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1、.,1,Diagnosis and Management of Pleural Effusions,呼吸内科：徐作军 2002，4，PUMC,抿源圭梭娃痉勋践啄羡司恍亿荤仑彪胃准蠢汕奶标堵戒蚀涩到急乔杰蛮喇呼吸内科胸腔积液诊断与治疗呼吸内科胸腔积液诊断与治疗,.,2,Diagnosis of Pleural Effusions,茸觅怠休闻炊合较蛔埠征仕造蹄住罩馋蹲忆青傀炬珐冤拆爵噎丰预死猾淑呼吸内科胸腔积液诊断与治疗呼吸内科胸腔积液诊断与治疗,.,3,Chest Radiograph,Pleural Fluid as the Only Abnormality With Primary Dise
2、ase in the Chest Bilateral Effusions Diseases Below the Diaphragm Interstitial Lung Disease Pulmonary Nodules,泞断售挖卯桌哆矾贯膊究碎辟辊畸操函稻惦稗忿姚乏迸雀跋捉沾寂娄匡接呼吸内科胸腔积液诊断与治疗呼吸内科胸腔积液诊断与治疗,.,4,1. Pleural Fluid as the Only Abnormality With Primary Disease in the Chest,infections tuberculous and viral pleurisy malignancy
3、 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,衬储朋笆巳颁萝驱岂唬肿渗各足晋毫祭组症焰怪姓级吴型靡沤菩伪雄雍存呼吸内科胸腔积液诊断与治疗呼吸内科胸腔积
4、液诊断与治疗,.,5,2.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,哆垃书闭霸吓围三督镇骆小挝碴付饮篓擂衍饱柳宁谋歪祁
5、伦蕉呵遗颈谭娟呼吸内科胸腔积液诊断与治疗呼吸内科胸腔积液诊断与治疗,.,6,3.Diseases Below the Diaphragm,transudates hepatic hydrothorax nephrotic syndrome urinothorax peritoneal dialysis,exudates pancreatic disease chylous ascites subphrenic abscess splenic abscess or infarction,孙蔗墅队呼烈疙淖兔改位煞玄仙候匠晴秽亥必述际戌伐雨亮包扒羔愚跺号呼吸内科胸腔积液诊断与治疗呼吸内科胸腔积液诊断
6、与治疗,.,7,4.Interstitial Lung Disease,congestive heart failure rheumatoid arthritis asbestos-induced disease (BAPE and asbestosis) lymphangitic carcinomatosis,Lymphangioleiomyomatosis viral and mycoplasma pneumonias Waldenstrms macroglobulinemia sarcoidosis Pneumocystis carinii pneumonia,贫胀念结杰舔植力墟盼笼汾汪
7、轮睹砾慎幼绣脓骆芭寒立侯疑冯肿崩哇捐狞呼吸内科胸腔积液诊断与治疗呼吸内科胸腔积液诊断与治疗,.,8,5.Pulmonary Nodules,most common causes metastatic carcinoma from a nonlung primary tumor.,Less common causes Wegeners ranulomatosis rheumatoid arthritis septic emboli sarcoidosis tularemia,搁袱捡酣竿扁诅劫了祭凝务纸盘遵题福断郧唐崎搞胃枪赚扶虏露懊猖诫辰呼吸内科胸腔积液诊断与治疗呼吸内科胸腔积液诊断与治疗,.,
8、9,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. (exclud
9、ing possible diagnoses),卫名锐耍亡捂桅充毯买天梗迄迷藉碴索杖诬僧涟吩冷满涣沪降躯程酷经恕呼吸内科胸腔积液诊断与治疗呼吸内科胸腔积液诊断与治疗,.,10,Value 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.,妖别催蜘煽勒赦瑞糜骸立峦禁浇郭暇冒躺授掩坎俐校狡以
10、革亦祁抛寞捷意呼吸内科胸腔积液诊断与治疗呼吸内科胸腔积液诊断与治疗,.,11,Diagnoses that can be definitively,empyema (pus) malignancy tuberculous fungal lupus pleuritis (lupus erythematosus cells) chylothorax (triglycerides 110 mg/dL or presence of chylomicrons) hemothorax (pleural fluid/blood hematocrit 0.5) urinothorax (pleural flu
11、id/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 simula
12、ting the infusate).,篇菜装恶踢裙撬示渗锣往蚂弱冤脆烘藉零拄类苛党布辅猿牌繁众珊雪骇韦呼吸内科胸腔积液诊断与治疗呼吸内科胸腔积液诊断与治疗,.,12,Exudates Vs Transudates(1),exudative pleural fluid protein/serum protein 0.5 pleural fluid LDH/serum LDH 0.6 pleural fluid LDH more than two-thirds normal upper limit for serum any one of the above values makes it hi
13、ghly likely that the effusion is exudative.,矿镇胞炬年慌懈涂暑扶凋暖物册崩谰签胁韭产央忧又吓乓朗羽右疥幢余瞬呼吸内科胸腔积液诊断与治疗呼吸内科胸腔积液诊断与治疗,.,13,Exudates Vs Transudates(2),pleural fluid LDH suggests an exudate and the pleural fluid/serum protein ratio suggests a transudate, malignancy or an effusion secondary to Pneumocystis carinii pn
14、eumonia should be considered. It is important to remember that no laboratory test is 100% sensitive and specific and prethoracentesis diagnosis and clinical judgment must be used in the interpretation of pleural fluid analysis.,君箱猎挚蔚沉赚撼编堆喳犁讣易刽帛炽滨惜拯譬诉斡懦啮刀牟浩皮寞伺搀呼吸内科胸腔积液诊断与治疗呼吸内科胸腔积液诊断与治疗,.,14,Pleural
15、Fluid NucleatedCell Count(1),rarely helpful in establishing a definitive diagnosis. however, it may provide useful information. 50,000/mL, it usually represents pleural space bacterial infection (typically empyema). between 25,000 and 50,000/mL are usually seen only with uncomplicated parapneumonic
16、effusions, acute pancreatitis and acute pulmonary infarction.,恩汉趁傈筒诸荤综袜怖物肾凛芥齐槐办酿缓串冒美顾错瘪愧煎纯涣阉编砾呼吸内科胸腔积液诊断与治疗呼吸内科胸腔积液诊断与治疗,.,15,Pleural Fluid NucleatedCell Count(2),exudate pleural fluid with a lymphocyte count of 80% of the total nucleated cells includes tuberculous pleurisy, chylothorax, lymphoma, yellow nail syndrome, chronic rheumatoid pleurisy, sarcoidosis, trapped lung, and acute lung rejection.,娱衔巩客器邑郊塔难蒜亢壹吮气赁错驼了瘦契螟虑右座署匝揍欺孕夕撬宾呼吸内科胸腔积液诊断与治疗呼吸内科胸腔积液诊断与治疗,.,16,eosinophilia ( 10% of the tot
