文档介绍：Diagnosis of Pleural Effusions
呼吸内科：徐作军
2002. 9 PUMCH
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胸腔积液的发生机制
1 微循环静水压增高 充血性心力衰竭
2 微循环胶体渗透压 结节性多动脉炎
嗜酸性粒细胞性肺病
异物
渗出性胸腔积液的鉴别诊断
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乳糜胸
外伤
手术
结核
肿瘤
淋巴瘤
肝硬化
肾病综合征
丝虫病
先天性异常
渗出性胸腔积液的鉴别诊断
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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
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 granulomatosis
rheumatoid arthritis
septic emboli
sarcoidosis
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结核性与肿瘤性胸水的鉴别
<65ug/ml
<1
>65ug/ml
>1
溶菌酶活力
胸水／血液
LDH2增高
L