|
 |
|
|||||||
|
|||||||||
Copyright © ERS Journals Ltd 1997
Original Articles |
Diagnostic principles in pleural disease
When a patient with an undiagnosed pleural effusion is evaluated, the first question to answer is whether the patient has a transudate or an exudate. This is best done using Light's criteria, but these criteria occasionally misidentify a transudate as an exudate. If the patient's pleural fluid meets exudative criteria, but the patient appears clinically to have a transudative effusion, then the serum-pleural fluid albumin gradient should be measured. If this is greater than 1.2 g-dL-1, the patient probably does have a transudative effusion. If the patient has an exudative pleural effusion, additional tests are indicated to determine the aetiology of the effusion. The gross appearance and the odour of the pleural fluid should be noted and samples of all exudates should be sent for bacterial cultures. Laboratory tests that are useful in the differential diagnosis of exudative pleural effusions include: differential white cell count of the pleural fluid; cytology of the pleural fluid; and levels of adenosine deaminase, glucose, amylase and lactate dehydrogenase in the pleural fluid. If pleural tuberculosis is suspected, a needle biopsy of the pleura is indicated. Thoracoscopy is very efficient at diagnosing malignant pleural effusion and tuberculosis pleuritis, but rarely establishes any other diagnosis.
This article has been cited by other articles:
|
|
 |
|
  R. Krenke, J. Nasilowski, P. Korczynski, K. Gorska, T. Przybylowski, R. Chazan, and R. W. Light Incidence and aetiology of eosinophilic pleural effusion Eur. Respir. J., November 1, 2009; 34(5): 1111 - 1117. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Rodriguez-Panadero, J. P. Janssen, and P. Astoul Thoracoscopy: general overview and place in the diagnosis and management of pleural effusion. Eur. Respir. J., August 1, 2006; 28(2): 409 - 422. [Full Text] [PDF]
|
|
|
|
 |
|
 A Medford and N Maskell Pleural effusion Postgrad. Med. J., November 1, 2005; 81(961): 702 - 710. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Woenckhaus, U. Grepmeier, B. Werner, C. Schulz, F. Rockmann, P. J. Wild, G. Rockelein, H. Blaszyk, M. Schuierer, F. Hofstaedter, et al. Microsatellite Analysis of Pleural Supernatants Could Increase Sensitivity of Pleural Fluid Cytology J. Mol. Diagn., October 1, 2005; 7(4): 517 - 524. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Uthaman, N. Behbehani, A. Abal, J. Madda, and S. Khan Percutaneous Multiple-Site Parietal Pleural Biopsy: Description and Evaluation of a New and Safe Technique Chest, May 1, 2004; 125(5): 1776 - 1782. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N A Maskell and R J A Butland BTS guidelines for the investigation of a unilateral pleural effusion in adults Thorax, May 1, 2003; 58(90002): ii8 - 17. [Full Text]
|
|
|
|
|
|
S. A. North, H.-J. Au, S. B. Halls, L. Tkachuk, and J. R. Mackey A Randomized, Phase III, Double-Blind, Placebo-Controlled Trial of Intrapleural Instillation of Methylprednisolone Acetate in the Management of Malignant Pleural Effusion Chest, March 1, 2003; 123(3): 822 - 827. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Zocchi Physiology and pathophysiology of pleural fluid turnover Eur. Respir. J., December 1, 2002; 20(6): 1545 - 1558. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Mitrouska and D. Bouros The Trans-Exudative Pleural Effusion Chest, November 1, 2002; 122(5): 1503 - 1505. [Full Text] [PDF]
|
|
|
|
|
|
F.-X. Blanc, K. Atassi, J. Bignon, and B. Housset Diagnostic Value of Medical Thoracoscopy in Pleural Disease* : A 6-Year Retrospective Study Chest, May 1, 2002; 121(5): 1677 - 1683. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. J. Burgess, H. Reuter, J. J. F. Taljaard, and A. F. Doubell Role of Biochemical Tests in the Diagnosis of Large Pericardial Effusions Chest, February 1, 2002; 121(2): 495 - 499. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Fartoukh, E. Azoulay, R. Galliot, J.-R. Le Gall, F. Baud, S. Chevret, and B. Schlemmer Clinically Documented Pleural Effusions in Medical ICU Patients : How Useful Is Routine Thoracentesis? Chest, January 1, 2002; 121(1): 178 - 184. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Odeh, E. Sabo, I. Srugo, and A. Oliven Tumour necrosis factor alpha in the diagnostic assessment of pleural effusion QJM, December 1, 2000; 93(12): 819 - 824. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Riantawan, P. Chaowalit, M. Wongsangiem, and P. Rojanaraweewong Diagnostic Value of Pleural Fluid Adenosine Deaminase in Tuberculous Pleuritis With Reference to HIV Coinfection and a Bayesian Analysis Chest, July 1, 1999; 116(1): 97 - 103. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Valdes, D. Alvarez, E. San Jose, P. Penela, J. M. Valle, J. M. Garcia-Pazos, J. Suarez, and A. Pose Tuberculous Pleurisy: A Study of 254 Patients Arch Intern Med, October 12, 1998; 158(18): 2017 - 2021. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O Eickelberg, C. Sommerfeld, C Wyser, M Tamm, F Reichenberger, P. Bardin, M Soler, M Roth, and A. Perruchoud MMP and TIMP expression pattern in pleural effusions of different origins Am. J. Respir. Crit. Care Med., December 1, 1997; 156(6): 1987 - 1992. [Abstract] [Full Text]
|
|
|
|
|
|
R. M. SEGURA, J. ALEGRE, E. VARELA, R. MARTI, J. M. SURIÑACH, J. JUFRESA, L. ARMADANS, C. PASCUAL, and T. F. de SEVILLA Interleukin-8 and Markers of Neutrophil Degranulation in Pleural Effusions Am. J. Respir. Crit. Care Med., May 1, 1997; 157(5): 1565 - 1572. [Abstract] [Full Text]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |