Diagnosis of Pleural effusion
Diagnostic Test list for Pleural effusion:
The list of medical tests
mentioned in various sources as
used in the diagnosis of Pleural effusion
includes:
- Chest examination
- Chest x-rays
- Laboratory tests of pleural fluid - when the fluid is extracted as a treatment.
Pleural effusion Diagnosis: Book Excerpts
Diagnostic Tests for Pleural effusion: Online Medical Books
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Pleural effusion and empyema:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Auscultation of the chest reveals decreased breath sounds; percussion detects dullness over the effused area, which doesn’t change with breathing. Chest X-ray shows fluid in dependent regions. However, diagnosis also requires other tests to distinguish transudative from exudative effusions and to help pinpoint the underlying disorder.
The most useful test is thoracentesis, in which pleural fluid is analyzed in the laboratory to show components. Acute inflammatory white blood cells and microorganisms may be evident in empyema.
In addition, if a pleural effusion results from esophageal rupture or pancreatitis, fluid amylase levels are usually higher than serum levels. Aspirated fluid may be tested for LE cells, antinuclear antibodies, and neoplastic cells. It may also be analyzed for color and consistency; acid-fast bacillus, fungal, and bacterial cultures; and triglycerides (in chylothorax). Cell analysis shows leukocytosis in empyema. A negative tuberculin skin test strongly rules against TB as the cause. In exudative pleural effusions in which thoracentesis isn’t definitive, pleural biopsy may be done. This is particularly useful for confirming TB or malignancy.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Pleural Effusion:
History
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
The patient’s history can often suggest that a pleural effusion is present. Small effusions, however, may cause no symptoms. Frequently, an underlying disease causes the patient’s initial symptoms.
A. Pulmonary. Dyspnea is the most common symptom. Did it develop acutely or gradually? Is there a dry cough present? Does the patient experience chest pain, especially pleuritic pain? Does the pain vary in quality (Chapter 8.5)?
B. Associated symptoms. The main goal here is to think about underlying illnesses that might produce a pleural effusion. Orthopnea, paroxysmal nocturnal dyspnea, dyspnea on exertion, and pedal edema suggest CHF. Does the patient have exertional chest pain that may be angina? Hemoptysis, weight loss, and anorexia point to malignancy. Has the patient been acutely ill? Productive cough, fever, chills, and night sweats suggest pneumonia. Does the patient have risks for deep venous thrombosis (e.g., recent travel, prolonged immobilization or fracture)? Symptoms of pulmonary embolism include tachycardia, hemoptysis, and dyspnea.
C. Past medical history. Has the patient had prior pulmonary diseases? Are cardiac risk factors present? Is there a history of hepatic or renal disease? Has the patient had cancer before?
D. Family history. Are there family members with premature coronary artery disease, tuberculosis, or malignancy?
E. Social history. Does the patient smoke? Does the patient use alcohol to excess? Where does the patient work? Is there solvent or asbestos exposure at work?
Physical examination (PE)
A. Focused PE. Observe the patient’s appearance and respiratory effort. Is the patient splinting or showing signs of respiratory distress? Vital signs should include respiratory rate. Is there tachycardia present (Chapter 7.12)? Typical findings on pulmonary examination include decreased or absent breath sounds over the affected side, dullness to percussion, decreased tactile fremitus, and possibly splinting of the affected side. Findings can be bilateral (e.g., CHF) or unilateral. The examination can also vary with the severity of the effusion. Findings are usually normal when less than 300 ml of fluid is present. A pleural rub may be noted. With a large effusion ( >1,500 ml), the affected hemithorax is often larger with bulging interspaces (2).
B. Additional physical examination. Think in terms of differential diagnosis to look for signs of underlying causes. Cardiac examination should look for signs of congestive heart failure, including cardiomegaly, displaced point of maximal impulse, and an S3 gallop. Is a heart murmur present? Abdominal examination may reveal hepatomegaly, liver tenderness, a fluid wave, and other signs of ascites. Are there signs of malignancy, including generalized or regional lymphadenopathy (Chapters 15.1 and 15.2)?
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Pleural effusion and empyema:
Diagnosis
(Handbook of Diseases)
A chest X-ray or thoracic computed tomography scan shows radiopaque fluid in dependent regions. Auscultation of the chest reveals decreased breath sounds; percussion detects dullness over the effused area, which doesn’t change with respiration. These tests verify pleural effusion. However, diagnosis also requires other tests to distinguish transudative from exudative effusions and to help pinpoint the underlying disorder.
The most useful test is thoracentesis, in which analysis of aspirated pleural fluid shows:
❑ transudative effusions: lactate dehydrogenase (LD) levels less than 200 IU and protein levels less than 3 g/dl
❑ exudative effusions: ratio of protein in pleural fluid to serum greater than or equal to 0.5, LD in pleural fluid greater than or equal to 200 IU, and ratio of LD in pleural fluid to LD in serum greater than or equal to 0.6
❑ empyema: acute inflammatory white blood cells and microorganisms
❑ empyema or rheumatoid arthritis: extremely decreased pleural fluid glucose levels.
In addition, if a pleural effusion results from esophageal rupture or pancreatitis, fluid amylase levels are usually higher than serum levels. Aspirated fluid may be tested for lupus erythematosus cells, antinuclear antibodies, and neoplastic cells. It may also be analyzed for color and consistency; acid-fast bacillus, fungal, and bacterial cultures; and triglycerides (in chylothorax). Cell analysis shows leukocytosis in empyema. Negative tuberculin skin test strongly rules against tuberculosis as the cause. With exudative pleural effusions in which thoracentesis isn’t definitive, pleural biopsy may be done; it’s particularly useful for confirming tuberculosis or malignancy.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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