Julius-Maximilians-Universität Würzburg, Klinikum Würzburg Mitte, Missioklinik, Department of Pneumology; Department of Respiratory Medicine, Hannover Medical School.
Dtsch Arztebl Int. 2019 May 24;116(21):377-386. doi: 10.3238/arztebl.2019.0377.
Pleural effusion is common in routine medical practice and can be due to many different underlying diseases. Precise differential diagnostic categorization is essential, as the treatment and prognosis of pleural effusion largely depend on its cause.
This review is based on pertinent publications retrieved by a selective search in PubMed and on the authors' personal experience.
The most common causes of pleural effusion are congestive heart failure, cancer, pneumonia, and pulmonary embolism. Pleural fluid puncture (pleural tap) enables the differentiation of a transudate from an exudate, which remains, at present, the foundation of the further diagnostic work-up. When a pleural effusion arises in the setting of pneumonia, the potential devel- opment of an empyema must not be overlooked. Lung cancer is the most common cause of malignant pleural effusion, followed by breast cancer. Alongside the treatment of the underlying disease, the specific treatment of pleural effusion ranges from pleurodesis, to thoracoscopy and video-assisted thoracoscopy (with early consultation of a thoracic surgeon), to the placement of a permanently indwelling pleural catheter.
The proper treatment of pleural effusion can be determined only after meticulous differential diagnosis. The range of therapeutic options has recently become much wider. More data can be expected in the near future concerning diagnostic test- ing for the etiology of the effusion, better pleurodetic agents, the development of interventional techniques, and the genetic background of the affected patients.
胸腔积液在常规医疗实践中很常见，可能由许多不同的潜在疾病引起。精确的鉴别诊断分类至关重要，因为胸腔积液的治疗和预后在很大程度上取决于其病因。
本综述基于在 PubMed 中进行的选择性搜索和作者的个人经验中检索到的相关出版物。
胸腔积液最常见的原因是充血性心力衰竭、癌症、肺炎和肺栓塞。胸腔积液穿刺（胸腔穿刺）可区分渗出液和漏出液，这仍然是进一步诊断工作的基础。当肺炎引起胸腔积液时，不应忽视潜在的脓胸发展。肺癌是恶性胸腔积液的最常见原因，其次是乳腺癌。除了治疗基础疾病外，胸腔积液的具体治疗方法包括胸膜固定术、胸腔镜和电视辅助胸腔镜（早期咨询胸外科医生），以及永久性留置胸腔导管的放置。
只有经过细致的鉴别诊断，才能确定胸腔积液的适当治疗方法。治疗选择范围最近变得更加广泛。未来不久将有更多关于积液病因的诊断测试、更好的胸膜固定剂、介入技术的发展以及受影响患者的遗传背景的数据。
