@胸腔积液诊断与治疗.ppt

Diagnosis and Management of Pleural Effusions Diagnosis of Pleural Effusions 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 1. 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 hypothyroidism 2.Bilateral Effusions transudative effusions congestive heart failure nephrotic syndrome hypoalbuminemia peritoneal dialysis constrictive pericarditis exudative effusions malignancy (extrapulmonic primary carcinomas, lymphoma) lupus pleuritis yellow nail syndrome 3.Diseases Below the Diaphragm transudates hepatic hydrothorax nephrotic syndrome urinothorax peritoneal dialysis exudates pancreatic disease chylous ascites subphrenic abscess splenic abscess or infarction 4.Interstitial Lung Disease congestive heart failure rheumatoid arthritis asbestos-induced disease (BAPE and asbestosis) lymphangitic carcinomatosis Lymphangioleiomyomatosis viral and mycoplasma pneumonias Waldenstr?ms macroglobulinemia sarcoidosis Pneumocystis carinii pneumonia 5.Pulmonary Nodules most common causes metastatic carcinoma from a nonlung primary tumor. Less common causes Wegeners ranulomatosis rheumatoid arthritis septic emboli sarcoidosis tularemia Value 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 pleural fluid analysis. (excluding possible diagnoses) Value of Pleural Fluid Analysis the initial pleural fluid analysis is e