胸腔积液诊断与治疗（52页）.ppt

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1、DiagnosisandManagementofPleuralEffusionsDiagnosisofPleuralEffusionsChestRadiographPleuralFluidastheOnlyAbnormalityWithPrimaryDiseaseintheChestBilateralEffusionsDiseasesBelowtheDiaphragmInterstitialLungDiseasePulmonaryNodules31.PleuralFluidastheOnlyAbnormalityWithPri

2、maryDiseaseintheChestinfectionstuberculousandviralpleurisymalignancycancer,non-Hodgkin'slymphoma,andleukemiapulmonaryembolismdrug-inducedlungdiseasebenignasbestospleuraleffusion(BAPE)lymphaticabnormalitieschylothoraxandyellownailsyndromeuremicpleurisyconstrictiveper

3、icarditishypothyroidism42.BilateralEffusionstransudativeeffusionscongestiveheartfailurenephroticsyndromehypoalbuminemiaperitonealdialysisconstrictivepericarditisexudativeeffusionsmalignancy(extrapulmonicprimarycarcinomas,lymphoma)lupuspleuritisyellownailsyndrome53.D

4、iseasesBelowtheDiaphragmtransudateshepatichydrothoraxnephroticsyndromeurinothoraxperitonealdialysisexudatespancreaticdiseasechylousascitessubphrenicabscesssplenicabscessorinfarction64.InterstitialLungDiseasecongestiveheartfailurerheumatoidarthritisasbestos-induceddi

5、sease(BAPEandasbestosis)lymphangiticcarcinomatosisLymphangioleiomyomatosisviralandmycoplasmapneumoniasWaldenström'smacroglobulinemiasarcoidosisPneumocystiscariniipneumonia75.PulmonaryNodulesmostcommoncausesmetastaticcarcinomafromanonlungprimarytumor.Lesscommoncauses

6、Wegener'sranulomatosisrheumatoidarthritissepticembolisarcoidosistularemia8ValueofPleuralFluidAnalysisInaprospectivestudyof78patientswithnew-onsetpleuraleffusion,adefinitivediagnosiswasestablishedbytheinitialpleuralfluidanalysisin25%,apresumptivediagnosisin55%,withth

7、eremaining20%havinganondiagnosticpleuralfluidanalysis.(excludingpossiblediagnoses)9ValueofPleuralFluidAnalysistheinitialpleuralfluidanalysisiseitherdefinitivelyorpresumptivelydiagnosticin80%ofpatientsandisvaluableclinicallyinabout90%ofcases.10Diagnosesthatcanbedefin

8、itivelyempyema(pus)malignancytuberculousfungallupuspleuritis(lupuserythematosuscells)chylothorax(triglycerides>110mg/dLorpresenceofchylomi