Bloody pleural effusion

Introduction Bloody pleural effusion refers to the appearance of pleural effusion. More than 15% of the leachate and more than 40% of the exudate may be bloody. The red blood cell count is between 5000~100000/l, only 5000~10000/l of red blood cells can be used to make the pleural effusion red, and only 1ml of blood can make 500ml pleural effusion bloody. Red blood cells of gross pleural effusion >100000/l; bloody pleural effusions suggest trauma, malignant tumors or pulmonary embolism.

Cause

Hematocrit of hematologic pleural effusion >50% suggests hemothorax, more common in trauma, occasionally in spontaneous pneumothorax, aortic rupture, pleural metastases, pleural mesothelioma, blood disease, anthrax pleurisy, paragonimiasis, connective Tissue disease, tuberculous pleurisy, etc.

an examination

Related inspection

Chest water examination chest CT examination flow cytometry DNA analysis

Bloody pleural fluid examination

1, pancreatic pleural effusion: pancreatic pleural effusion about 40% blood, is caused by internal bleeding of pseudocyst, chronic alcoholic pancreatitis pleural effusion can also be bloody.

2, spontaneous pneumothorax: can cause blood vessels in the pleural adhesions caused by rupture of blood vessels.

3, tumor: malignant tumor with bloody pleural effusion is very common, lung cancer accounted for 4.2%, followed by breast cancer, lymphoma and other tumor pleural metastasis, pleural mesothelioma and other rare tumors were 0.5%.

4, tuberculous pleurisy: mostly exudative, a small amount of bloody pleural effusion. Lesions cause pleural inflammatory infiltration, resulting in increased vascular permeability, capillary hyperplasia, or tuberculous nodules directly causing vascular wall necrosis or vascular rupture.

5, trauma including aortic aneurysm rupture, esophageal rupture and other major bleeding, into the pleural cavity caused by bloody pleural effusion.

Differential diagnosis

Symptoms of bloody pleural effusion

Lung cancer pleural effusion: a common complication of patients with advanced lung cancer, may initially have little effect on quality of life, but as the disease progresses, it may cause symptoms such as difficulty breathing, cough, chest pain, and even worse than the lung cancer itself. . The symptoms of pleural effusion in lung cancer are: the swelling is serious, and the gas is thick and full, and the sputum is full, pink foamy sputum, sitting position, can not lie down, difficulty breathing, visible tri-concavity, patients are extremely painful, have a sense of death, The condition is critical, for the water in the chest, oppressing the lungs.

Malignant pleural effusion: refers to pleural metastasis of malignant tumors or pleural effusion caused by malignant tumors of the pleura. Infection, pain, and pericardial effusion of cancer are common complications of advanced cancer. The reduction of stress-induced atelectasis, restrictive ventilatory disorder, respiratory failure, and decreased blood volume caused by a large amount of pleural effusion seriously affects the respiratory cycle function and directly threatens the patient's life.

Exudative pleural effusion: 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 pleura by bacteria, viruses or fungi, leading to pleural effusion, or due to Pulmonary embolism, pancreatitis, connective tissue disease and other non-infectious inflammation caused by pleural effusion; the second type is neoplastic, such as cancer in the long pleural or metastatic invasion of the pleural effusion, can be seen 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.

Leaky (hydraulic) 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 occurs Leakage of the thoracic cavity; part of the disease that causes ascites, lymphatic drainage through the diaphragm of the diaphragm to cause pleural effusion. Clinical manifestations include cough, chest swelling, shortness of breath and primary disease. The body has a pleural fluid sign. The pleural effusion is non-transparent and relatively dense.

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. Clinical onset can be more urgent, but also slowly, with fever, chest pain, dry cough, fatigue, weight loss, loss of appetite, night sweats and other symptoms of tuberculosis. In the stage of dry pleurisy, chest pain is exacerbated by deep breathing and coughing, and pleural friction sounds are important signs. As the amount of pleural effusion increases, the patient gradually feels shortness of breath, and the pleural fluid is transparent or turbid, which is frosted glass. The relative density of pleural fluid is often above 1.016, the total number of white blood cells is 1~2X10/L, and the acute phase is neutral. Granulocyte-based, in the chronic phase, lymphocytes account for the majority, mesothelial cells are generally less than 1%; protein content is above 25g / L, sugar content is more than 2.8mmol / L; lysozyme and adenylate in pleural fluid Increased ammoniaase; tuberculosis smear and collection of bacteria are easy to find tuberculosis, about one-third of the culture method. For 1/2 cases of pleural biopsy, cheese or non-cheese granulomatous tissue can be seen. When the pleura has inflammatory adhesion, a wrapped pleural effusion can be formed.

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