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Pleural effusion

最后审阅: 20 Aug 2025
最后更新: 09 Sep 2025

小结

定义

病史和体格检查

关键诊断因素

  • congestive heart failure, pneumonia, and malignancy
  • dyspnea
  • dullness to percussion
完整详情

其他诊断因素

  • pleuritic chest pain
  • cough
  • absent or decreased breath sounds
  • decreased or absent tactile fremitus
完整详情

危险因素

  • congestive heart failure
  • pneumonia
  • malignancy
  • pulmonary embolism
  • recent coronary artery bypass graft surgery
  • recent myocardial infarction
  • occupational lung disease
  • rheumatoid arthritis
  • systemic lupus erythematosus
  • renal failure
  • drug-induced pleural effusion
  • recent ovarian stimulation treatment
  • chylothorax
完整详情

诊断性检查

首要检查

  • posteroanterior and lateral chest x-ray
  • pleural ultrasound
  • LDH and protein in pleural fluid and serum
  • red blood cell count in pleural fluid
  • WBC count and differential of pleural fluid
  • cytology of pleural fluid
  • culture of pleural fluid
  • pH of pleural fluid
  • glucose in pleural fluid
  • protein gradient
  • CBC
  • CRP
  • blood culture
  • sputum Gram stain and culture
  • N-terminal pro-brain natriuretic peptide (NT-pro-BNP) in pleural fluid
完整详情

需考虑的检查

  • pleural fluid cholesterol level
  • thoracic CT scan
  • thoracic MRI
  • helical CT scan
  • amylase in pleural fluid
  • adenosine deaminase (ADA) level in pleural fluid
  • lipid analysis of pleural fluid
  • antinuclear antibody (ANA) analysis of pleural fluid
  • thoracoscopy
  • bronchoscopy
  • pleural biopsy
  • interferon-gamma in pleural fluid and real-time polymerase chain reaction of pleural fluid
  • procalcitonin
完整详情

新兴检查

  • tumor markers in pleural fluid

治疗流程

急症处理

congestive heart failure

infective

malignant: poor performance status or limited lifespan (Karnofsky score ≤30% or ECOG score of ≥2)

malignant: good performance status (Karnofsky score >30% or ECOG score of 0 or 1)

持续性治疗

persistent empyema despite chest tube

recurrent symptomatic malignant effusions

recurrent benign effusion

撰稿人

作者

Orhan Orhan, MBBS, BSc, FRCP, SFHEA, MSc

Consultant Respiratory Physician

Chelsea and Westminster Hospital NHS Foundation Trust

London

UK

利益声明

OO declares that he has no competing interests.

鸣谢

Dr Orhan Orhan would like to gratefully acknowledge Drs Clare Ross, Philip W. Ind, Anob M. Chakrabarti, Richard Light, Amber Degryse, Rachel J. Davies, and Peter M. George, previous contributors to this topic.

利益声明

RL received speaking fees provided by Cardinal Health; owned stock in Denver Biomaterials until it was purchased by Cardinal Health; received fees for consulting from Denver Biomaterials; and is an author of references cited in this topic. CR, PWI, AMC, AD, RJD, and PMG declare that they have no competing interests.

同行评议者

Y.C. Gary Lee, MBChB, PhD, FCCP, FRACP

Consultant Chest Physician and Senior Lecturer

Oxford Centre for Respiratory Medicine and University of Oxford Churchill Hospital

Oxford

UK

利益声明

YCGL declares that he has no competing interests.

Clare Hooper, MBBS

Pleural Research Registrar

North Bristol Lung Centre

Southmead Hospital

Westbury on Trym

Bristol

UK

利益声明

CH declares that she has no competing interests.

Steven Sahn, MD

Professor of Medicine and Director

Division of Pulmonary/Critical Care/Allergy/Sleep Medicine

Medical University of South Carolina

Charleston

SC

利益声明

SS declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Roberts ME, Rahman NM, Maskell NA, et al. British Thoracic Society Guideline for pleural disease. Thorax. 2023 Jul;78(suppl 3):s1-42.全文

Rahman NM, Maskell NA, West A, et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med. 2011 Aug 11;365(6):518-26. 摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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