胸腔积液诊断与治疗.ppt

Malignant Pleural Effusions 第三十页，共五十二页，2022年，8月28日 Malignant Pleural Effusions(1) Dyspnea is the most common presenting symptom, followed by cough. Of patients presenting with a massive pleural effusion, approximately two thirds will have malignancy. When there is contralateral mediastinal shift with a large or massive effusion, the effusion is usually caused by a carcinoma that is not a lung primary. 第三十一页，共五十二页，2022年，8月28日 Malignant Pleural Effusions(2) When there is a large or complete opacification of the hemithorax without contralateral shift or ipsilateral shift, lung cancer is the most likely cause, usually squamous cell carcinoma involving the mainstem bronchus; other diagnoses : a fixed mediastinum from malignant lymph nodes, malignant mesothelioma, and parenchymal tumor invasion. 第三十二页，共五十二页，2022年，8月28日 Malignant Pleural Effusions(3) Bilateral effusions with a normal heart size malignancy (50%) The other 50% transudative effusions: hepatic hydrothorax, nephrotic syndrome, severe hypoalbuminemia, and constrictive pericarditis, exudates :lupus pleuritis, esophageal rupture, and tuberculous pleurisy (rare except in HIV-positive patients). 第三十三页，共五十二页，2022年，8月28日 Malignant Pleural Effusions(4) Lung and breast : the most common causes (about 65% of cases); Ovarian and gastric cancer: the two next most common carcinomas ( 6 to 10% of cases). Lymphoma : (about 10% of cases) Less than 10% of malignant effusions have an unknown primary tumor at the time of diagnosis. 第三十四页，共五十二页，2022年，8月28日 Malignant Pleural Effusions(5) Malignant pleural effusions are typically exudative but on rare occasion can be transudative. Transudative malignant effusions are most commonly caused by concomitant disease, particularly congestive heart failure, but also may be due to early lymphatic obstruction and endobronchial obstruction producing an atelectatic effusion. 第三十五页，共五十二页，2022年，8月28日 Malignant Pleural Effusions(6) The pleural fluid glucose and the pH ar