胸腔积液和脓胸（Pleural effusion and empyema）.docVIP

胸腔积液和脓胸（Pleural effusion and empyema） Twelfth unit pleural effusion, empyema Section 1 pleural effusion Pleural effusion is a common medical problem. Lung, pleural and extrapulmonary diseases can cause it. I. etiology (1) elevated hydrostatic pressure in pleural capillaries: congestive heart failure, constrictive pericarditis, etc. pleural effusion. (two) increased pleural permeability: pleural inflammation (pulmonary tuberculosis, pneumonia), pleural tumor, pleural effusion. (three) the decrease of colloid osmotic pressure in pleural capillaries: hypoproteinemia, cirrhosis, nephrotic syndrome and so on. (four) obstruction of lymphatic drainage of parietal pleura: carcinomatous lymphatic obstruction and so on. (five) injury: aortic aneurysm rupture, rupture of the esophagus, hemothorax, empyema etc.. Two 、 clinical manifestation (I) symptoms 1, breathing difficulties: the most common symptoms, when a large number of fluid accumulation, breathing difficulties more obvious. 2, chest pain. 3, cough, expectoration. 4, other: fever, heart palpitations and so on. (two) signs 1, a small amount of fluid can be no obvious signs. 2, with the accumulation of fluid increases Visual examination: the affected side is full of chest; Palpation: the trachea shifts to the uninjured side, and the tactile speech weakens; Percuss: ipsilateral partial dullness; To reduce or disappear the breath sounds. Three 、 diagnosis and differential diagnosis (I) diagnosis 1, determine whether or not pleural effusion (1) clinical manifestations (symptoms and signs). (2) imaging examination Chest radiograph: the most basic method of examination. CT examination: high sensitivity, helps to find the cause of pleural effusion. MRI: better for liquids than for CT. B ultrasound: 50ml or so pleural effusion can be displayed. 2 distinguish between leakage fluid and exudate (1) conventional methods (2) light method Check the exudate LDH pleural effusion / serum 0.6 and pleural effusion were higher than normal