examination of pleural effusion and pleurisy in the elderly, diagnosis of pleural effusion and pleurisy in the elderly
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Common examinations of pleural effusion and pleurisy in the elderly
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1. Routine inspection
Including appearance, specific gravity,
Coagulation, cell number and classification, protein detection, etc. Most of the leaked fluid is colorless or light yellow transparent liquid, which will not be solidified when placed, specific gravity <1.018, cell number <0.3*109/L, Rivanta test negative, protein quantitative ≤30g/L, pleural fluid protein/serum protein <0.5, glucose Quantitative >3.3mmol/L; the exudate is clear or turbid, with different colors, which can be straw yellow, brown yellow, red, dark red, milky white, green, etc., easy to solidify, specific gravity >1.018, cell number >0.3 *109/L, Rivanta test is positive, protein quantification>30g/L, pleural fluid protein/serum protein>0.5, glucose quantification>3.3mmol/L.
Finding malignant cells in pleural effusion is helpful for tumor diagnosis. The white blood cell count of cancerous and tuberculous pleural effusion is mostly (0.5～2.5)*109/L, and purulent pleural effusion is >1*1010/L. Leukocytes are mainly classified as mononuclear cells, which are more common in tuberculosis or viral, and multinucleated cells are mainly found in purulent and early tuberculosis.
3. Bacteriological examination
Suspected purulent infection pleural fluid smear staining or centrifugal sedimentation of bacterial culture is helpful for pathogenic diagnosis.
4. Other laboratory examinations of pleural fluid
(1) pH value:
The pH value of normal intrapleural fluid is 7.32～7.52, the pH value of leakage fluid and cancerous pleural fluid is generally in the normal range, and the pH value of inflammatory pleural fluid is often <7.2.
(2) Enzymology examination:
①Pleural fluid lysozyme (LZM)>20mg/L, pleural fluid/serum of lysozyme >1.2 is more indicative of inflammation, pleural fluid/serum of lysozyme <1.0 is more indicative of cancer; ②Thymus adenosine deaminase (ADA)>50U/L is highly suggestive of tuberculosis, <45U/L can rule out tuberculosis; ③Pleural fluid lactate dehydrogenase (IDH) <200U indicates leakage, and >200U indicates more exudate.
(3) Cytokine detection:
①Interferon-γ (IFN-γ) is significantly increased in tuberculous pleural effusion, cancerous patients are significantly decreased, and rheumatoid is almost disappeared. The sensitivity and specificity of this test are both up to 90%. ②Tumor necrosis factor (TNF) increased in tuberculosis, decreased in cancerous.
(4) Immunological testing:
①Pleural fluid carcinoembryonic antigen (CEA)>20μg/L, and pleural fluid/serum CEA>1.0 is helpful to judge malignant pleural effusion; ②pleural fluid carbohydrate antigen 50 (CA50)>20kU/L highly indicates the possibility of malignancy;③ Anti-tuberculosis antibody (anti-PPD-IgG) anti-PPD-IgG in tuberculous pleural effusion is significantly higher than that in malignant pleural effusion; ④The proportion and absolute number of CD3 and CD4 cells in tuberculous pleural effusion of T lymphocyte subsets are higher than those in peripheral blood, while malignant pleural effusion The absolute numbers of CD3, CD4, CD8 and the ratio of CD8 in water are significantly lower than those in peripheral blood; ⑤Polymerase chain reaction (PCR) and nucleic acid probe technology have high sensitivity and specificity for the diagnosis of tuberculous pleural effusion.
(5) Biotechnology inspection:
The appearance of hyperdiploid and polyploid chromosomal cells in pleural fluid mostly indicates malignant pleural effusion; pleural effusion cell silver phagocytic protein staining can also help distinguish between benign and malignant cells.
5. X-ray chest film
A small amount of effusion can only be manifested as blurred, blunt or disappearing of the costophrenic angle of the affected side; medium effusion shows a large uniform and dense shadow of the lower chest of the affected side, and the upper edge is curved with a high outside and low inside; when a large amount of effusion is on the affected side The chest presents a large uniform dense shadow, the trachea and the mediastinum are displaced on the opposite side, and the affected side diaphragm moves downward; the encapsulated effusion appears as a round or semi-circular uniform dense shadow of varying sizes, with smooth and clear edges; interleaf accumulation The fluid on the lateral radiograph shows a uniform and dense shadow with a sharp axis and a sharp edge in the interlobular fissure; the lung base effusion is easily confused with the elevation of the diaphragm on the anterior radiograph, and the level of the diaphragm can be seen in the fluoroscopy or film of the affected side. Normal, pleural fluid is distributed along the lower chest wall. X-ray examination can not only diagnose effusion, but also help the diagnosis of the primary disease.
6. CT and MRI examination
CT and MRI have the characteristics of high density resolution and two-dimensional images, which can distinguish liquid and solid shadows, and can well show small lesions or a small amount of fluid in the blind area of X-ray films, and can highlight that they are covered by pleural fluid The block shadow in the lungs also helps to distinguish the nature of the effusion.
7. Ultrasound examination
It is more sensitive to the detection of a small amount of pleural fluid than X-ray, and helps to locate the puncture.
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