胸腔积液诊断与治疗

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1、DiagnosisandManagementofPleuralEffusions呼吸内科：徐作军2002，4，PUMCDiagnosisofPleuralEffusions3ChestRadiographPleuralFluidastheOnlyAbnormalityWithPrimaryDiseaseintheChestBilateralEffusionsDiseasesBelowtheDiaphragmInterstitialLungDiseasePulmonaryNodules41.PleuralFluidastheOnlyAbnormalityWithPrimaryDise

2、aseintheChestinfectionstuberculousandviralpleurisymalignancycancer,non-Hodgkin'slymphoma,andleukemiapulmonaryembolismdrug-inducedlungdiseasebenignasbestospleuraleffusion(BAPE)lymphaticabnormalitieschylothoraxandyellownailsyndromeuremicpleurisyconstrictivepericarditishypothyroidism52.BilateralE

3、ffusionstransudativeeffusionscongestiveheartfailurenephroticsyndromehypoalbuminemiaperitonealdialysisconstrictivepericarditisexudativeeffusionsmalignancy(extrapulmonicprimarycarcinomas,lymphoma)lupuspleuritisyellownailsyndrome63.DiseasesBelowtheDiaphragmtransudateshepatichydrothoraxnephroticsy

4、ndromeurinothoraxperitonealdialysisexudatespancreaticdiseasechylousascitessubphrenicabscesssplenicabscessorinfarction74.InterstitialLungDiseasecongestiveheartfailurerheumatoidarthritisasbestos-induceddisease(BAPEandasbestosis)lymphangiticcarcinomatosisLymphangioleiomyomatosisviralandmycoplasma

5、pneumoniasWaldenström'smacroglobulinemiasarcoidosisPneumocystiscariniipneumonia85.PulmonaryNodulesmostcommoncausesmetastaticcarcinomafromanonlungprimarytumor.LesscommoncausesWegener'sranulomatosisrheumatoidarthritissepticembolisarcoidosistularemia9ValueofPleuralFluidAnalysisInaprospectivestudy

6、of78patientswithnew-onsetpleuraleffusion,adefinitivediagnosiswasestablishedbytheinitialpleuralfluidanalysisin25%,apresumptivediagnosisin55%,withtheremaining20%havinganondiagnosticpleuralfluidanalysis.(excludingpossiblediagnoses)10ValueofPleuralFluidAnalysistheinitialpleuralfluidanalysisiseithe

7、rdefinitivelyorpresumptivelydiagnosticin80%ofpatientsandisvaluableclinicallyinabout90%ofcases.11Diagnosesthatcanbedefinitivelyempyema(pus)malignancytuberculousfungallupuspleuritis(lupuserythematosuscells)chylothorax(triglycerides>110mg/