西安交通大学医学院呼吸系统疾病课件 PLEURAL EFFUSION.pptVIP

PLEURALEFFUSION Etiology Physiology Manifestation Imigiologic Findings Laboratory Findings Identify the characteristic of effusion Identify the characteristic of effusion Differential diagnosis Differential diagnosis Recognize causes History and PE TB malignant inflammatory heart failure Pleural fluid analysis Thoracentesis Lab Transudates / Exudates apperance cells proteins glucose 30g/L 0.5 30g/L 0.5 protein effusion／blood （＋） （－） Rivalta automatic no coagulation 1.018 1.018 proportion Unclear,blody yellow，clear appearance exudate transudate 500×106 /L 100 ×106 /L WBC 200IU/L 0.6 200IU/L 0.6 LDH effusion／blood exudate transudate Pleural biopsy Thoracoscopy An open pleural biopsy 500ug/ml 500ug/ml LDH 7.35 7.30 PH mesothelial cell lymphocyte cell large，aggresive Middle, little effusion （－） （＋） PPDtest Middle age, old youg age malignant TB ineffective effective CHAMOTHERAPY TUMOR TB granuloma BIOPSY 10-15ug /L 1 5ug/L 1 CEA effusion／blood 45u/L 45u/L ADA malignant TB １. Tuberculous pleuritis chemotherapy Thoracentesis Corticosteroid treatment 2. Malignant effusion Anti-tumor chemotherapy Drainage Support 3. Empyema Antibiotics Drainage Surgery Support * * Zhubo Definition Abnormal fluid accumulate in the pleura space Parietal pleura covers the surface of chest wall diaphragm mediastinum receives blood from systemic circulation contains sensory nerves Visceral pleura covers and adheres to surface of both lungs receives blood from pulmonary circulation contains no sensory nerves two pleural surfaces are separated by a potential space —a pleural space --exists 5-10ml of fluid mean pressure in space is – 0.5 cmH2O Major Forces Hydrostatic forces? Colloid oncotic pressure ? Permeability ? lymphatic flow ?