What Is Exudative Pleural Effusion?

Exudative causes are many and can be 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, resulting in pleural effusion, or due to pulmonary embolism, pancreatitis Pleural effusion caused by non-infectious inflammation such as connective tissue diseases; the second type is tumorous, such as cancer growing in the pleura or metastasis invading the pleura and causing effusion, which can be found in pleural mesothelioma, lung cancer, breast cancer, gastric cancer, etc. . The cause of leaky pleural effusion can be a systemic disease, such as hypoproteinemia, allergic disease, or a disease of an organ, such as congestive heart failure, liver cirrhosis, amoebic liver disease, ruptured thoracic duct Wait.

Exudative pleural effusion

The pleural cavity is a closed cavity composed of the parietal pleura and the visceral pleura. The inside of the pleura is negative pressure. Under normal circumstances, there is a small amount (about 1 ~ 30 ml) of fluid between the two layers of pleura for lubrication. , To reduce the friction between the two layers of pleura during the breathing process, which is conducive to the lungs contraction and contraction in the chest cavity. This fluid is produced from the parietal pleura and absorbed by the visceral pleura. It is in dynamic equilibrium with constant circulation, and the amount of fluid remains constant. When something happens that affects the pleura, whether the pleural pleura produces pleural effusion or the visceral pleura absorbs pleural effusion, the fluid in the thoracic cavity can increase, which is the so-called pleural effusion (effusion). Pleural effusion can be divided into exudative pleural effusion and leaky pleural effusion.

Affected area

chest

Related diseases

Pulmonary embolism, pleural effusion, liver cirrhosis, chronic pancreatitis, gastric cancer, pulmonary embolism and pulmonary infarction, chronic purulent pleurisy, congestive heart failure, malignant pleural effusion, elderly pulmonary embolism, pleural effusion, and pleurisy in children

Related symptoms

Septicemia congestion night sweat hypoalbuminemia toxemia blunt pain cachexia cyanosis fatigue lung infection pulmonary embolism ascites dry cough high fever chill dyspnea respiratory failure tuberculosis nodule cough sputum lymph node tuberculosis hemoptysis empyema abscess fatigue short breath granuloma chylothorax Excessive pleural fluid, lack of appetite, edema, wasting, heart failure, pleural friction, pleural thickening, pleural transfer, pleural effusion, chest pain, blood sugar, elevated blood pleural sclerosis

Affiliated Department

Surgical Infectious Diseases

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Pleural effusion flow cytometry DNA analysis

Exudative causes are many and can be 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, resulting in pleural effusion, or due to pulmonary embolism, pancreatitis Pleural effusion caused by non-infectious inflammation such as connective tissue diseases; the second type is neoplastic, such as cancer growing in the pleura or metastasis and invasion of the pleura causing effusion. . The cause of leaky pleural effusion can be a systemic disease, such as hypoproteinemia, allergic disease, or a disease of an organ, such as congestive heart failure, liver cirrhosis, amoebic liver disease, ruptured thoracic duct Wait.

I. Symptoms

The main symptoms are dyspnea, normal body temperature, and high heart sounds. During the chest wall percussion, horizontal dullness appeared on both sides, and the position of the dullness boundary changed with the patient's position. During auscultation, no alveolar sounds can be heard in the dullness area, and sometimes bronchial breathing sounds can be heard. Often accompanied by ascites, pericardial effusion, and subcutaneous edema.

2. Diagnosis

It is not difficult to confirm the diagnosis based on the systemic symptoms such as lack of heat waiting and the horizontal dullness of percussion. It must be distinguished from pleurisy. Pleuritis has hot weather, chest pain, cough, and pleural friction sounds. It usually occurs on one side. Pleutonitis is an exudate, which contains a large amount of fibrin and protein, and it is positive for Leviathan's response. The pleural effusion has no systemic symptoms, and the fluid in the thoracic cavity is leaky. It is relatively clear and thin, contains a small amount of fibrin and protein, and the Rivata reaction is negative.

Differential diagnosis of exudative pleural effusion:

1. Leaking (hydropleural) pleural effusion

When hypoproteinemia due to congestive heart failure, nephrotic syndrome, liver cirrhosis, etc. causes colloid osmotic pressure reduction and retention of water and steel to cause pleural effusion; superior vena cava obstruction for any reason, and pleural effusion occurs; some cause ascites Disease, pleural effusion caused by diaphragmatic lymphatic drainage into the chest cavity. Clinical manifestations include coughing, chest tightness, shortness of breath, and primary symptoms. Physical examination showed signs of pleural effusion. The pleural fluid is non-transparent, the relative density is 1.016, the protein content is below 30g / L, the ratio of pleural fluid and serum protein is less than 0.5; the lactate dehydrogenase of pleural fluid is less than 200U / L, and the ratio of lactate dehydrogenase of pleural fluid and serum is less than 0.6. Glucose content is similar to blood glucose; leukocytes in pleural fluid often work completely at 1X10 / L without pathogenic bacteria.

Tuberculous pleural effusion

Tuberculous pleurisy is a highly allergic reaction of the body to the protein components of tuberculosis bacteria, which is the consequence of the primary infection or secondary tuberculosis in children and adolescents involving the pleura. Clinical onset can be rapid or slow, with fever, chest pain, dry cough, and fatigue, weight loss, lack of appetite, night sweats and other symptoms of tuberculosis. In the dry pleurisy stage, chest pain increases with deep breathing and coughing, and pleural friction sounds are important signs. With the increase of the amount of pleural effusion, the patient gradually felt shortness of breath. The pleural effusion was grassy yellow transparent or cloudy, and frosty glass-like. Compared with the liberated effusion, the effusion was dark yellow mixed. The relative density of pleural effusion was often above 1.016. The total number is 1 ~ 2X10 / L. In the acute phase, neutrophils are predominant, and in the chronic phase, lymphocytes are the majority. Mesothelial cells are generally less than 1%. The protein content is above 25g / L, and the sugar content is more than 2.8mmol. / L; lysozyme and adenylate deaminase increased in pleural fluid; tuberculosis bacteria were easily found in pleural fluid smears and bacteria collection, and the culture method was about 1/3 positive. Pleural biopsy in 1/2 cases showed caseous or non- casey granulomatous tissue. When pleural inflammatory adhesions occur, a cystic effusion can form.

Third, malignant pleural effusion

Primary cancers are mainly lung and breast cancers, followed by lymphomas; a few are ovarian, gastric, and uterine tumors. The direct mechanism of tumor-induced pleural effusion is pleural metastasis, which increases vascular permeability; pleural lymphatic drainage is blocked. Mediastinal lymph nodes obstruct lymphatic return; thoracic duct obstruction; bronchial air occlusion reduces pleural cavity pressure; pericardial involvement (elevated hydrostatic pressure of the blood vessel produces leakage). Acoustic mechanisms include hypoproteinemia, obstructive pneumonia, pulmonary embolism, and Complications of radiation therapy. In addition to the many symptoms of the tumor itself, malignant pleural effusion often has shortness of breath, weight loss, chest pain, fatigue, and appetite. X-ray examination can show from small to full pleural effusion. When the volume of effusion is large, the shadows of lung and mediastinal lymph node tumors are often difficult to identify. At this time, CT examination can show the lesion. Malignant pleural fluid is often bloody, and it grows rapidly after pumping. The pleural fluid examination includes routine, cytology, enzymatic changes, carcinoembryonic antigen, etc. Finding cancer cells in pleural fluid is the basis for the diagnosis of malignant pleural effusion. Because the cancer is mostly located in the visceral pleura, and the parietal pleura may only be scattered, the positive rate of pleural biopsy is not high.

Fourth, empyema

Purulent pleural effusion is abbreviated as empyema. Common causes include lung infections (such as pneumonia, lung abscesses, bronchiectasis, tuberculosis, etc.) that spread to the pleural space, nearby infections (such as septal abscesses) or sepsis, and sepsis affects the pleura. Cavity can also be a complication of chest surgery, comorbidities of chest wall penetrating injury, improper treatment of tuberculous pleurisy can become tuberculous empyema, clinical manifestations are acute, high fever, chills, dyspnea, chest pain and weight loss, Cough, sputum and cyanosis, signs of pleural effusion. Pleural fluid is purulent, and anaerobic infections have an odor. The number of white blood cells in the pleural fluid is above 2X10 / L. It is mainly composed of weeping cells. The pleural fluid has bacterial growth. The culture should include aerobic and anaerobic. Even tuberculosis cultures; the pH and sugar levels of pleural fluid are reduced. X-ray examination showed pleural effusion or enveloping effusion. If there is a bronchial pleural fistula, see the fluid level.

Five, chylothorax

The thoracic duct is ruptured or blocked, causing chylothorax to form chylothorax in human pleural cavity. Common causes of tuberculosis or cancerous enlargement of lymph nodes, malignant lymphoma, filariasis, external or thoracic surgery, etc. Acute onset of clinical signs of rash and pleural effusion. The pleural fluid cannot be milky, and there is an oil film formed on the surface after standing. For example, ether can make the liquid clear and odorless. The specific gravity of the chyle is 1.012 ~ 1.025, and lymphocytes and red blood cells can be seen. High content of protein in pleural fluid, rich in fly fat and triglyceride, higher than plasma content, but cholesterol is lower than plasma content, cholesterol / triglyceride ratio is 1. Radionuclide lymphangiography can be used to confirm the presence of thoracic ducts and interthoracic fistulas.

Cholesteric pleurisy, sometimes tuberculous, rheumatoid arthritis or cancerous, old (more than one year) effusion can also be milky, in which the cholesterol content is high, and the active scale-like cholesterol formation can be seen with the naked eye. Contains fat globules or chylomicrons. Microscopic examination showed a large number of degenerative cells and cholesterol formation. Its relative density is above 1.018, the qualitative test of mucin is positive, its chyle-like appearance is caused by the degeneration and destruction of pus cells, and the real chyle is left after shaking with ether, the color is unchanged, and it is not translucent.

Six, pleural mesothelioma

It is a rare tumor that originates in pleural mesothelial tissue or subpleural mesothelial tissue. It is divided into two types: localized pleural mesothelioma and diffuse malignant mesothelioma. The latter is often associated with serous, serous, or bloody pleural effusion. liquid. There are many men with this disease. The age of onset is mostly 40 to 60 years old. The main manifestations are persistent chest dull pain and shortness of breath. The symptoms gradually worsen. The chest pain does not decrease due to the increase of effusion; fatigue, weight loss, hemoptysis, etc. Signs of pleural effusion and pleural thickening are becoming more and more significant in the later period. Frozen chest can be formed after invasion of the chest wall. Although there is obvious pleural thickening without intercostal or chest wall depression, there is local chest wall bulging. In the late stage, with the rapid development of bloody pleural effusion, cachexia and respiratory failure died suddenly. The pleural effusion was mostly bloody, and tumor cells found in pleural effusion could be confirmed. Pleural biopsy and thoracoscopic pull can be confirmed. X-ray manifestations are mainly pleural effusion or irregular pleural thickening, and the shadow of pleural thickening is sometimes hump-like. CT showed irregular and diffuse thickening of the pleura, which was nodular and had a wide range.

Connective tissue disease with pleurisy

Systemic lupus erythematosus and rheumatoid arthritis are common. Pleural effusion is unilateral or bilateral, mostly small to moderate. Often accompanied by other changes in the primary disease. Pleural fluid from systemic lupus erythematosus is grass yellow exudate, and a few are bloody or purulent. Increased protein content, positive antinuclear antibodies, increased immunoglobulins, reduced complement, lupus cells can be found; antituberculosis and antibiotic treatment are not effective, and corticosteroids are effective. Rheumatoid pleural fluid is a slightly yellow and green turbid fluid, and it can also be chylous or pseudochylous, with high protein content, often above 40g / L, fat and cholesterol levels also increased, and pleural lactate dehydrogenase concentration. It is higher than serum, and the pleural fluid volume does not increase with the increase of blood glucose; the body purulence in pleural fluid decreases, rheumatoid factor is positive, and specific rheumatoid arthritis cells are found in pleural fluid, which is a powerful diagnosis of this disease in accordance with. Pleural biopsy presents non-specific inflammation, which has little significance for diagnosis.

I. Symptoms

The main symptoms are dyspnea, normal body temperature, and high heart sounds. During the chest wall percussion, horizontal dullness appeared on both sides, and the position of the dullness boundary changed with the patient's position. During auscultation, no alveolar sounds can be heard in the dullness area, and sometimes bronchial breathing sounds can be heard. Often accompanied by ascites, pericardial effusion, and subcutaneous edema.

2. Diagnosis

It is not difficult to confirm the diagnosis based on the systemic symptoms such as lack of heat waiting and the horizontal dullness of percussion. It must be distinguished from pleurisy. Pleuritis has hot weather, chest pain, cough, and pleural friction sounds. It usually occurs on one side. Pleutonitis is an exudate, which contains a large amount of fibrin and protein, and it is positive for Leviathan's response. The pleural effusion has no systemic symptoms, and the fluid in the thoracic cavity is leaky. It is relatively clear and thin, contains a small amount of fibrin and protein, and the Rivata reaction is negative.

1. Actively prevent and cure primary diseases. Pleural effusion is part of a chest or systemic illness, so active prevention of primary disease is the key to preventing this disease.

2. Enhance physical fitness and improve disease resistance.

3. Pay attention to your life. The place of residence should be kept dry to avoid the invasion of wet evils, not to eat cold, not to overeating, and to maintain the normal function of the spleen and stomach. After getting sick, treat in time, avoid wind and cold, live carefully, and be emotional, so as to recover as soon as possible.