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Tepe outing “Diagnostic evaluation of a pleural effusion in adults: Initial testing sears ecowmenomons Evaluacion diagnéstica de un derrame pleural en adultos: Pruebas iniciales. |NOICATIONS FOR THORACENTESSS ‘ivr bm Helle Etre MOSetn VCore ined ‘covemons n8cnosE0 BF 1 Cc ae MO éter i:ai ‘renucenese ‘estate eva LUD MUS Somat ‘otc Gre pee ere ene es cnet i in pte Teme ne micah Me 28 vo Entenpeiontittentaien Tin aps ya Cet oe inrRooueTion an InTRODUCCION + Wetine stamina cava tale son's react anf hava coe Literacies den dere prs ia enn med mer lanl Gt pla ‘a quantea to crane aC cotet” Latoacocontsis es n proceso sepluro ala aa con un gui omgees ue pare omar muostas del ue, vsuaaro, ‘xamario merescpicarente y unriicato para determina sucorenide quia y tia. ‘sya pose o ana of edn concen wih te cial resents lows cokes to ugh he cause ta fuse, nar he aorta agnosesand sign a managment anna maorty of patents who unto slowal Nd ana. ‘Un enioae stoma pra lands avid nto conf preseiacn cca perme as mics dagostcar la casa oo un dora, ‘duces dagntsicos dlcencie y aaa un pln oe mane maya Geos paces ques somaten sun ens di plu ‘an oprah to pla td aa ibe prosensd ate ‘ui se preseiars una aroma a anisole Plea ud miobilogctests, pualimaging the ecknique cf heracentess, an an aproach ole esos of uncanny ater the ia evluton se cussed sepa. Us pubs mceioigcas detiqude lua a magendoga lou aia ds eracontess yl abodae ds ramos lous stolons inceta dese den evatiocsn cal 6 anlzan pr sap, (See main oneal esos nals ad “Ucn ded acento and spon evn of a sion acl ‘Aaailon! sac wdeemined toby an "Tuercuous pleural esr” and Perl ef n HV afectes pss and Pavsnaurade fin and nevena.n ats) (Const agnes de erames pleural en adultos yToacetes guia por aso y Evan hagndsica de dramas leurs en ‘ites: Pacts adenses pve olga no detmnadsy Deane pews! uberis’ y Ehsaespawsles n pacts ifectass po Vit y«Dorame yerpsma prasnourénios on ads) INDICATIONS FOR THORACENTESIS INDICACIONES PARA LA TORACENTESIS “Tho ndaton for dogost hracntss the new dng ofa pow efsien Lndcacen pra a forcentenis apnea cre alge de on dean pea. ‘senate neue dapnstc hxscnless, may Be warated uals Nea aye and Weal pewsy Lactservac, eninge de a teacertets anndsten, ovede scare ena insistence cariaca a Complicate flees ial Inthe tomer sting, the cine agnosis usualy sou nth at, thoes yal smal amount Enelcanteo antl dagnésice cinco suse ser spiro en este tna, tpeament hay un pequefia can dl ido Hoeven stuson stp or desl poms as sched eacenies shouldbe paruoned ‘Sn emtaran st stueoinclinca es lice an teresa sginlo pein, so dee relearn acne “ho ndatons ane enancatons of beraceross re prsorod separate ss indcacnesyconandescones dee aceres se presenta par separa. (See unsound pues orcs) {Cons Tracers quadaprutasondo) ‘CONDITIONS DIAGNOSED BY THORACENTESIS ‘CONDICIONES DIAGNOSTICADAS POR TORACENTESIS ‘nly select numba of dagnses can bo etabished inte by omconsss ‘Sto se pu estbecr detent un ime sla de dado mediante acne, ‘Those elude fusions asa est et mabgancy, empyene,ubercuois plus, ungatnecen oe paw space, cyethre, costal usin, neeraxosophgea rupture, herethra,prtonea ass, and extavascur maton of cena venous cat al 1) Esosincuren demames como rsa de magna epiema.pivie ieraior, misc mien del espacio pea ania, dram calor urna, nptua solic, hamotax, dss prtoncaly mga oxrevascular de un site venoso cent ala 1) [1 arerconitns at can te dagosed ty racers dude giynomorx, ceetrosinal ud shape, and paras ectan oe ples sare ss condones mis aus que se pueden dagostcr pr traces ince gn, ipa celui cfaloraqudo encod parstora espacio pew) Poste pleural tad ups entbamstosus (LE) co preparston tests, pura fad tra atbudes ANA) tars 1 160, na plea! Mois pusbospostves d reparacion de clas do pus earns (LE) ent Kao ora. os los d antes anticeares do aio peual (ANA) 21-16, yun roporn de ANA quo pew a suo 21 se habion consderad prevmetedagéstos de peu lipcs Hoeve soe of ese trys occu slam us puis ‘Samara, ringun 6 esos halazys produce cameo ona pews pica. ‘Moscincalabralones no lnge orm ups al preparation ss, whch are eng ae compl 2 {La mayerta de sabes cies ye ne reatzan puss de prepacin de clas de ups, que son lugs y cars [2 tough LE cas may be net detected by peal hud cog, sting Nas ow dagost ty ‘Aunayo tas cas LE pode deta inioriaont po cla dol uo pleural, eo halazgo tone ue baud do dames, ‘Ts because LE cls nave en enc oun pla fu alan examination non ups ea son (=, maianany, ‘maura amens) (255) Eso so deb a qos clas LE han so oniadas en xen ckieas den de uid ral en dears no rlconados cone |upus(p€j,Turors manos, artis eure) 25.6). ‘Stray, sat case Saves suppest a prt fd ANA He 21160 no dagooste of upus peut pect of 83 econ] because Such ters can aso be ound in exudate sxepneuneni an malgnanc esocaie esos (1 ‘De manera str, pouotasSnls do casos suporen a tu de ANA oo ai awa = 160 nes dagéstice de lus inca (especie dl 8 por cont) [7] debitoa que dos tos tare so puodenenconr en dames estos, paanauénicsy mares 19) Even an extemetynigh pal ud ANA >t 60 can occu malignant eMons 1 Incluso unui pleura reader ato ANAWD3 640 pode aparece en deares manos [10 2 plural fd ANA er 21180, Ronever rains a enstve (860100 perce for deci pus plein pens wih krown ean lupus {23} ey aterentstng between pus lout nd fer causes opel ehsies m ups patents ‘Un tuo do ANA onl ato paral: 160, sn embargo, sue iodo ura heart sonsbl (86 a 100 por Cot) pra dtc apes tips paconts con un iagndsteo concco elupus [7-1], ferencando as ene la plurs ipa y as casas de daramespleuraies En acai con ips Using eat of leur efusion serum ANA of 21 [7.2] orANA sarang pate n plu Td ofa row ny ata! eprstc value ‘orks purs 8.10) €tusode a ceacén de darame plural a ANA sérco de =1 [79,10] opatén de tctn ANA en qu lea no prpercona ning aor asgnstcnascons pra pours pea [8,1 “Thus, measug eure ANA tes nas eter nga rede vue han postive prev vale and appears 1 to Use ON or oxcng te dagoss of ups leurs, priculary in paters who have a kaw gnosis f SLE ori tno cin des uo de ANA ene gu pela un meow rave agave que un arpecop y pata oo son para excel dagntsico de aus pce, ptlsmente en pacetes que onan un daghtsto conocido do LES. (Soe Putmnary mniosatns of sta ucusenhamatousin as") (Wor Manfestaconespumonars ups rtmaoso ssn en ado) PLEURAL FLUID ANALYSIS. ANALISIS DE FLUIDOS PLEURALES “Test tiney prom on pera anc cell cunt and cel alee pH rote lac deycogenae (LOM) and gicoee Las pruebas que sevesizan runaranente eo igud ual nye ecvnt cary ence al, pcos, tate deshetonenasa (DH) ahcosa ‘edie! como promod tess insole pater incde amas, chs, cers, Neil pera ative: patie (BNP), ceatnne, adenosine deaminase, gam and ads! baas (AFB) sta, bali and AFB cure, ar cen ‘spt acca corner raion en paces slaconade cuen emia cleo tigers, ppd nate xo. ‘retro Nominal BNP) rena, aseosnadesaminas, nn do Gram baclo dbp (AFB), ctv batotano AFB, clin ‘ose appearance — inl dognose cues canbe cine by goss specon of perl Muda Bag spate om he patents chest 3} ‘Aspaca genet se puaten cee pss dagodstcas mis Medsrela speci oneal del qu let a masa qu se asp dst ‘ere patent (i, tseratons tht we help fr dagnoss a sted ine tbe aie) Las easrvadones quo son les pata agnostic se erameran en ata bia 2), ‘charactarization — Tho perl huis next characte as sie a ransutate or an oxo Caracereac: tude owas caractza a cotruscon core un tans oun exo (see nse cia bow) (Wer Ciloes de dag 8 contusion) “Tranudates —Trarsudnes est lm imbalances nhydesah ard enc pressures inte chest occur wih CHF and naps, or constons eral te perl space “Transodos.ostansudads one esvlado de desequltns en las reine hiosteas yonceas nto, accents earns a spac pets "Exapis fo iat inclu movement fd om be orton crebrospnal, oretepertaneal spaces, Hom toner cases, sch as ‘stad nson trough a conta enous cater that has mae the mediastinum cr wasps Les eameoa do ets dios nciyen el mova de ude desde oe especies parton, crebospnalo rebopertonal, por causas ‘atogencas, como a its de erstaodes eas doun cle vaso cntal que a mira a moda o espacio Pew Nevoress,ransudates have alte nunbor of dagrstic esis hat can suay He scored rom te pabents incl resonaton cone) ‘Sh ebego os vase Sanen in nto Hod depos de Sago qu gnsalmente se pun ceri a pat presen cinca det pacorte (aba 3) | x como oxure cena IGG yi nudates— in contast uae ots present mre ofa dlgnost chaloge. ‘Suotos en conte, os coremes enutavos pesensa nas un deste diagno. Disease in vital ny ogen can cause exudative peal sens by ava of mechanisms chug cen, malgnancy immundoge responses, phate abner reninfcieus infarmaton regen cause, and movement of us om Bab he diaphragm (abi) |aesermota en vtuanents cniuirégane puede causa coraresplouaes exuties pr una arid do mecansmes, cy occn, mained espuests nmundliges, annie Insss ilamacon no nisccsa, causes togéncas y mavimto de iqado desde eb dl dakapra (ale 4) vues su pay tom pleura and ug ifsrmatn (sung nnseesed entry of ud and ron due o eve callry pemesoity) or rom neared pha riage ote pleural pace Fesung in a doceasod real of paral and proton) Ls exudes se debon princpalmen a namacon pray puronao quo ests en una maj ents de iquo pti debi ‘ermésbiidad capa loved) 0 al deteoro del drenaje lattice del espacio pleural (io que produce una disminucKn de a iminacin del guide y——— Exudoes can 60 est tor movement fu fom he pertooa spare, a seen wth acl or cron: pancreas, chcus ascites, ad personel cwenamatoss ‘es exis tami pusden sur movin de gud desde espacio prota, co se chess en panes apie occa, asi quilsa ys carceematoss pertonea (See ach of lun acca nse”) (Wer Mecasnos de acumuac de que lows en a efemeda’) Diagnostic cera — Tho Uns rte ul isa radon ead fdierntatngYanswats ard oxealos hat measures soma and eral ui protein ae LOH (2) ‘Cites de dagnsten la Ree de crteras de Lights un metodo aden pa deen vansudos y aodos que moa tana ‘seo dln pleura y a LO 112 ‘Abroad vrsns of Light's Ctra Rul have slr agnosie acura a have teen recommended fer incl ws.) as vesinossbreuadas dea Rega de crores de ight tenen una presi dgnésicesmiary se han ecamendado paras ini (13.6) ‘Aconing oe von Lips Gta Rue, fast one oolong eects, Corgan est he) fled, he Rud eine as an ext 12 ‘De acu con a Rega de Citrine a uz acon sse cumple al mans uno de os ts cies igen (es doc, spruces do campoventes doa ep}! tudo se dine como un ead [12 + Pleura pron serun poten ato itr han 05, cr ‘Proporta pratana d sue ria de Kato paul spar 05,0 + Plural id LOHserum LOH rato eater ran 06. or ‘+ Proporin de LDH a liu plural LOH en suo sper 88,0 + Pleutlhd LOH restr han two ish upper mts of eats’ real stu LDH ‘= Literal mayor a doses os Ite syporeres da LDH sércanomal et aberatoo Combing ests fo omer dchstomeus tess it @ agnostic ni, as dane by he Light's Ceri Rule, wharin nove componettest ‘esut needs tobe postive to make e ees postive days nceasas Senta expense of ecseasing spect of he Me Lacambracin dos resitas dos o mis rustas destmica n unarepla de hgndseo, came bo hes i Rega do Crisis do Lin endo slo resi dln prusba component abe se posto pra que rsulago dara sea psive, sere aurea a senso ‘eapenas dois espactdatdecrecete dea og ‘As would be expect, mart, e sens ce Light’ Cite Rule ger han We sens ofeach he Bvee components ofthe ro tuethe soc fhe os lowe ants nil corpenents oro tanto, come es de espera a sensi de ala do coos de Lit es mayor quo sonst do caa una do sos pas do components dela epe, pl especie de legs es mena qu Sus components nails “Ts tatoo of none sent fr ler spctty ine dsign of LMC Russ apron for evavaing pow Msbocause is npevanthatexutates rt be missed, snc hy can have mporant ogres pcans Este campromiso de maj Sarsided po ura menerespectdad eno deo dea Rep de Crtars de Ligh as aropado para elute gud ows peque es mga ue nos plaan os exutatos, ye que puoden one mparants mpeacoasprnisas ‘Sere ransufaes, however, maybe missed as an xucae becuse oe decreased specie of he i] ‘Shenae alos ransutadospudon circ enénearents como sxuodosdebd al smnucen de laespecced de rena 15 Lugs tere nave toon cz fo nudeg bath he pleut Ms LOMSetum LOM eto and eeu Mu LH 15 because ey ae Mah comoed 12151 Les ris o Lint ha sd ita erin at otacn LOH digi peal! LOH en sero came a LOH el ii pla 13 rue eatin atameneconeaconad (13,18) ‘omatve danas itora as exst Tambien stn raves dagndsicos atoms ‘Amol. aaiss of ght stuthos (1448 pats examines soul ui ets nd found hat soe tsts ert exudates we acuracy sia ‘hose used n ght csi, but i rt eqireconuren measure of sarum pon LDH LS) ‘Un metsandiss each esses (448 pastes) examin ns rues de quid plows encone que vais prusbesnsscaten eas «cam un recs sia 3s utah en cries Lg, pro no equrenla medcn simutnea de poten sas OLOM [13] Proposed tw ria and eee criera éagnos ues, whch require ene crisin beet fine an ext, rie Las ags de apnstinpopunis de cos cts yas res, qu equeren que se cunplaun tae para dein ex, ncyen + Trotest le ‘Rosia do dos puss + Por! ud celeste ret han 45 mai * Clete del gud perl superior 45mg, + Pur! ud LOH gree nan 045 res pe it te abarstarys norma seum LOH * Lia pleural LDH suporera 0.4 veces te superior LDH sérco noma dl boas 1 Regl dewesprachas + Pres! td poten greater than 28 4.250) * Pretend indo wal superior 329 9/4. 20 9/L) + Pura! uc cheese greater han 45 gi (115 eit) + Cols one plea sipetora 45mg (165 neo) + eur! ud LOH greater nan 045 res wpe it ot abot nora eum LOH + Liao pleura LH siperr 0.45 veces te spe LDH Seo del boo “Tho rovus plow ud LOH cio point fo feentting betneon exes ae tansaos nthe cial Ugh ria ue was 67 pacont (1067 ts) he up tf nema atu LOH punto econ air de Ltt en gud peur pra rence ex0d30syarsudados ena res 8B Geos es de Lh {vol 67 por cero (0067 vos) ot suptr doa LOH sca norma “Toi ben changed oS percent, asada ena of ach ron eid 315) sto sea canbato a4 por conto tase en ol uow ands deca itso rdvitument [13 10) ‘A alableests may wiscasiy plea ud as exudates or tansdaos when values neath cao pits [12 198 “dass psoas dsponbls pueden clscareréneamets io paral cono exudes otrnsicaes anoles ales stn ceca do los pros decor 121815) “Thus clini jciomment is vaquirwed wren eating peters with bowletine test results 42)