Exudative pleural effusion

Introduction The thoracic cavity is a closed cavity composed of the parietal pleura and the visceral pleura. The inside is a negative pressure. Under normal circumstances, there is a very small amount (about 1~30 ml) of liquid between the two pleuras. To reduce the friction between the two layers of pleura during respiratory activities, which helps the lungs to contract in the chest cavity. This fluid is produced from the parietal pleura, absorbed by the visceral pleura, constantly circulating in a dynamic equilibrium, and the amount of fluid remains constant. When a certain condition affects the pleura, whether the pleural effusion of the parietal pleura or the rate of absorption of the pleural effusion by the visceral pleura changes, the fluid in the thoracic cavity is increased, which is called pleural effusion (effusion). Hydrothorax can be divided into exudative pleural effusion and leaking pleural effusion.

Cause

There are many causes of exudative, which are summarized into two categories: one is caused by inflammatory lesions, such as infectious inflammation caused by infection of the pleura by bacteria, viruses or fungi, leading to pleural effusion, or due to pulmonary embolism, pancreatitis Non-infectious inflammation such as connective tissue disease causes pleural effusion; the second type is neoplastic, such as cancer in the pleural effusion or metastasis invading the pleural effusion, which can be found in pleural mesothelioma, lung cancer, breast cancer, stomach cancer, etc. . The cause of leakage pleural effusion can be systemic diseases, such as hypoproteinemia, allergic diseases, or diseases of certain organs, such as congestive heart failure, cirrhosis, hepatic amebiasis, thoracic duct rupture. Wait.

an examination

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Pleural effusion check flow cell DNA analysis Raman sign

First, the symptoms

The main symptoms are difficulty breathing, normal body temperature, and high heart sound. The chest wall was percussed with horizontal dullness, and the position of the voiced boundary changed with the patient's position. At the time of auscultation, the alveolar sound is not heard in the voiced area, and bronchial breath sounds are sometimes heard. Often accompanied by ascites, pericardial hydrops and subcutaneous edema.

Second, diagnosis

According to the lack of heat and other systemic symptoms and the level of voiced percussion, it is not difficult to diagnose. But it must be distinguished from pleurisy. Pleuritis has heat, chest pain, cough, pleural friction sound, one side occurs, pleurisy is exudate, contains a lot of fibrin and protein, and the Levastat reaction is positive. The pleural effusion has no systemic symptoms, and the liquid in the thoracic cavity is leaking liquid. It is relatively clarified and thin, contains a small amount of fibrin and protein, and the Levastat reaction is negative.

Differential diagnosis

First, leakage (hydraulic chest) pleural effusion

When congestive heart failure, nephrotic syndrome, cirrhosis and other forms of hypoproteinemia lead to decreased colloid osmotic pressure and water retention caused by pleural effusion; any cause of superior vena cava obstruction, leakage of pleural effusion; part of the ascites Disease, transthoracic lymphatic drainage into the chest cavity causes pleural effusion.

Second, tuberculous pleural effusion

Tuberculous pleurisy is a highly allergic reaction to the protein component of tuberculosis, which is the result of primary infection in children and adolescents or secondary tuberculosis involving the chest membrane.

Third, malignant pleural effusion

The primary cancer is mainly lung cancer and breast cancer, followed by lymphoma; a few are ovarian cancer, stomach cancer, uterine tumor, etc. The direct mechanism of pleural effusion caused by tumor is pleural metastasis, which increases vascular permeability; pleural lymphatic drainage is blocked. Mediastinal lymph nodes obstruct lymphatic drainage; thoracic duct obstruction; branch gas obstruction reduces pleural pressure; pericardial involvement (increased vascular hydrostatic pressure, resulting in leakage.) The phonological mechanism is hypoproteinemia, obstructive pneumonia, pulmonary embolism and Radiation therapy complications.

Fourth, empyema

Purulent pleural effusion referred to as empyema, common disease due to pulmonary infection (such as pneumonia, lung abscess, bronchiectasis, tuberculosis, etc.) spread to the pleural cavity, adjacent infection (such as septum abscess) or sepsis, sepsis involving the pleura The cavity can also be a complication of thoracic surgery, a complication of chest wall penetrating injury, and improper treatment of tuberculous pleurisy can become tuberculous empyema.

Five, chylothorax

The rupture or obstruction of the thoracic duct causes the chyle to overflow into the pleural cavity to form the chylothorax. Common causes are mediastinal lymph node tuberculosis or cancerous enlargement, malignant lymphoma, filarial granuloma, external or thoracic surgery.

Pleural mesothelioma

It is a rare tumor originating from pleural mesothelial tissue or subpleural mesothelial tissue. It is divided into two types: localized pleural mesothelioma and diffuse malignant mesothelioma. The latter is often accompanied by serous, serous or blood pleural effusion. liquid. There are more males with this disease, and the age of onset is more than 40-60 years old.

Seven, connective tissue disease complicated by pleurisy

Systemic lupus erythematosus, rheumatoid arthritis and more common. The pleural effusion is unilateral or bilateral, mostly small to medium. Often accompanied by other changes in the primary disease. The pleural fluid of systemic lupus erythematosus is a grass yellow exudate, and a few are bloody or purulent. The protein content is increased, the anti-nuclear antibody can be positive, the immunoglobulin is increased, the complement is reduced, and the lupus cells can be found; the anti-tuberculosis and antibiotic treatment are ineffective, and the corticosteroid is effective.

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