrapulmonic primary carcinomas, lymphoma) lupus pleuritis yellow nail syndrome43.Diseases Below the Diaphragm transudates hepat
4、ic hydrothorax nephrotic syndrome urinothorax peritoneal dialysis exudates pancreatic disease chylous ascites subphrenic abscess splenic abscess or infarction54.Interstitial Lung Disease congestive heart failure rheumatoid arthritis asbestos-induced disease (BAPE and asbestosis) lymphangitic carcino
5、matosis Lymphangioleiomyomatosis viral and mycoplasma pneumonias Waldenstrms macroglobulinemia sarcoidosis Pneumocystis carinii pneumonia65.Pulmonary Nodules most common causes metastatic carcinoma from a nonlung primary tumor. Less common causes Wegeners ranulomatosis rheumatoid arthritis septic em
6、boli sarcoidosis tularemia7Value of Pleural Fluid Analysis In a prospective study of 78 patients with new-onset pleural effusion, a definitive diagnosis was established by the initial pleural fluid analysis in 25% , a presumptive diagnosis in 55%, with the remaining 20% having a nondiagnostic pleura
7、l fluid analysis. (excluding possible diagnoses)8Value of Pleural Fluid Analysis the initial pleural fluid analysis is either definitively or presumptively diagnostic in 80% of patients and is valuable clinically in about 90% of cases.9Diagnoses that can be definitively empyema (pus) malignancy tube
8、rculous fungal lupus pleuritis (lupus erythematosus cells) chylothorax (triglycerides 110 mg/dL or presence of chylomicrons) hemothorax (pleural fluid/blood hematocrit 0.5) urinothorax (pleural fluid/serum creatinine 1.0) peritoneal dialysis (total protein 0.5 g/dl and glucose 200 to 400 mg/dL) esophageal rupture (increased salivary amylase and pH 7.00) rheumatoid pleurisy (pleural fluid cytology) extravascular migration of a central venous catheter (high glucose level or pleural fluid simulating the infusate). 10
