Sep 22, 2017 pleural effusion classification pleural effusions are traditionally classified as either exudates or transudates but they can also contain blood haemothorax or chyle chylothorax. Approaches to diagnosis of a difficult problem pleural effusions, seen in isolation or in association with a number of pulmonary and systemic diseases, are common problems in both the inpatient and outpatient setting. About 7 to 11% of patients with breast carcinoma develop a malignant pleural effusion during the course of the disease. Pleural effusion, which in pediatric patients most commonly results from an infection, is an abnormal collection of fluid in the pleural space. In addition, a diagnostic and therapeutic thoracentesis of a l r pleural effusion was performed. A pleural effusion is present when there is an excess quantity of fluid in the pleural space. Apr 30, 2018 pleural effusion, which in pediatric patients most commonly results from an infection, is an abnormal collection of fluid in the pleural space. Analysis of this fluid yields a large amount of information regarding the cause. The most important aspect of forming a differential diagnosis of pleural effusion is performing a thoracentesis and obtaining a sample of the pleural fluid. Dec 19, 2014 in addition, a diagnostic and therapeutic thoracentesis of a l r pleural effusion was performed. Guided sampling of small compressed lung pleural effusions. Leading causes of pleural effusion in the united states, according to analysis of patients subjected to thoracentesis. List of 126 disease causes of pleural effusion, patient stories, diagnostic guides, 9 drug side effect causes. The diagnosis of pleural effusion is very difficult, even though the patients.
Respiratory division, department of internal medicine, konyang university college of medicine, daejeon, korea pleural effusion is not a rare disease in korea. Pleural fluid studies were suggestive of a transudative process, though with some abnormal characteristics including lymphocyte predominance, as well as presence of signet cells. Differential diagnosis of pleural effusions jmaj 49910. Pdf a pleural effusion is an excessive accumulation of fluid in the pleural space. Pleural effusion develops because of excessive filtration or defective absorption of accumulated fluid. The mechanisms that cause pleural effusion all result in an. Large volume pleural effusions cause pressure on the adjacent lung resulting in collapse. Here is a case of recurrent massive left pleural effusions due to pancreaticopleural fistula ppf secondary to. The sensitivity and specificity of findings for pleural effusion are listed below.
Effusions can be asymptomatic, though large collections can cause shortness of breath, cough, and pain, as well as. A presumptive diagnosis should be established from the clinical and radiological findings. A diagnosis of pleural effusion may be sug gested by characteristic symptoms e. Pleural effusions are a common medical problem with more than 50 recognised causes including disease local to the pleura or underlying lung, systemic conditions, organ dysfunction and drugs. If pleural fluid is milky or there is clinical suspicion of chylothorax, add triglycerides. The pleura are thin membranes that line the lungs and the inside of the chest cavity and act to lubricate and facilitate breathing. Pleural effusion is common in various diseases and especially malignant effusions can have rapid onset symptoms such as dyspnea, chest pain, and coughing. Identifying the causes of pleural effusions by pleural fluid analysis is essential for proper treatments.
The pathological accumulation of serous fluids in the pleural, peritoneal and pericardial space occurs in a variety of conditions. New dimensional perspectives on differential diagnosis of pleural effusion. Diagnostic approach to pleural effusion in adults american. Pleural effusions are traditionally classified as either exudates or transudates but they can also contain blood haemothorax or chyle chylothorax.
The first step in differential diagnosis of pleural effusion is to determine whether the effusion is transudative or exudative. How pleural effusion and pleurisy are diagnosed through a variety of tests, such as xrays, ct scans, and ultrasounds. Differential diagnosis of pleural effusion decreased air entry on auscultation x consolidation x collapse x pleural thickening investigation of pleural effusion x bloods o including amylase, ldh, tft o rf and autoimmune profile x abg x cxr o sensitive to. This diagnosis was ruled out because the ph level in the pleural fluid was normal, the protein level was in the transudative range and results of. Some clinicians may perform mechanical pleurodesis during a diagnostic thoracoscopic procedure. The incidence of pleural effusion in the general population is hard to estimate. An unusual presentation of chronic pancreatitis vijaya kumar thyagaraj, pradeep rangappa, ipe jacob, karthik rao abstract chronic pancreatitis is a rare cause of recurrent pleural effusion. Pleural effusion is defined as an abnormal amount of pleural fluid accumulation in the pleural space and is the result of an imbalance between excessive pleural fluid formation and pleural fluid. Pleural effusion in adultsetiology, diagnosis, and treatment. Differential diagnosis issues of atypical pleural lesions. Clinical features in the diagnosis of pleural effusions and identifying etiology.
Pleural effusion classification emergency care institute. A chylothorax usually occurs because of disruption of the thoracic duct. Pleural disease remains a commonly encountered clinical problem for both. Pdf diagnostic tools of pleural effusion researchgate. Since patient management depends on right and timely diagnosis, biochemical analysis of extravascular body fluids is considered a valuable tool in the patient management process. One of the main ways that pleural effusion develops is after someone develops an asbestosrelated disease, such as mesothelioma or asbestosis. In normal conditions, the pleural space contains a limited amount of fluid. In exudative effusions accompanying inflammatory reactions in pneumonia are the. Normally, a small amount of fluid is present in the pleura. Your doctor will perform a physical exam, listen to your chest and discuss your symptoms. Pleural effusion has a wide differential diagnosis. The primary site could be assessed by cytological examination in 57. Diagnosis and treatment of pleural effusion sciencedirect. Cell count and differential total protein albumin 2 ldh.
The two primary items to consider on the differential diagnosis when you see this are chylothorax chyle or lymph fluid in the pleural space due to disruption of the thoracic duct and pseudochylothorax some chronic inflammatory process, such as rheumatoid pleurisy, leads to the deposition of cholesterol crystals in the pleural space. The main causes of pe were specified in previous guidelines. A delayed etiological diagnosis can be associated with markedly higher morbidity and mortality, e. Etiology, clinical manifestations, diagnosis, and evaluation of pleural effusions in the neonate view in chinese congenital pleural effusions, there are numerous causes for acquired pleural effusions. Cells in pleural fluid and their value in differential diagnosis. The differential diagnosis for unilateral pleural effusion includes parapneumonic effusion, neoplasms such as mesothelioma, primary lung cancer, pleural metastases, lymphoma, other entities such as cirrhosis, pancreatitis, and trauma. In this article, we provide an overview of the most common causes of pleural effusions likely to be encountered by the general practitioner, and a practical approach to the diagnosis and. Dec 11, 2015 pleural effusion is common in various diseases and especially malignant effusions can have rapid onset symptoms such as dyspnea, chest pain, and coughing. Diagnostic tools of pleural effusion pubmed central pmc. Its most common causes are congestive heart failure, cancer, pneumonia, and pulmonary embolism. Management of malignant pleural effusions american. Approach to diagnosis of pleural effusion page 1 of 3 department of clinical effectiveness v4 approved by the executive committee of the medical staff on 03262019 prior thoracentesis performed.
The pleural space lies between the lung and chest wall and normally contains a very thin layer of fluid, which serves as a coupling system. Unilateral pleural effusion differential diagnosis. However, the differential diagnosis of pleural effusion sometimes. The diagnosis and the treatment approaches require several pleural techniques and knowledge about concomitant disease. Approach to diagnosis of pleural effusion page 1 of 3. Estimated prevalence of pleural effusion is 320 cases per 100,000 people in industrialized countries, with a distribution of etiologies related to the prevalence of underlying diseases. Nov 23, 2010 this diagnosis was ruled out because the ph level in the pleural fluid was normal, the protein level was in the transudative range and results of the microbiologic analysis were normal.
Pleural thickening is a descriptive term given to describe any form of thickening involving either the parietal or visceral pleura. It can occur with both benign and malignant pleural disease. Pleural fluid studies were suggestive of a transudative process, though with some abnormal characteristics including lymphocyte predominance, as well. Differential diagnosis of an exudative lymphocytic pleural effusion.
Leading causes of pleural effusion in the united states. Using the ratio of pleural effusion to serum ana of. Jun 30, 2016 a pleural effusion is an abnormal collection of fluid in the pleural space resulting from excess fluid production or decreased absorption or both. Diagnostic tools of pleural effusion moon jun na, m. Chylothorax was high on the differential diagnosis because the effusion was milky offwhite to yellow, bilateral, and of sudden onset in a patient with lymphoma.
A systematic approach to the investigation and diagnosis of a. Lights criteria table 61 should be used to differentiate transudates and exudates by analyzing the levels of protein and lactate dehydrogenase ldh in the pleural fluid and serum. A pleural effusion is the accumulation of fluid in the pleural space, which normally contains no more than 15 ml of serous fluid. What is the process for differential diagnosis of pleural. This diagnosis was ruled out because the ph level in the pleural fluid was normal, the protein level was in the transudative range and results of the microbiologic analysis were normal. Pleural effusion is defined as the presence of excessive fluid in the pleural cavity resulting from transudation or exudation from the pleural surfaces. Pleural effusions can be diagnosed on the basis of clinical history, physical exam, and xray findings. As the differential diagnosis is wide, a systematic approach to. The precise pathophysiology of fluid accumulation varies according to underlying aetiologies. However, if the volume of the effusion is greater than the degree of collapse, there will be accompanying mediastinal shift. Pleural effusion summary radiology reference article. The most useful test in establishing the diagnosis of pleural effusion is pleural fluid cytology and pleural fluid cell count.
Remember, even if someone exhibits all of the aforementioned symptoms, the only true way to determine pleural effusion is through a doctors diagnosis. Diagnosis and treatment of pleural effusion arch bronconeumol. However, in the appropriate clinical setting and the absence of congestive heart failure or a pleural fluid ldh level close to the exudative range, determination of pleural fluid cytology. Pleural effusion in an asymptomatic patient chest journal. Malignancy of 58 patients with a primary diagnosis of malignancy, the most common types.
Following diagnostic thoracentesis, the cause of a pleural effusion is not evident in up to 25 percent. Definition pleural effusion is the accumulation of fluid in the pleural space. Evaluation of a patient with a pleural effusion requires a thorough clinical history and physical examination in conjunction with pertinent laboratory tests and imaging studies. Pleural effusion, sometimes referred to as water on the lungs, is the buildup of excess fluid between the layers of the pleura outside the lungs. Most patients with pleural effusion come to the doctor complaining of shortness of breath, which is caused by fluid accumulating in the chest and compressing the lung 2. In 43% of those patients, the effusion is the first symptom of metastatic disease. Treatment for pleural effusion is based on what caused the pleural effusion.
Differential diagnosis between benign and malignant pleural. Diagnosis and chest wall li f diaphragm pleural effusion liver sampling of loculated pleural effusions 2. A pleural effusion is an abnormal collection of fluid in the pleural space resulting from excess fluid production or decreased absorption or both. Differential diagnosis of pleural effusion decreased air entry on auscultation x consolidation x collapse x pleural thickening investigation of pleural effusion x bloods o including amylase, ldh, tft o rf and autoimmune profile x abg x cxr o sensitive to effusion 300ml some places say 200 x uss. Summary fluid in the pleural space is a common sequela of a wide range of diseases. Management of malignant pleural effusions american journal. In exudative effusions accompanying inflammatory reactions in pneumonia are the most common reasons. Pleural effusion causes, symptoms, types, and treatments. May 29, 2014 the first step in differential diagnosis of pleural effusion is to determine whether the effusion is transudative or exudative. Pleural effusions can develop as a result of over 50 different pleuropulmonary or systemic disorders. Accumulation of fluid between the pleural layers epidemiology of pleural effusion. Pleural effusion how is pleural effusion abbreviated. Relationship between pleural fluid appearance and causes. A case study of a patient with a pleural effusion is presented, as well as a brief description of the signs and symptoms, pathophysiology, and management of this disease process.
Cells in pleural fluid and their value in differential. It is reabsorbed mainly through the lymphatics of the parietal pleura. The diagnoses were confirmed by the combination of patient history. It is the most common manifestation of pleural disease, with etiologies ranging from cardiopulmonary disorders to symptomatic inflammatory or malignant diseases requiring urgent evaluation and trea.
Complicated parapneumonic effusion became part of the differential diagnosis given the colour and consistency of the pleural fluid, even though bilateral complicated parapneumonic effusions are rare. Diagnostic checklist, medical tests, doctor questions, and related signs or symptoms for pleural effusion. Pleural fluid originates in the pleural capillaries mainly those of the parietal pleura, lymphatics, intrathoracic blood vessels, the interstitial pulmonary space, and the peritoneal cavity. Recently, there has been interest in combining a fibrino. In paramalignant pleural effusions, pleural fluid cytology and pleural biopsy are negative because attempts at nonsurgical pleurodesis were partially successful or the effusion is significantly loculated.
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