Pleural effusion is characterized by the pleural cavity filled with fluids,and it is developed by various etiologies.Pleural effusion is not a disease,but the clinical manifestations and signs of the diseases.Therefore,it is not the end that we get the diagnosis of pleural effusion,while it is our ultimate goal to find the etiologies.Both the etiologies and mechanisms of pleural effusion are complicated,so it is very difficult to confirm the ultimate diagnosis. In clinical practice,it would be essential for diagnosis process that includes the analysis of transudative or exudative effusion,the differentiation of benign and malignant effusion,the noninvasive examination in priority,and the invasive examination in necessity.The appropriate application of the integral and dialectical thinking is the art in the diagnostic consideration.
[1]陈灏珠,林果为.实用内科学[M].13版.北京:人民卫生出版社,2009:1866.
[2]Light RW,Macgregor MI,Luchsinger PC,et al.Pleural effusions:the diagnostic separation of transudates andexudates[J].Annlntern,Med,1972,77(4):507-516.
[3]Romero S,Martinez A,Hemandez L,et al.Light′s criteria revisitedconsistency and comparison with new proposed alternativecriteria for separating pleural transudates from exudates[J].Respiration,2000,67(1):18-23.
[4]Romero S,Candela A,Martin C,et al.Evaluation of different criteria for the separation of pleural transudates from exudates[J].Chest,1993,104(2):399-404.
[5]RomeroCandiera S,Fernande C,Martin C,et al.Influence of diuretics on the concentration of proteins and other components of pleural transudates in patients with heart failure[J].Am J Med,2001,110(9):681-686.
[6]Gotsman I,Fridlender Z,Meirovitz A,et al.The evaluation of pleural effusions in patients with heart failure[J].Am J Med,2001,111(5):375-378.
[7]Gonlugur U,Gonlugur TE.The distinction between transudates and exudates[J].J Biomed Sci,2005,12(6):985-990.
[8]Porcel JM,Chorda J,Cao G,et al.Comparing serum and pleural fluid probrain natriuretic peptide(NTproBNP) levels with pleural toserum albumin gradient for the identification of cardiac effusions misclassified by Light′s criteria[J].Respiology,2007,12(5):644-659.
[9]Hooper C,Lee YC,Maskell N,et al.Investigation of a unilateral pleural effusion in adults:British Thoracic Society:Plueral Disease Guideline 2010.Thorax,2010,65(Suppl 2):114-117.
[10]Delamp MM Jr,Mentzer SJ,Swanson SJ,et al.Malignant effusive disease of the pleura and pencardium[J].Chest,1997,112(4supp 1):291-295.
[11]Ryu JS,Lee HJ,Cho JH,et al.The implication of elevated carcinoembryonic antigen level in pleural fluid of patients with nonmalignant pleural effusion[J].Respirology,2003,8(4):487-491.
[12]Yang CT,Lee MN,Lan RS,et al.Telomerase activity in pleural effusions.Diagnostic significance[J].J Clin Oncol,2008,16(2):567-573.
[13]潘祥林,王鸿利.诊断学的任务与发展方向[J/CD].中华诊断学电子杂志,2013,1(1):8-9.