RT Book, Section
A1 Doherty, Gerard M.
SR Print(0)
ID 58097733
T1 Pleural Effusion
T2 Quick Answers Surgery
YR 2010
FD 2010
PB The McGraw-Hill Companies
PP New York, NY
SN 
LK accesssurgery.mhmedical.com/content.aspx?aid=58097733
RD 2024/04/20
AB •  Presence  of  fluid  within  pleural  space•  Etiology  includes:  -Increased  pulmonary  hydrostatic  pressure-Decreased  intravascular  oncotic  pressure-Increased  capillary  permeability-Decreased  intrapleural  pressure  (atelectasis)-Decreased  lymphatic  drainage  (carcinomatosis)-Rupture  of  vascular  or  lymphatic  structure  (trauma)•  When  nature  of  fluid  of  known,  more  specific  terms  may  be  used:-Pyothorax:  Pus  in  pleural  cavity  (empyema)-Hemothorax:  Blood  in  thorax-Chylothorax:  Chyle  in  thorax-Hydrothorax:  Collection  of  serous  fluid  (transudative  or  exudative)•  Etiology  for  hydrothorax:-Tuberculosis:  History  of  exposure,  can  be  sanguineous;  >  1000  lymphocytes,  positive  for  acid-fast  bacilli,  positive  tuberculin  skin  test,  positive  pleural  biopsy,  glucose  <  60  mg/dL-Cancer:  67%  bloody,  cytology  positive  in  50%,  glucose  rarely  <  60  mg/dL-Congestive  heart  failure  (CHF):  Presence  of  CHF,  serous,  <  10,000  RBCs,  right-sided  in  up  to  70%,  may  be  bilateral;  interlobal  fissure  fluid  collection  called  "pseudotumors"-Pneumonia:  Respiratory  infection,  serous,  neutrophils  predominate  in  fluid,  culture  and  stain  positive  for  organisms,  infiltrate  on  chest  film-Rheumatoid  arthritis:  Joint  involvement,  turbid  or  yellow-green  color,  lymphocytes  predominate,  glucose  <  20  mg/dL,  rapid  clotting  time,  eosinophils  present-Pulmonary  embolism:  Risk  for  embolism,  often  sanguineous-Other  causes:  Nephrotic  syndrome,  rupture  of  hydronephrosis  into  pleural  space  (elevated  creatinine  in  fluid),  pancreatitis  (left-sided,  elevated  amylase),  cirrhosis  (5%  of  patients  with  ascites)•  Etiology  for  chylothorax:-Most  often  due  to  surgical  procedures-Other  causes  include  trauma,  malignancy,  central  line  placement,  thoracic  aortic  aneurysms,  filariasis-Blunt  trauma:  Thoracic  duct  shearing  at  diaphragm