The differential diagnosis of pericardial effusion as well as history and physical exam findings are discussed in the context of a case presentation. Jul 31, 2009 a massive hemorrhagic pleural effusion is extremely rare in tuberculosis, but tuberculosis is a very protean disease and should always be included in the differential diagnosis of pleural effusions we report a case of an immunocompetent 18yearold man with a massive hemorrhagic, exudative, lymphocytic pleural effusion. Pleural effusion is the most common manifestation of pleural disease and a common presentation of other conditions such as heart failure or kidney failure. It can pose a diagnostic dilemma to the treating physician because it may be related to disorders of. Pdf characteristics of pleural effusions in systemic. Empyema must be diffrentiated from pneumonia, lung abscess, lung cancer and parapneumonic effusions on the basis of the presentation, physical examination findings, chest xray, ultrasound and ct scan findings. A study was undertaken to assess the diagnostic accuracy of tus in differentiating malignant and benign pleural disease. It is the most common manifestation of pleural disease, with etiologies ranging from cardiopulmonary disorders to symptomatic inflammatory or malignant diseases requiring urgent evaluation and trea. Ctindifferential diagnosis of diffuse pleural disease. Differential diagnosis from new growth of the lung has to be made by explora tion and aspiration of the fluid. A delayed etiological diagnosis can be associated with markedly higher morbidity and mortality, e. Reeder and felsons gamuts in radiology, comprehensive lists of roentgen differential diagnosis.
A case study of a patient with a pleural effusion is presented, as well as a brief description of the signs and symptoms, pathophysiology, and management of this disease process. It is estimated that a million americans develop a pleural effusion each year 1. Worlds best powerpoint templates crystalgraphics offers more powerpoint templates than anyone else in the world, with over 4 million to choose from. A massive hemorrhagic pleural effusion does not exclude. Pericardial effusion is the presence of an abnormal amount of andor an abnormal character to fluid in the pericardial space. An effusion is exudative if it meets any of the following three criteria. The pleural space lies between the lung and chest wall and normally contains a very thin layer of fluid, which serves as a coupling system. Approach to the patient with ascites differential diagnosis ascites refers to the pathologic accumulation of fluid within the peritoneal cavity. Diagnosis and treatment of pleural effusion 364 arch bronconeumol. Pleural effusion if presenting with pleuritic chest pain, theres unilateral loss of breath sounds at a base, with dullness to percussion all the way up to the fluid level. There is a large left pleural effusion obscuring the lower half of the left hemi thorax. A diagnosis of pleural effusion may be sug gested by characteristic symptoms e. Cleveland, ohio introduction strictly speaking, the term pleural effusion applies to inflammatory exudates within the pleural cavity, usually a result of acute fibrinous pleurisy. Detection of a pleural effusion, either by physical exam or radiograph, necessitates an investigation into the cause of the effusion.
The differential diagnosis of exudate poses a more difficult challenge for clinicians. The patient must be placed on standard chemotherapy as follows. Thoracic ultrasound in the diagnosis of malignant pleural. Pleural effusion in adultsetiology, diagnosis, and treatment. Winner of the standing ovation award for best powerpoint templates from presentations magazine.
Pleural effusion in cats vetlexicon felis from vetstream. Pleural disease is, therefore, often a secondary effect of another disease process. The diagnosis of a malignant effusion should be established only by histocytopathologic confirmation of malignant cells in the pleural fluid or tissue. Your doctor will perform a physical exam, listen to your chest and discuss your symptoms. Differential diagnosis ascites refers to the pathologic accumulation of fluid within the peritoneal cavity. This algorithm has been developed for md anderson using a multidisciplinary approach considering circumstances particular to md andersons specific patient population, services. The use of certain pleural fluid tests such as leukocyte count and differential, glucose, ph and, when indicated, pleural fluid amylase determinations, helps to narrow the differential diagnosis of an exudative pleural effusion.
There is also a right pleural effusion with fluid tracking into the minor fissure. Pdf diagnostic tools of pleural effusion researchgate. For bilateral effusion with a normal heart size, the differential diagnosis should include malignancy and, less commonly, lupus pleuritis and constrictive pericarditis3. Jun 30, 2016 a pleural effusion is an abnormal collection of fluid in the pleural space resulting from excess fluid production or decreased absorption or both. The differential diagnosis for unilateral pleural effusion includes parapneumonic effusion, neoplasms such as mesothelioma, primary lung cancer, pleural metastases, lymphoma, other entities such as cirrhosis, pancreatitis, and trauma. A pleural effusion is present when there is an excess quantity of fluid in the pleural space.
Large unilateral pleural effusion radiology reference. This algorithm has been developed for md anderson using a multidisciplinary approach considering circumstances particular to md andersons specific patient population, services and structure, and clinical information. Differential diagnosis issues of atypical pleural lesions. Clinically, however, the term includes any fluid within the pleural cavity. Bilateral effusions can be tricky, because the findings are symmetrical you just have to realize that breath sounds should be audible in the lower thorax. The use of certain pleural fluid tests such as leukocyte count and differential, glucose. Unilateral pleural effusion differential diagnosis. The differential diagnosis of pleural effusions ncbi nih. Mar 21, 2008 the aim was to determine the cutoff value for adenosine deaminase ada and the sensitivity and specificity of ada and evaluate pleural fluid cytology and pleural biopsy in the differential diagnosis of malignant and tuberculous pleurisy. Ctindifferential diagnosis of diffuse pleural disease annn. A diagnosis of pleural effusion may be suggested by characteristic symptoms e. Evaluation of a patient with a pleural effusion requires a thorough clinical history and physical examination in conjunction with pertinent laboratory tests and imaging studies.
The most important aspect of forming a differential diagnosis of pleural effusion is performing a thoracentesis and obtaining a sample of the pleural fluid. Differential diagnosis of tuberculous and malignant pleural. Nov 28, 2018 pericardial effusion is the presence of an abnormal amount of andor an abnormal character to fluid in the pericardial space. Radiographic techniques an effusion of more than 75 ml is often visible on chest radiographs. Diagnostic approach to pleural effusion in adults american. Thoracic ultrasound in the diagnosis of malignant pleural effusion n r qureshi,1 n m rahman,2 f v gleeson3 see editorial, p 97 c additional details of the techniques, statistical analysis and figures are published online. Ct in differential diagnosis of diffuse pleural disease. It can be caused by a variety of local and systemic disorders, or it may be idiopathic. What is the process for differential diagnosis of pleural. Types of pleural effusion including their causes, diagnosis, and related symptoms from a list of 126 total causes of symptom pleural effusion. What does the color of liquid draining from a patient with pleural effusion indicate. To explore the role of mri in the differential diagnosis of pleural disease. Mri and ct in the differential diagnosis of pleural disease.
Differential diagnosis of hemorrhagic pleural effusions when the thoracocentesis yields pleural fluid that initially looks like blood, several possibilities should be considered. Mar 14, 2019 the differential diagnosis of pericardial effusion as well as history and physical exam findings are discussed in the context of a case presentation. The first consideration is to decide whether the effusion represents hemorrhage, or a hemorrhagic pleural effusion. Request pdf the differential diagnosis of pleural effusions unlabelled. It is important to establish a cause for its development and to initiate a rational treatment regimen to avoid some. Pleural effusions can be either free flowing or loculated and either typically or atypically. Common types of pleural effusions, their management and disposal a tubercular pleural effusion. When a pleural effusion is large and unilateral, concern for an underlying abnormality should be raised. The differential diagnosis of pleural effusions request pdf. The morphologic features of pleural lesions and magnetic resonance signal intensity on t1weighted. Tpe was confirmed in 54 patients and malignant effusion in 67 patients. Bilateral pleural effusion is commonly seen in heart failure. Tus was used to assess pleural surfaces using previously.
Approach to diagnosis of pleural effusion page 1 of 3. Certain studies have investigated biochemical parameters to facilitate the diagnosis of exudative pleural effusion. Treatment for pleural effusion is based on what caused the pleural effusion. Dec 19, 2014 clinical features in the diagnosis of pleural effusions and identifying etiology. Approach to the patient with ascites differential diagnosis. Other tests help ful for diagnosis include helical computed tomography and thoracoscopy. Pleural effusion is suspected in patients with pleuritic pain, unexplained dyspnea, or suggestive signs.
Clinical features in the diagnosis of pleural effusions and identifying etiology. A pleural effusion is an excessive accumulation of fluid in the pleural space. Role of the neutrophillymphocyte ratio in the differential. Fortytwo patients with pleural disease were included. Pdf differential diagnosis of pleural effusion by lactate. The differential for a single pleural mass is essentially the same as that for multiple pleural masses with the addition of a few entities. A pleural effusion is defined as an abnormal collection of fluid between the thin layers of tissue lining the lung and the wall of the chest cavity. Pleural lesions that require differential diagnosis with mediastinal diseases, especially tumors cap.
Pdf pleural effusion is defined as an abnormal amount of pleural fluid accumulation in the pleural. Pleural effusion in adultsetiology, diagnosis, and treatment ncbi. Additionally, betas microglobulin, whichwas found increased in some malignant pleural ef. An exudative effusion is diagnosed if the patient meets lights criteria. The problems of pleural effusions are connected with many areas of medicine. It can pose a diagnostic dilemma to the treating physician because it may be related to disorders of the lung or pleura, or to. Ppt approach to pleural effusion powerpoint presentation. Diagnostic tests are indicated to document the presence of pleural fluid and to determine its cause see figure diagnosis of pleural effusion. Its most common causes are congestive heart failure, cancer, pneumonia, and pulmonary embolism. A systematic approach to the evaluation and management of various complaints. A massive hemorrhagic pleural effusion is extremely rare in tuberculosis, but tuberculosis is a very protean disease and should always be included in the differential diagnosis of pleural effusions we report a case of an immunocompetent 18yearold man with a massive hemorrhagic, exudative, lymphocytic pleural effusion. Differential diagnosis of pleural effusions jmaj 49910. Pleural effusion has a wide differential diagnosis.
A pleural effusion is an abnormal collection of fluid in the pleural space resulting from excess fluid production or decreased absorption or both. Approach to diagnosis of pleural effusion page 2 of 3 disclaimer. Specific differential diagnosis problems generated by pleural nodules, where the main concern is establishing if the complementary ct scan is needed. Precise differential diagnostic categorization is essential, as the treatment and prognosis of pleural effusion largely depend on its cause.
The aim was to determine the cutoff value for adenosine deaminase ada and the sensitivity and specificity of ada and evaluate pleural fluid cytology and pleural biopsy in the differential diagnosis of malignant and tuberculous pleurisy. Definition pleural effusion is the accumulation of fluid in the pleural space. Pdf characteristics of pleural effusions in systemic lupus. The history and physical examination are critical in guiding the evaluation of pleural effusion signs and symptoms of an effusion vary depending on the underlying disease, but dyspnea, cough, and pleuritic chest pain are common. The differential diagnosis of pleural effusion may be difficult and may require several procedures, including invasive ones. Get a printable copy pdf file of the complete article 1.
Pleural effusion, empyema, and pneumothorax clinical gate. Pleural effusion differential diagnoses medscape reference. Many pleural fluid tests are useful in the differential diagnosis of exudative effusions. Early in the disease course, the effusion usually is freeflowing also known as a simple effusion and sterile. How pleural effusion and pleurisy are diagnosed through a variety of tests, such as xrays, ct scans, and ultrasounds. In a retro spective study, we found that measurement of cea couldbe helpfulinthisrespect. Diagnosis and treatment of pleural effusion sciencedirect. A massive hemorrhagic pleural effusion does not exclude the. However, the accuracy of these features in the differential diagnosis of diffuse pleural disease has not been assessed before. Differential diagnosis of tuberculous and malignant. Pleural fluid cytologic examination is the first line of investigation in suspected cases and has a sensitivity up to 60% dependent on tumor type, extent of disease, and experience of the. Theyll give your presentations a professional, memorable appearance the kind of sophisticated look that.