呼吸内科胸腔积液诊断与治疗

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1、DiagnosisandManagementofPleuralEffusions呼吸内科：徐作军2002，4，PUMCDiagnosisofPleuralEffusionsChestRadiographPleuralFluidastheOnlyAbnormalityWithPrimaryDiseaseintheChestBilateralEffusionsDiseasesBelowtheDiaphragmInterstitialLungDiseasePulmonaryNodules31.PleuralFluidastheOnlyAbnormalityWithPrimaryDiseasein

2、theChestinfectionstuberculousandviralpleurisymalignancycancer,non-Hodgkin'slymphoma,andleukemiapulmonaryembolismdrug-inducedlungdiseasebenignasbestospleuraleffusion(BAPE)lymphaticabnormalitieschylothoraxandyellownailsyndromeuremicpleurisyconstrictivepericarditishypothyroidism42.BilateralEffusionst

3、ransudativeeffusionscongestiveheartfailurenephroticsyndromehypoalbuminemiaperitonealdialysisconstrictivepericarditisexudativeeffusionsmalignancy(extrapulmonicprimarycarcinomas,lymphoma)lupuspleuritisyellownailsyndrome53.DiseasesBelowtheDiaphragmtransudateshepatichydrothoraxnephroticsyndromeurinoth

4、oraxperitonealdialysisexudatespancreaticdiseasechylousascitessubphrenicabscesssplenicabscessorinfarction64.InterstitialLungDiseasecongestiveheartfailurerheumatoidarthritisasbestos-induceddisease(BAPEandasbestosis)lymphangiticcarcinomatosisLymphangioleiomyomatosisviralandmycoplasmapneumoniasWaldens

5、tröm'smacroglobulinemiasarcoidosisPneumocystiscariniipneumonia75.PulmonaryNodulesmostcommoncausesmetastaticcarcinomafromanonlungprimarytumor.LesscommoncausesWegener'sranulomatosisrheumatoidarthritissepticembolisarcoidosistularemia8ValueofPleuralFluidAnalysisInaprospectivestudyof78patientswithnew-o

6、nsetpleuraleffusion,adefinitivediagnosiswasestablishedbytheinitialpleuralfluidanalysisin25%,apresumptivediagnosisin55%,withtheremaining20%havinganondiagnosticpleuralfluidanalysis.(excludingpossiblediagnoses)9ValueofPleuralFluidAnalysistheinitialpleuralfluidanalysisiseitherdefinitivelyorpresumptive

7、lydiagnosticin80%ofpatientsandisvaluableclinicallyinabout90%ofcases.10Diagnosesthatcanbedefinitivelyempyema(pus)malignancytuberculousfungallupuspleuritis(lupuserythematosuscells)chylothorax(triglycerides>110mg/dL