What is the process for differential diagnosis of pleural. Theyll give your presentations a professional, memorable appearance the kind of sophisticated look that todays audiences expect. Winner of the standing ovation award for best powerpoint templates from presentations magazine. There is a large left pleural effusion obscuring the lower half of the left hemi thorax. The primary diagnosis of the cause for the pleural effusion was consistent between reporting consultants k0. As regards pleural malignancies, the diagnostic yield of closed pleural biopsy cpb is only 5060% overall, and 20% in malignant mesothelioma mm.
Percentage of cases cytologic study of pleural fluid establishes diagnosis of malignant pleural effusion ranges from 40% to 87%. For instance on ultrasound, empyema is positive for suspended. Fortytwo patients with pleural disease were included. The differential for a single pleural mass is essentially the same as that for multiple pleural masses with the addition of a few entities. Unilateral pleural effusion differential diagnosis. Pleural effusion differential diagnoses medscape reference. A diagnosis of pleural effusion may be suggested by characteristic symptoms e. A systematic approach to the evaluation and management of various complaints. Diagnostic approach to pleural effusion in adults american. Following diagnostic thoracentesis, the cause of a pleural effusion is not evident in up to 25 percent of patients. The list of types of pleural effusion mentioned in various sources includes. Diagnostic value of pleural effusion linkedin slideshare. Reeder and felsons gamuts in radiology, comprehensive lists of roentgen differential diagnosis.
Diagnostic evaluation of pleural effusion in adults. Pdf pleural effusion is defined as an abnormal amount of pleural fluid accumulation in the pleural. Pleural effusions can develop as a result of over 50 different pleuropulmonary or systemic disorders. 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. Large unilateral pleural effusion radiology reference. Your doctor will perform a physical exam, listen to your chest and discuss your symptoms. The differential diagnosis of pericardial effusion as well as history and physical exam findings are discussed in the context of a case presentation.
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. Detection of a pleural effusion, either by physical exam or radiograph, necessitates an investigation into the cause of the effusion. Nov 28, 2018 pericardial effusion is the presence of an abnormal amount of andor an abnormal character to fluid in the pericardial space. Mri and ct in the differential diagnosis of pleural disease. Other tests help ful for diagnosis include helical computed tomography and thoracoscopy. The pleural fluid was aspirated and examined for total cell count, differential cell count, protein, sugar, ada and pcr for mtb. Dec 19, 2014 clinical features in the diagnosis of pleural effusions and identifying etiology.
Conventional chest radiography and computed tomography ct scanning are the primary imaging modalities that are used for evaluation of all types of pleural disease, but ultrasound and magnetic resonance. Pleural effusion occurs when fluid collects between the parietal and visceral pleura. Tpe was confirmed in 54 patients and malignant effusion in 67 patients. Pdf diagnostic tools of pleural effusion researchgate. Pleural fluid from patients with undiagnosed exudative pleural effusions should be cultured for bacteria aerobically and anerobically, mycobacteria, and fungi. Differential diagnosis of tuberculous and malignant. A ct thorax was done in all the 106 patients of pleural effusion and. Diagnosis and management of patients with pleural effusions. Pleural disease is, therefore, often a secondary effect of another disease process. Types of pleural effusion including their causes, diagnosis, and related symptoms from a list of 126 total causes of symptom pleural effusion. 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. This article discusses the causes and treatment of pleural effusions, referencing guidelines produced by the british thoracic society. Bilateral pleural effusion is commonly seen in heart failure.
Pleural effusion in cats vetlexicon felis from vetstream. Diagnostic workup of pleural effusions fulltext respiration. Differential diagnosis of pleural effusions jmaj 49910. Pleural effusion is the most common manifestation of pleural disease and a common presentation of other conditions such as heart failure or kidney failure. The differential diagnosis of pleural effusion may be difficult and may require several procedures, including invasive ones. In such cases, diagnosis is achieved by adding a differential cytology exam of the pleural fluid showing lymphocytes with evident nucleoli. 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. Chest ultrasound is helpful in the diagnosis of pleural effusion and for monitoring the progression of parapneumonic effusion.
Overview disease name must be differentiated from other diseases that cause clinical feature 1, clinical feature 2, and clinical. Pdf differential diagnosis of pleural effusion by lactate. Get a printable copy pdf file of the complete article 1. It can be caused by a variety of local and systemic disorders, or it may be idiopathic. However, the accuracy of these features in the differential diagnosis of diffuse pleural disease has not been assessed before. 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. When a pleural effusion is large and unilateral, concern for an underlying abnormality should be raised. Parapneumonic pleural effusions were noted on chest xrays in six patients. 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. An effusion is exudative if it meets any of the following three criteria. Pleural effusion is a complex problem caused by a variety of conditions requiring different treatment depending on the underlying diagnosis. Pleural effusion develops because of excessive filtration or defective absorption of accumulated fluid. What is the differential diagnosis of elevated hcg in early pregnancy.
Pleural effusion, which in pediatric patients most commonly results from an infection, is an abnormal collection of fluid in the pleural space. A diagnosis of pleural effusion may be sug gested by characteristic symptoms e. Pericardial effusion is the presence of an abnormal amount of andor an abnormal character to fluid in the pericardial space. Pleural effusion is a major diagnostic problem, since the pleura is an inner cavity with no direct access. Full text full text is available as a scanned copy of the original print version. Ppt approach to pleural effusion powerpoint presentation. Ob gyn blueprints ovarian cancer urinary incontinence. Role of the neutrophillymphocyte ratio in the differential.
Several additional tests can be performed when clinical setting requires it fig. Classification of and therapies for parapneumonic effusion and empyema cont. The fluid contains 80% lymphocytes and, therefore, this should be classified as a lymphocyterich pleural effusion. The differential diagnosis of exudative pleural effusion is often a lengthy process. 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. Differential diagnoses of tmpes include tpes, malignant pleural effusions, parapneumonic pleural effusion, pleural effusion caused by connective tissue disease, and other viral infections 8 9. Evident nucleoli indicate nuclear activity, that is, proliferating activity, attesting that cells are immature need of intense cell division, with appearance of young or immature cells. For bilateral effusion with a normal heart size, the differential diagnosis should include malignancy and, less commonly, lupus pleuritis and constrictive pericarditis3. Ctindifferential diagnosis of diffuse pleural disease annn. Certain studies have investigated biochemical parameters to facilitate the diagnosis of exudative pleural effusion. The value of cytology and pleural biopsy in the differential.
Very small loculated pleural effusions below 300ml are difficult to see on plain. Differential diagnosis issues of atypical pleural lesions. The differential diagnosis of exudate poses a more difficult challenge for clinicians. For a unilateral pleural effusion evident on chest radiographs, the differential diagnosis is extensive table 1. Rare types of medical conditions and diseases in related medical categories. Pleural lesions that require differential diagnosis with mediastinal diseases, especially tumors cap. The differential diagnosis is based on the clinical history, the physical examination, the analysis of the pleural fluid, and the laboratory data mainly blood tests. Get a printable copy pdf file of the complete article 795k, or click on a page image below to browse page by page. 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. Specific differential diagnosis problems generated by pleural nodules, where the main concern is establishing if the complementary ct scan is needed. Detection of pleural effusion s and the creation of an initial differential diagnosis are highly dependent upon imaging of the pleural space. Very small or complexmultiple loculated pleural effusions.
Common etiologies of neonatal pleural effusion sciencedirect. 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. Multiple etiologies for a pleural effusion one cause was identi. The first consideration is to decide whether the effusion represents hemorrhage, or a hemorrhagic pleural effusion. However, no universally accepted definition exists for an undiagnosed effusion. 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 pleural effusions and the creation of an initial differential diagnosis are highly dependent upon imaging of the pleural space. Clinical features in the diagnosis of pleural effusions and identifying etiology. A pleural effusion is excess fluid that accumulates in the pleural cavity, the fluid filled space that. Treatment for pleural effusion is based on what caused the pleural effusion. Case 7 answers pleural effusions clinical respiratory.
Ctindifferential diagnosis of diffuse pleural disease. To explore the role of mri in the differential diagnosis of pleural disease. It is estimated that a million americans develop a pleural effusion each year 1. Chart and diagram slides for powerpoint beautifully designed chart and diagram s for powerpoint with visually stunning graphics and animation effects. 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. Clinically, however, the term includes any fluid within the pleural cavity. There may be a pericardial effusion in the patient with pericarditis, while myocarditis is not associated with a pericardial effusion. Ct in differential diagnosis of diffuse pleural disease. Recommended algorithm for the evaluation of patients with pleural effusion fig. Approach to diagnosis of pleural effusion page 1 of 3. Evident nucleoli indicate nuclear activity, that is, proliferating activity, attesting that cells are immature need of intense cell division. The differential diagnosis for bilateral pleural effusions is narrower and includes causes of.
All16patients haddiffuse pleural thickening, defined as. Differential diagnosis of hemorrhagic pleural effusions when the thoracocentesis yields pleural fluid that initially looks like blood, several possibilities should be considered. Our new crystalgraphics chart and diagram slides for powerpoint is a collection of over impressively designed datadriven chart and editable diagram s guaranteed to impress any audience. Contrary to thoracocentesis and percutaneous cpb, thoracoscopy permits biopsy with direct visualization. A pleural effusion is an abnormal collection of fluid in the pleural space resulting from excess fluid production or decreased absorption or both. Empyema is defined as pus noted in the pleural fluid, positive culture, or positive grams stain. It can pose a diagnostic dilemma to the treating physician because it may be related to disorders of the lung or pleura, or to. Worlds best powerpoint templates crystalgraphics offers more powerpoint templates than anyone else in the world, with over 4 million to choose from. As noted earlier, the leading items on the differential for such effusions includes tuberculous pleurisy, lymphoma, chylothorax, chronic rheumatoid pleurisy, sarcoidosis and some other less. 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. Pleurisy and pleural effusion in differential diagnosis. Differential diagnosis of tuberculous and malignant pleural.
As noted earlier, the leading items on the differential for such effusions includes tuberculous pleurisy, lymphoma, chylothorax, chronic rheumatoid pleurisy, sarcoidosis and some other less common causes. The presence of pleural fluid eosinophilia is of little use in the differential diagnosis of pleural effusions and is often the result of air or blood in. 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. A pleural effusion is usually diagnosed on the basis of medical history and physical. Any information contained in this pdf file is automatically generated from digital. The morphologic features of pleural lesions and magnetic resonance signal intensity on t1weighted. A pleural effusion is an excessive accumulation of fluid in the pleural space. The most important aspect of forming a differential diagnosis of pleural effusion is performing a thoracentesis and obtaining a sample of the pleural fluid. Edema\nascites\ npleural effusion \nhemoconcentration\nhypercoagulability. Processes causing a distortion in body fluid mechanics, such as in heart failure or nephrotic. The differential diagnosis of pleural effusions ncbi nih. There is also a right pleural effusion with fluid tracking into the minor fissure.
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