Pleural EffusionsCan-mao Xie Dept. of Pulmonary 2. The Gram stain of the pleural fluid is positive for organisms;3. The pleural fluid glucose level is less than 40 mg/100 ml; 4. The pleural fluid PH is below 7.00.34Dr. Canmao xieTuberculous Pleural Effusions At the onset of tuberculous pleuritis, most patients also have pleuritic chest pain. Tuberculosis toxic syndrome dry cough, low grade fever, night sweat and losing body weight.With a positive tuberculin skin test (PPD) and significantly high ADA level in pleural effusion. The fluid is invariably an exudate. Frequently the pleural fluid protein is over 50 g/L and this finding is very suggestive of tuberculous pleuritis. The differential white cell count reveals more than 80% lymphocytes. Pleural biopsy has its greatest utility in establishing the diagnosis of tuberculous pleuritis. The demonstration of granuloma in the parietal pleura is highly suggestive of tuberculous pleuritis. Caseous necrosis or acid-fast bacilli need to be demonstrated. 35Dr. Canmao xieTuberculous Pleurisy36Dr. Canmao xieManagement of Tuberculous Pleural Effusions nAnti-tuberculosis chemotherapy: Adequate therapy for tuberculous pleuritis is a 9-month course of isoniazid and rifampin daily. nThe performance of the therapeutic thoracentesis is highly recommended as soon as the diagnosis is confirmed.nThe administration of corticosteroids will rapidly relieve the patients symptoms of pleuritic chest pain, malaise, and fever and does not seem to lead to dissemination of the tuberculosis. Markedly symptomatic patients should be started on prednisone 40 mg/day and then gradually tapered over several weeks. 37Dr. Canmao xieMalignant Pleural EffusionsnMalignant disease involving the pleura is the second leading cause of exudative pleural effusions.nFrequent seen in patients with age45 Ys, manifestated by chest pain, hemoptysis and emaciate.nBloody and massive pleural effusion is the typical clinical picture. Significantly high LDH and CEA level(20ug/L) in pleural fluid.nPleural fluid cytology, needle biopsy, thoracoscopy or open pleural biopsy has its greatest utility in establishing the diagnosis of malignant pleural effusions.38Dr. Canmao xieManagement of malignant pleural effusionn Treatment of the primary tumor. n Therapeutic thoracentesis with or without a chest tube. n Chemical pleurodesis lMechanisms of pleurodesis not clearly understood. In general, an inflammation producing agent is injected into the pleural space. Resulting inflammatory reaction leads to pleural fibrosis such that the visceral and parietal pleurae fuse. lTalc, Tetracycline Derivatives (Tetracycline, Doxycycline), Antineoplastic drugs (Bleomycin, Mitoxantrone, Nitrogen mustard) are the choice of pleurodesis agents.39Dr. Canmao xieDiagnostic and Treatment Workup of a Pleural EffusionWhether it is a pleural effusion or not ？Is the effusion a transudate or an exudate?What is the disease responsible for its production?Treatment for etiology and relieving symptoms40Dr. Canmao xieThank you for attention!41Dr. Canmao xie