最近审阅: 29 十月 2020
最近更新: 13 二月 2019

小结

定义

病史和体格检查

关键诊断因素

  • 存在的危险因素
  • 呼吸困难
  • 叩诊浊音

其他诊断因素

  • 胸膜炎性胸痛
  • 咳嗽
  • 呼吸音减弱
  • 触觉语颤减低或消失

危险因素

  • 充血性心力衰竭
  • 肺炎
  • 恶性肿瘤
  • 肺栓塞
  • 近期冠状动脉旁路移植术
  • 近期心肌梗死
  • 职业性肺疾病
  • 类风湿关节炎
  • 系统性红斑狼疮
  • 肾功能不全
  • 药物引发的胸腔积液
  • 乳糜胸

诊断性检查

首要检查

  • 后前位和侧位胸部 X 线检查
  • 胸腔超声
  • 胸腔积液和血清中的 LDH 及蛋白质水平
  • 胸腔积液的红细胞计数
  • 胸腔积液的白细胞计数与分类
  • 胸水细胞学检查
  • 胸水培养
  • 胸水 pH 值
  • 胸腔积液的糖浓度检测
  • 胸腔积液的胆固醇检测
  • 蛋白梯度
  • 全血细胞计数(FBC)
  • C 反应蛋白 (CRP)
  • 血液培养
  • 痰革兰氏染色和培养
  • 胸腔积液内的 N 末端前体脑钠肽 (NT-pro-BNP)
更多 首要检查

需考虑的检查

  • 胸部 CT 平扫
  • 胸部核磁共振检查
  • 螺旋 CT 扫描
  • 胸腔积液的淀粉酶检测
  • 胸腔积液的腺苷脱氨酶 (ADA) 检测
  • 胸腔积液的脂质分析
  • 胸腔镜
  • 支气管镜检查
  • 胸膜活检
更多 需考虑的检查

新兴检查

  • 胸腔积液的肿瘤标志物检测
  • 胸腔积液干扰素 γ 水平检测以及胸腔积液的实时 PCR 检测
  • 髓系细胞表达的可溶性触发因子
  • 降钙素原
更多 新兴检查

治疗流程

撰稿人

Consultant Respiratory Physician

Chelsea and Westminster Hospital NHS Foundation Trust

London

UK

利益声明

OO declares that he has no competing interests.

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 of references cited in this topic. CR, PWI, AMC, AD, RJD, and PMG declare that they have no competing interests.

同行评议者展开全部内容

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.

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.

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.

内容使用需遵循免责声明