Differential diagnosis of pleural effusions jmaj 49910. The present study showed that measurement of orosomucoid in pleural fluid is valuable for diagnosis of malignant effusions. 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. Pleural effusion, the pathological accumulation of fluid in the pleural space, is very common. Investigation of a unilateral pleural effusion in adults. The aetiology of the pleural effusion determines other signs and symptoms. A pleural effusion describes an excess of fluid in the pleural cavity, usually resulting from an imbalance in the normal rate of pleural fluid production or absorption, or both. Pleural effusion current medical diagnosis and treatment. The resultant homeostasis leaves 515 ml of fluid in the normal pleural space. Thoracic ultrasonography is more sensitive than chest radiography in detecting pleural effusion and also provides additional diagnostic information as to the cause of the effusion exudative, empyema, malignant pleural effusion. Pdf clinical and laboratory parameters in the differential.
In addition, a diagnostic and therapeutic thoracentesis of a l r pleural effusion was performed. Pleurisy and pleural effusion in differential diagnosis br med j 1943. Pleural effusion differential diagnoses medscape reference. Utility of hyaluronic acid in pleural fluid for differential. The differential diagnosis between tuberculous effusion and other effusions usually requires a good diagnostic test. Lateral decubitus with affected side down requires 5075 cc of fluid for visualization.
Tuberculous pleural effusion is synonymous with the term tuberculous pleurisy. Jun 21, 2017 a pleural effusion is a buildup of fluid in the space between the lungs and chest cavity, called the pleural space. Efficacy of pleural needle biopsy and pleural fluid cytopathology in the diagnosis of malignant neoplasm involving the pleura. Two patients with eosinophilic effusion are described in detail, and several others of. The differential diagnosis of pleural effusions request pdf. Pleural effusion in adultsetiology, diagnosis, and treatment ncbi. Pleural lesions that require differential diagnosis with mediastinal diseases, especially tumors cap. The tests most commonly used to diagnose and evaluate pleural effusion include.
Differential diagnosis issues of atypical pleural lesions. However, the accuracy of these features in the differential diagnosis of diffuse pleural disease has not been assessed before. Pleural effusion symptoms, diagnosis and treatment bmj. If the patient has an exudative effusion, attempts should be made to define the etiology.
Ct in differential diagnosis of benign and malignant pleural disease. Pleural effusions are abnormal accumulations of fluid within the pleural space. Diagnostic approach to pleural effusion in adults american family. In general, pleural effusions can be divided into transudates caused by fluid leaking from blood vessels and exudates where fluid leaks from inflammation of the pleura and lung. Pleural effusion develops because of excessive filtration or defective absorption of accumulated fluid. Patients predominantly present with breathlessness, but cough and pleuritic chest pain can be a feature. 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 tuberculosis and respiratory. They may result from a variety of pathological processes which overwhelm the pleuras ability to reabsorb fluid.
Additionally, betas microglobulin, whichwas found increased in some malignant pleural ef. Feb 07, 2020 a pleural effusion is due to the manifestations of another illness. Diagnostic approach to pleural effusion in adults american. Evaluation of the patient with pleural effusion is challenging, because the differential diagnosis is broad and includes both benign and lifethreatening conditions. A pleural effusion is due to the manifestations of another illness in general, pleural effusions can be divided into transudates caused by fluid leaking from blood vessels and exudates where fluid leaks from inflammation of the pleura and lung. The presence of infected pleural fluid is a medical. Routine investigations of pleural fluid, sputum and pleural biopsy still remain the best method of diagnosis jpma. Differential diagnosis of pleural effusions since the condition often resolves with treatment of the underlying cause or with diuretics, thoracentesis is typically not required unless there is ventilatory impairment or signi.
It can be estimated, on the basis of registry data from the united states, that some 400 000 to 500. The use of certain pleural fluid tests such as leukocyte count and differential, glucose, ph and, when indicated, pleural fluid amylase determinations, helps to narrow the differential diagnosis of an exudative pleural effusion. Pleural effusions may be classified by differential diagnosis table 925 or by. Pleural effusion differential diagnoses medscape emedicine. Differential diagnosis of pleural effusion by lactate.
Therefore new biological markers may increase diagnostic yield and provide better. The aim is to establish a diagnosis swiftly while minimising unnecessary invasive investigations and facilitating treatment, avoiding the need for repeated therapeutic aspirations when possible. Treatment for pleural effusion is based on what caused the pleural effusion. Chest radiography standard posteroanterior and lateral chest radiography remains the most important technique for the initial diagnosis of pleural effu. Pleural effusions describe fluid between the two layer of tissue pleura that cover the lung and the lining of the chest wall. The aim of this study was to investigate the role of ptx3 in the differential diagnosis of pleural effusions. Pdf pleural effusion is defined as an abnormal amount of pleural fluid accumulation in the pleural. Diagnostic performance of adenosine deaminase activity in pleural fluid. The differential diagnosis of pleural fluids is wide and may indicate the presence of pleural, pulmonary or extrapulmonary disease. Clinical and laboratory parameters in the differential. Furthermore, tus is essential during thoracentesis and chest tube drainage as it increases. However, no studies evaluating the efficacy of ultrasound elastography for diagnosing mpe are available. Your doctor will perform a physical exam, listen to your chest and discuss your symptoms.
Pdf pleural effusion is defined as an abnormal amount of pleural fluid accumulation in the pleural space and is the result of an imbalance between. A delayed etiological diagnosis can be associated with markedly higher morbidity and mortality, e. To determine the diagnostic value of pleural fluid lactate dehydrogenase ldh isoenzyme analysis in the differential diagnosis of pleural fluid. Dec 28, 2017 pleural effusion pleff, mostly caused by volume overload, congestive heart failure, and pleuropulmonary infection, is a common condition in critical care patients. 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. In the absence of trauma, an additional indicator of pleural effusion associated with malignancy is a red blood cell count 50,000ul. A pleural effusion is an abnormal accumulation of fluid in the pleural space.
Pleural effusion is defined as a fluid collection between the pleural. Mar 12, 2018 the differential diagnosis of pleural effusion can be daunting, but an organized approach that begins with the patients history and focuses on identification of conditions that require urgent evaluation can guide appropriate care. Pleural effusion in adultsetiology, diagnosis, and. Up to 25 percent of pleural effusions can remain undiagnosed with an unclear pathogenesis. The diagnosis, which is often elusive, should be prompt so that therapy can be quickly initiated. Pleural effusion pleff, mostly caused by volume overload, congestive heart failure, and pleuropulmonary infection, is a common condition in critical care patients. In 5060% of cases, classification of the effusion leads to a presumptive diagnosis. Pleural effusion acute medicine wiley online library.
Ct in differential diagnosis of diffuse pleural disease. Introduction pleural effusion caused by number of diseases, poses a common diagnostic problem 1. Analysis of pleural effusions in acute pulmonary embolism. Thoracentesis a needle is inserted between the ribs to remove a biopsy, or sample of fluid pleural fluid analysis an examination of the fluid removed from the pleura space cleveland clinic is a. Moreover, the invasive and noninvasive tests required to make an etiological diagnosis may not be readily available in a primary care setting, and patients may require symptomatic. Large volume pleural effusions cause pressure on the adjacent lung resulting in collapse. Cytology cytologic examination for appropriate stains eg, mycobacteria, actinomyces, nocardia can be sent when organisms requiring special. A diagnosis of pleural effusion may be sug gested by characteristic symptoms e. Tuberculous pleural effusion is the second most common form of extrapulmonary tuberculosis after lymphatic involvement and is the most common cause of pleural effusion in areas where tuberculosis is endemic 15. However, if the volume of the effusion is greater than the degree of collapse, there will be accompanying mediastinal shift. Therefore new biological markers may increase diagnostic yield and provide better understanding of pathogenesis of pleural effusion.
The first step of differential diagnosis or determination of pathogenesis for pleural fluid is to determine whether. Evaluation of the patient with pleural effusion cmaj. Considerations in the differential diagnosis of transudative pleural effusion include the following. Ultrasound elastography, a relatively new technique, has been used to differentiate malignant disease from benign disease by evaluating tissue stiffness. When untreated, chylothorax is associated with high morbidity and mortality.
The differential diagnosis of pleural fluid acidosis, a feature typically associated with a complicated parapneumonic effusion or empyema is discussed below. Absorption of pleural fluid occurs through parietal pleural lymphatics. The etiology of the pleural effusion determines other signs and symptoms. The diagnostic role of pentraxin3 in the differential. Feline pleural disease diagnosis and treatment introduction. Introduction traditional thoracic ultrasound tus is often the initial tool used to help diagnose malignant pleural effusion mpe. A pleural effusion is a buildup of fluid in the space between the lungs and chest cavity, called the pleural space. The evaluation of a pleural effusion begins with imaging studies to assess the amount of pleural fluid, its distribution and accessibility, and possible associated intrathoracic abnormalities. Treatment of pleural effusion must first address the immediate presence of fluid and then later the cause of the fluid accumulation. Pleural fluid studies were suggestive of a transudative process, though with some abnormal characteristics including lymphocyte predominance, as well as presence of signet cells. The most common causes of pleural effusion are congestive heart failure, pneumonia, malignancies. Get a printable copy pdf file of the complete article 1. Pneumonia, cancer, tuberculosis, and pulmonary embolism account for most exudative effusions.
The first page of the pdf of this article appears above. In a retro spective study, we found that measurement of cea couldbe helpfulinthisrespect. Articles pleurisy and pleural effusion in differential diagnosis. An exudative effusion is diagnosed if the patient meets lights criteria. The differential diagnosis of pleural effusion often requires invasive procedures. The diagnostic role of pentraxin3 in the differential diagnosis of pleural effusions. Pleural effusions insights in chest diseases imedpub. Pleural effusion, which in pediatric patients most commonly results from an infection, is an abnormal collection of fluid in the pleural space. Differential diagnosis for a repiratory disesae outbreak. Thoracic ultrasound tus helps clinicians not only to visualize pleural effusion, but also to distinguish between the different types.
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. Posteroanterior chest xray will show an effusion of 200 ml of fluid. One purpose of this paper is to report that the cause of such an effusion may be a fungus infection. When we attempt to identify the cause of the pleural effusion, most patients undergo various diagnostic procedures. Two patients with eosinophilic effusion are described in detail, and several others of which we have knowledge are mentioned briefly. The value of cells in the pleural fluid in the differential diagnosis. Thus, 71 percent of malignant effusions with negative cytology were diagnosed by an increased value 100 mg100 ml of orosomucoid. Pleurisy and pleural effusion in differential diagnosis the bmj. Other tests help ful for diagnosis include helical computed tomography and thoracoscopy. Pleural effusion is an abnormal collection of fluid in pleural space resulting from excess production or disruptions of homeostatic forces that regulate the flow of fluid in and out of the area. The advance metabolomics approach is mentioned for the usefulness for.
Pleural effusion in which a high proportion of the cells are eosinophils is not a widely recognized phenomenon. Parapneumonic pleural effusions are exudates that accompany bacterial pneumonias. Thoracentesis a needle is inserted between the ribs to remove a biopsy, or sample of fluid pleural fluid analysis an examination of the fluid removed from the pleura space cleveland clinic is a nonprofit academic medical center. Pleurisy and pleural effusion in differential diagnosis. Clinical features in the diagnosis of pleural effusions and identifying etiology.
As the differential diagnosis for a unilateral pleural effusion is wide, a systematic approach to investigation is necessary. An ultrasound, chest computed tomography scan, or lateral decubitus study indicates whether the fluid is freeflowing or loculated, and whether or not septations are present. A definitive diagnosis is made through cytology or identification of causative organism in 25% of cases. Chylothorax refers to the presence of chyle in the pleural space. Ischemia modified albumin in the differential diagnosis of. The differential diagnosis of pleural effusions ncbi nih. Pleural effusions are common, with an estimated 11. The modern diagnosis and management of pleural effusions.
Role of pleural fluid cytology, adenosine deaminase level, and pleural biopsy in diagnosis. He also has aching chest pain on the right side tha. Pleural effusion has a wide differential diagnosis. Cytologic examination of the effusions was also performed.
The precise pathophysiology of fluid accumulation varies according to underlying aetiologies. Diagnosis of exudative effusions in 25% of cases, pleural effusion result from malignant disease. The orosomucoid assay was the most helpful in identifying malignant effusions. Clinical and laboratory parameters in the differential diagnosis of pleural effusion secondary to tuberculosis or cancer. Many pleural fluid tests are useful in the differential diagnosis of exudative effusions. Its most common causes are congestive heart failure, cancer, pneumonia, and pulmonary. May 24, 2019 pleural effusion has a wide differential diagnosis. 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.
A 70yearold man with an 80packyear history of smoking and a history of congestive heart failure presents with increasing shortness of breath. Patients and methods eightyseven consecutive patients with pleural effusion caused by congestive heart failure 33, infection 33, and malignancy 21 comprised a derivation set of patients. Pleural effusion in adultsetiology, diagnosis, and treatment. This prospective study enrolled all consecutive patients from two tertiary hospitals who underwent diagnostic. Dec 19, 2014 clinical features in the diagnosis of pleural effusions and identifying etiology. An ultrasound, chest computed tomography scan, or lateral decubitus study indicates whether the fluid is freeflowing. Specific differential diagnosis problems generated by pleural nodules, where the main concern is establishing if the complementary ct scan is needed. Its most common causes are congestive heart failure, cancer, pneumonia, and pulmonary embolism. The differential diagnosis of exudate poses a more difficult challenge for clinicians. Carcinoembryonic antigen cea, orosomucoid beta2 microglobulin, and alpha fetoprotein were quantified in the pleural fluid and serum of 58 hospitalized consecutive patients in order to differentiate malignant from nonmalignant effusions. Pleural effusion summary radiology reference article.
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