What is the process of differential diagnosis of pleural discharge?
Pleural effusion occurs when the fluid collects in the area between the lungs and the pleura, the membrane located between the lungs and the chest cavity. This accumulation of fluids can be caused by a number of different processes of the disease. Pleural discharge detection, either a physical test or an X -ray image requires an exploration of the cause of the discharge. The most important aspect of forming a differential diagnosis of pleural discharge is the design of thoracentesis and obtaining a sample of pleural fluid. The analysis of this fluid provides a large amount of information about the cause.
Pleural effusion can be diagnosed on the basis of clinical history, physical tests and X -ray findings. Patients may report symptoms such as shortness of breath or pain in deep inspiration. In a physical test, doctors can identify the area of reduced resonance of drums or areas of reduced brass sounds over pleural discharge. Findings on the chest X -ray may include dulling coconophrenic angles created by a meeting of ribs anddiaphragm and area of opacity in the lung fields.
After identifying its presence, the next step in the differential diagnosis of the pleural disintegration of the procedure called the toracenis. The importance of the chest cannot be minimized; In fact, doctors learn to do it as soon as possible in cases of pleural discharge. With this procedure, a sterile needle is inserted between the ribs to obtain a fluid sample. The procedure can be performed using an ultrasonic machine or can be performed by maneuvers of a physical test to locate the discharge.
Pleural fluid obtained by tooracentesis is sent to the laboratory for a number of tests. The first step in the diagnosis is to determine whether fluid is exudate or transudate. Light criterion is traditionally used to distinguish exudates from transudates. Pleural effusion is considered to be exudates if the ratio between the protein of the pleural fluid to the concentration of proteinIn serum greater than 0.5. In addition, if the pleural fluid is lactate dehydrogenase (LDH) greater than two -thirds of the upper limit of normal, or if the ratio of pleural fluid LDH to LDH serum is greater than 0.6, pleural discharge is considered exudatory.
know whether the pleural effusion is exudative or transudative is important for diagnosis. Transrantive pleural excavation is caused by imbalances in the pressures in the chest cavity. Examples of the causes of transudative pleural effusion include congestive heart failure, nephrotic syndrome and hypoalbuminemia. In contrast, exudative pleural effusion is more often caused by infectious or inflammatory conditions. Examples of causes of exudative pleural effusion include pneumonia, tuberculosis, cancer and connective tissue disorders.
There are other ways that pleural fluid can be useful in differential diagnosis of pleural discharge. Fluid is often cultivated to see if any bac can be grownTerial species. For cytogenetic analysis, it may be sent to see if there is any evidence of malignancy. High levels of amylase in liquid may indicate pancreatitis, esophagus or cancer rupture. Very low glucose levels could indicate tuberculosis, lupus or rheumatoid arthritis.