小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 近期肺炎
- 全身性症状
- 发热和寒战
- 叩诊浊音
- 呼吸音和语音共振减弱
- 出现脓毒症体征
其他诊断因素
- 亚急性起病
- 排痰性咳嗽
- 胸膜炎性胸痛
- 呼吸困难
危险因素
- 肺炎
- 胸膜腔内医源性操作
- 胸部外伤
- 免疫功能受损状态
- 合并肺部疾病
- 男性
- 年龄较大或较小
诊断性检查
首要检查
- 血液培养
- C 反应蛋白 (CRP)
- 白细胞计数
- 胸部 X 线检查
- 胸腔穿刺术：胸水外观
- 胸腔穿刺术：胸水气味
- 胸腔穿刺术：胸水 pH 值
- 胸腔穿刺术：胸水总蛋白质浓度
- 胸腔穿刺术：胸水 LDH 水平
- 胸腔穿刺术：胸水葡萄糖浓度
- 胸腔穿刺术：胸水白细胞分类
- 胸腔穿刺术：胸水的涂片镜检、培养和药敏试验
- 胸部超声
需考虑的检查
- 造影剂胸部增强 CT
- 胸部 MRI
- PET 扫描
- 胸腔积液聚合酶链反应 (PCR)
治疗流程
成人（培养结果待定）
儿童（培养结果待定）
成人（培养结果已出）
儿童（培养结果已出）
撰稿人
作者
Athanasia D. Pataka, MRCP
Assistant Professor of Respiratory Medicine
Respiratory Failure Unit
G Papanikolaou Hospital Thessaloniki
Aristotle University of Thessaloniki
Thessaloniki
Greece
利益声明
ADP declares that she has no competing interests.
Renata L. Riha, BMedSc, MD, FRACP, FRCPE
Respiratory Consultant
Royal Infirmary
Edinburgh
Scotland
UK
利益声明
RLR declares that she has no competing interests.
Najib M. Rahman, DPhil MSc FRCP
Professor of Respiratory Medicine
Director, Oxford Respiratory Trials Unit
Nuffield Department of Medicine, University of Oxford
Oxford
UK
利益声明
NMR declares that Roche UK supplied clinical trial supplies and funding for the MIST2 trial that he conducted.
鸣谢
Dr Athanasia D. Pataka, Dr Renata L. Riha, and Dr Najib M. Rahman would like to gratefully acknowledge Dr Eleanor K. Mishra, a previous contributor to this topic. EKM declares that she has no competing interests.
同行评议者
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.
Nicholas Maskell, MD
Senior Lecturer and Consultant Physician
North Bristol Lung Centre
Southmead Hospital
Bristol
UK
利益声明
NM declares that he has no competing interests.
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.
鉴别诊断
- 肺炎
- 单纯性肺炎旁胸腔积液
- 肺脓肿
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