文档介绍：Diagnosis and Management of Pleural Effusions
呼吸内科：徐作军
2002，4，PUMC
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Diagnosis of Pleural Effusions
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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
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1. Pleural Fluid as the Only Abnormality With Primary Disease in the Chest
infections
tuberculous and viral pleurisy
malignancy
cancer, non-Hodgkin's 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
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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
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Below the Diaphragm
transudates
hepatic hydrothorax
nephrotic syndrome
urinothorax
peritoneal dialysis
exudates
pancreatic disease
chylous ascites
subphrenic abscess
splenic abscess or infarction
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Lung Disease
congestive heart failure
rheumatoid arthritis
asbestos-induced disease (BAPE and asbestosis)
lymphangitic carcinomatosis
Lymphangioleiomyomatosis
viral and mycoplasma pneumonias
Waldenström's macroglobulinemia
sarcoidosis
Pneumocystis carinii pneumonia
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Nodules
most common causes
metastatic carcinoma from a nonlung primary tumor.
Less common causes
Wegener's ranulomatosis
rheumatoid arthritis
septic emboli
sarcoidosis
tularemia
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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% havi