胸膜渗出诊疗讲述.ppt

Diagnosis and Management of Pleural Effusions Cause of pleural effusions a mirror of systemic disease. Disease affecting virtually any organ can result in a pleural effusion Cause of pleural effusions chest disease organs below the diaphragm splenic infarction systemic diseases systemic lupus erythematosus diseases of the lymphatic system yellow nail syndrome Pathophysiology of Pleural Fluid Accumulation increased hydrostatic pressure congestive heart failure decreased oncotic pressure hypoalbuminemia decreased pleural pressure atelectasis increased endothelial permeability pneumonia Pathophysiology of Pleural Fluid Accumulation decreased lymphatic drainage malignancy movement from the peritoneal space hepatic hydrothorax thoracic duct rupture chylothorax iatrogenic extravascular migration of central venous catheter Symptoms at Presentation Awareness of the symptoms and signs of specific diseases in patients who present with pleural effusions may be helpful in narrowing the differential diagnosis of the exudative effusion. postcardiac injury syndrome, lupus pleuritis, and malignant mesothelioma usually are symptomatic at presentation with a pleural effusion. Symptoms at Presentation about 75% of patients with carcinomatous malignant effusions, 50% of patients with rheumatoid pleurisy, less than half of the patients with benign asbestos pleural effusion (BAPE) Chest Radiograph Pleural Fluid as the Only Abnormality With Primary Disease in the Chest Bilateral Effusions Diseases Below the Diaphragm Interstitial Lung Disease Pulmonary Nodules Pleural Fluid as the Only Abnormality With Primary Disease in the Chest infections tuberculous 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 and hypothyroidism Bilateral Effusions