文档介绍：胸腔积液诊断与治疗
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Diagnosis of Pleural Effusions
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Chest Radiograph
Pleural Fluidng a nondiagnostic pleural fluid analysis. (excluding possible diagnoses)
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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.
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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 > )
urinothorax (pleural fluid/serum creatinine > )
peritoneal dialysis (total protein < g/dl and glucose 200 to 400 mg/dL)
esophageal rupture (increased salivary amylase and pH < )
rheumatoid pleurisy (pleural fluid cytology)
extravascular migration of a central venous catheter (high glucose level or pleural fluid simulating the infusate).
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Exudates Vs Transudates(1)
exudative
pleural fluid protein/serum protein >
pleural fluid LDH/serum LDH >
pleural fluid LDH more than two-thirds normal upper limit for serum
any one of the above values makes it highly likely that the effusion is exudative.
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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 pneumonia 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.
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Pleural Fluid NucleatedCell Count(1)
rarely helpful in establishing a definitive diagnosis. however, it may provide useful information.
< 500/mL, the fluid is usually a transudate
> 50,000/mL, it usually represents pleural