pleuraleffusions胸膜滲出中山大學內(nèi)科學-資料下載頁
2025-02-21 13:25本頁面
【正文】 n of the pleural fluid is positive for anisms。 3. The pleural fluid glucose level is less than 40 mg/100 ml。 4. The pleural fluid PH is below . 34 Dr. Canmao xie Tuberculous Pleural Effusions At the onset of tuberculous pleuritis, most patients also have pleuritic chest pain. Tuberculosis toxic syndrome– dry cough, low grade fever, night sweat and losing body weight. With a positive tuberculin skin test (PPD) and significantly high ADA level in pleural effusion. The fluid is invariably an exudate. Frequently the pleural fluid protein is over 50 g/L and this finding is very suggestive of tuberculous pleuritis. The differential white cell count reveals more than 80% lymphocytes. Pleural biopsy has its greatest utility in establishing the diagnosis of tuberculous pleuritis. The demonstration of granuloma in the parietal pleura is highly suggestive of tuberculous pleuritis. Caseous necrosis or acidfast bacilli need to be demonstrated. 35 Dr. Canmao xie Tuberculous Pleurisy 36 Dr. Canmao xie Management of Tuberculous Pleural Effusions ? Antituberculosis chemotherapy: Adequate therapy for tuberculous pleuritis is a 9month course of isoniazid and rifampin daily. ? The performance of the therapeutic thoracentesis is highly remended as soon as the diagnosis is confirmed. ? The administration of corticosteroids will rapidly relieve the patient39。s symptoms of pleuritic chest pain, malaise, and fever and does not seem to lead to dissemination of the tuberculosis. Markedly symptomatic patients should be started on prednisone 40 mg/day and then gradually tapered over several weeks. 37 Dr. Canmao xie Malignant Pleural Effusions ? Malignant disease involving the pleura is the second leading cause of exudative pleural effusions. ? Frequent seen in patients with age45 Ys, manifestated by chest pain, hemoptysis and emaciate. ? Bloody and massive pleural effusion is the typical clinical picture. Significantly high LDH and CEA level(20ug/L) in pleural fluid. ? Pleural fluid cytology, needle biopsy, thoracoscopy or open pleural biopsy has its greatest utility in establishing the diagnosis of malignant pleural effusions. 38 Dr. Canmao xie Management of malignant pleural effusion ? Treatment of the primary tumor. ? Therapeutic thoracentesis with or without a chest tube. ? Chemical pleurodesis ?Mechanisms of pleurodesis not clearly understood. In general, an inflammation producing agent is injected into the pleural space. Resulting inflammatory reaction leads to pleural fibrosis such that the visceral and parietal pleurae fuse. ?Talc, Tetracycline Derivatives (Tetracycline, Doxycycline), Antineoplastic drugs (Bleomycin, Mitoxantrone, Nitrogen mustard) are the choice of pleurodesis agents. 39 Dr. Canmao xie Diagnostic and Treatment Workup of a Pleural Effusion Whether it is a pleural effusion or not ？ Is the effusion a transudate or an exudate? What is the disease responsible for its production? Treatment for etiology and relieving symptoms 40 Dr. Canmao xie Thank you for attention! 41 Dr. Canmao xi
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