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1、DiagnosisandManagementofPleuralEffusions呼吸內(nèi)科：徐作軍2002，4，PUMCDiagnosisofPleuralEffusionsChestRadiographPleuralFluidastheOnlyAbnormalityWithPrimaryDiseaseintheChestBilateralEffusionsDiseasesBelowtheDiaphragmInterstitialLungDiseasePulmonaryNodules31.PleuralFluidastheOnlyAbnormalityWithPrimaryDiseasein
2、theChestinfectionstuberculousandviralpleurisymalignancycancer,non-Hodgkin'slymphoma,andleukemiapulmonaryembolismdrug-inducedlungdiseasebenignasbestospleuraleffusion(BAPE)lymphaticabnormalitieschylothoraxandyellownailsyndromeuremicpleurisyconstrictivepericarditishypothyroidism42.BilateralEffusionst
3、ransudativeeffusionscongestiveheartfailurenephroticsyndromehypoalbuminemiaperitonealdialysisconstrictivepericarditisexudativeeffusionsmalignancy(extrapulmonicprimarycarcinomas,lymphoma)lupuspleuritisyellownailsyndrome53.DiseasesBelowtheDiaphragmtransudateshepatichydrothoraxnephroticsyndromeurinoth
4、oraxperitonealdialysisexudatespancreaticdiseasechylousascitessubphrenicabscesssplenicabscessorinfarction64.InterstitialLungDiseasecongestiveheartfailurerheumatoidarthritisasbestos-induceddisease(BAPEandasbestosis)lymphangiticcarcinomatosisLymphangioleiomyomatosisviralandmycoplasmapneumoniasWaldens
5、tr?m'smacroglobulinemiasarcoidosisPneumocystiscariniipneumonia75.PulmonaryNodulesmostcommoncausesmetastaticcarcinomafromanonlungprimarytumor.LesscommoncausesWegener'sranulomatosisrheumatoidarthritissepticembolisarcoidosistularemia8ValueofPleuralFluidAnalysisInaprospectivestudyof78patientswithnew-o
6、nsetpleuraleffusion,adefinitivediagnosiswasestablishedbytheinitialpleuralfluidanalysisin25%,apresumptivediagnosisin55%,withtheremaining20%havinganondiagnosticpleuralfluidanalysis.(excludingpossiblediagnoses)9ValueofPleuralFluidAnalysistheinitialpleuralfluidanalysisiseitherdefinitivelyorpresumptive
7、lydiagnosticin80%ofpatientsandisvaluableclinicallyinabout90%ofcases.10Diagnosesthatcanbedefinitivelyempyema(pus)malignancytuberculousfungallupuspleuritis(lupuserythematosuscells)chylothorax(triglycerides>110mg/dL
