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
其他诊断因素
- pleuritic chest pain
- cough
- absent or decreased breath sounds
- decreased or absent tactile fremitus
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
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
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
新兴检查
- tumor markers in pleural fluid
治疗流程
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)
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
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.
鉴别诊断
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- Elevated hemidiaphragm
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