胸膜淀粉样变

目的探讨胸膜淀粉样变在胸腔积液鉴别诊断中的意义。方法回顾性分析系统性淀粉样变病例中胸腔积液的发生率及其临床特点。结果１５例系统性淀粉样变中，７例（４７％）合并胸腔积液，其中４例由经皮针胸膜活检刚果红染色阳性而确诊为胸膜淀粉样变。结论系统性淀粉样变合并胸腔积液并非罕见。多器官损害合并胸腔积液时应疑及该病。经皮针胸膜活检具确诊价值。     

Pleural cryptococcosis

Pleural infection by Cryptococcus neoformans is uncommon and when present typically occurs in the immunocompromised host. We report two renal transplant patients who developed pleural cryptococcosis.     

Pleural infection

Pleural infection is a relatively common complication of pneumonia with a broad aetiology. Parapneumonic effusions caused by an infection of the pleural membranes occur in 40–57% of cases of pneumonia. A variable percentage (10–20%) of parapneumonic effusions progresses to empyema (pus) and/or abscess formation (encapsulation). Pleural infection is associated with significant morbidity and mortality. Diagnosis requires a multidisciplinary approach which may include respiratory physicians, thoracic surgeons, microbiologists and radiologists. Rigorous and prompt treatment with antibiotics, good clinical care and timely drainage of effusions remain the cornerstones of effective management.     

Pleural manometry

The goals of therapeutic thoracentesis are to remove the maximum amount of pleural fluid to improve dyspnea and to facilitate the diagnostic evaluation of large pleural effusions. Pleural manometry may be useful for immediately detecting an unexpandable lung, which may coexist when any pleural fluid accumulates. Pleural manometry may improve patient safety when removing large amounts of pleural fluid. The basics of pleural space mechanics are discussed as they apply to the normal pleural space and to pleural effusion associated with expandable and unexpandable lung. This article also discusses the instrumentation required to perform bedside manometry, how manometry may decrease the risk of re-expansion pulmonary edema when large amounts of fluid are removed, and the diagnostic capabilities of manometry.     

Pleural ultrasonography

Ultrasonography has achieved acceptance as a routine clinical tool for clinicians managing pleural disease. This article provides an overview of the field of pleural ultrasonography with an emphasis on clinical applicability and procedure guidance.     

Pleural fibrosis

Pleural fibrosis can result from a variety of inflammatory processes. The response of the pleural mesothelial cell to injury and the ability to maintain its integrity are crucial in determining whether normal healing or pleural fibrosis occurs. The pleural mesothelial cell, various cytokines, and disordered fibrin turnover are involved in the pathogenesis of pleural fibrosis. The roles of these mediators in producing pleural fibrosis are examined. This article reviews the most common clinical conditions associated with the development of pleural fibrosis. Fibrothorax and trapped lung are two unique and uncommon consequences of pleural fibrosis. The management of pleural fibrosis, including fibrothorax and trapped lung, is discussed.