Porcel José M, Light Richard W
Internal Medicine Department, Arnau de Vilanova University Hospital, Lleida, Spain.
Am Fam Physician. 2006 Apr 1;73(7):1211-20.
The first step in the evaluation of patients with pleural effusion is to determine whether the effusion is a transudate or an exudate. An exudative effusion is diagnosed if the patient meets Light's criteria. The serum to pleural fluid protein or albumin gradients may help better categorize the occasional transudate misidentified as an exudate by these criteria. If the patient has a transudative effusion, therapy should be directed toward the underlying heart failure or cirrhosis. If the patient has an exudative effusion, attempts should be made to define the etiology. Pneumonia, cancer, tuberculosis, and pulmonary embolism account for most exudative effusions. Many pleural fluid tests are useful in the differential diagnosis of exudative effusions. Other tests helpful for diagnosis include helical computed tomography and thoracoscopy.
评估胸腔积液患者的第一步是确定积液是漏出液还是渗出液。如果患者符合Light标准，则诊断为渗出性积液。血清与胸腔积液的蛋白或白蛋白梯度可能有助于更好地对偶尔被这些标准误判为渗出液的漏出液进行分类。如果患者有漏出性积液，治疗应针对潜在的心力衰竭或肝硬化。如果患者有渗出性积液，则应尝试明确病因。肺炎、癌症、结核病和肺栓塞是大多数渗出性积液的病因。许多胸腔积液检查对渗出性积液的鉴别诊断有用。其他有助于诊断的检查包括螺旋计算机断层扫描和胸腔镜检查。
