Duysinx B, Corhay J L, Nguyen D, Louis R
Service de Pneumologie, CHU Sart-Tilman, Liège, Belgique.
Rev Med Liege. 2008 Oct;63(10):615-23.
Pleural involvements are common and various respiratory diseases including inflammatory, infectious, occupational, or neoplastic pathological entities...Pleural thickening and pleurisy are usual radiological presentation. Etiological diagnosis imposes a vast and sometimes difficult exploration and it, especially since the conventional imaging by radiology, ultrasound, scanning and nuclear magnetic resonance has no specific diagnostic criteria for pleural malignancy. The metabolic imaging by positron emission tomography (PET) has been gradually positioned in the decision-making algorithm exploration of the pleural disease due to its excellent sensitivity in the diagnosis of malignant pleurisy (88.8%-100%). The analysis of chemistry, bacteriology and cytology pleural fluid makes a significant contribution to the diagnostic approach. However, although inescapable, thoracocentesis has a diagnostic sensibility not exceeding 62%. Moreover, the sensibility of the pleural blind needle biopsies does not exceed 51%. So, thoracoscopy, more invasive, is often justified to precise pleural disease with a diagnostic sensitivity greater than 95%. Finally, despite the diagnostic arsenal available, over 10% of pleurisies remain unknown etiology.
胸膜受累很常见，多种呼吸系统疾病包括炎症性、感染性、职业性或肿瘤性病理实体……胸膜增厚和胸膜炎是常见的影像学表现。病因诊断需要进行广泛且有时困难的检查，尤其是自从放射学、超声、扫描和核磁共振等传统影像学检查对胸膜恶性肿瘤没有特异性诊断标准以来。正电子发射断层扫描（PET）的代谢成像由于其在诊断恶性胸膜炎方面具有出色的敏感性（88.8%-100%），已逐渐在胸膜疾病的决策算法检查中占据一席之地。胸膜液的化学、细菌学和细胞学分析对诊断方法有重要贡献。然而，尽管胸腔穿刺术是必不可少的，但它的诊断敏感性不超过62%。此外，胸膜盲目针吸活检的敏感性不超过51%。因此，胸腔镜检查虽然侵入性更强，但对于明确胸膜疾病往往是合理的，其诊断敏感性大于95%。最后，尽管有可用的诊断手段，但仍有超过10%的胸膜炎病因不明。
