Maître B, Atassi K, Housset B
Service de pneumologie, Centre hospitalier intercommunal, Créteil.
Rev Prat. 1997 Jun 15;47(12):1298-303.
Diagnosis of pleural effusion, suggested by chest pain or dyspnea, is assessed by physical examination, chest X-ray sometimes completed by other imaging techniques, and mainly by thoracentesis. Thoracentesis is mandatory for the diagnostic of pleural effusion as three diagnosis are associated with an emergency treatment: pulmonary embolism; hemothorax; empyema. If the fluid is a transudate, no further invasive studies are necessary. If the cause of pleural exsudat cannot be established by a careful history, physical examination and fluid analysis, generally closed pleural biopsy should be done, followed, in absence of an established diagnosis, by thoracoscopy. At this time, less than 10% of the cases remain without explanation, leading to a careful follow-up of patients since a carcinomatous lesion may develop in 1/3 of them.
胸腔积液的诊断可通过胸痛或呼吸困难提示，通过体格检查、有时借助其他成像技术完成的胸部X线检查以及主要通过胸腔穿刺术进行评估。胸腔穿刺术对于胸腔积液的诊断是必需的，因为有三种诊断与紧急治疗相关：肺栓塞；血胸；脓胸。如果液体是漏出液，则无需进一步的侵入性检查。如果通过详细的病史、体格检查和液体分析仍无法确定胸腔渗出液的病因，通常应进行闭式胸膜活检，若仍未确诊，则接着进行胸腔镜检查。此时，不到10%的病例仍无法解释，因此要对患者进行仔细随访，因为其中三分之一可能会发展为癌性病变。
