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INTRODUCTION
Other
• •Congestive heart failure
• •Cirrhosis
• •Nephrotic syndrome
• •Kidney failure
• •Peritoneal dialysis
TRANSUDATIVE PLEURAL • •Urinothorax
EFFUSIONS • •Myxoedema
• •Hypoalbuminemia
• •Atelectasis
• •Sarcoidosis
• •Pulmonary embolism
• •Vena cava superior syndrome
• •Meigs syndrome
• •Constrictive pericarditis
• •Cerebrospinal fluid leakage to pleural space
• •Neoplastic diseases
• •Metastatic diseases
• •Mesothelioma
• •Lymphoma
• •Infectious diseases
EXUDATIVE PLEURAL
EFFUSION • •Bacterial infections
• •Tuberculosis
• •Fungal infections
• •Parasitic infections
• •Viral infections
• •Pulmonary embolism
• •Cardiovascular diseases
• etc
• •Asbestos exposure
• •Lung transplantation
• •Bone marrow transplantation
• •Trapped lung
• •Radiation exposure
• •Drowning
OTHER
• •Amyloidosis
• •Thoracotomy
• •Electrical burns
• •Extramedullary hematopoiesis
• •ARDS
• •Syphilis
• •Iatrogenic pleural effusions
• •Haemothorax
• •Idiopathic pleural effusions
DIAGNOSTIC APPROACH IN PLEURAL
EFFUSION
Antibiotic treatment
Operation
Supportive treatment
ANTIBIOTIC TREATMENT
• The most common pathogen of community- • For community-acquired pleural infection, the
acquired pleural infection is streptococcus, combination of penicillin + βlactamase inhibitor
followed by anaerobion and staphylococcus would be selected
• MRSA and drug-resistance gram-negative bacteria • For community-acquired pleural infection, the
are the most common bacteria in hospital- combination of penicillin + βlactamase inhibitor
acquired pleural infection. would be selected
• The proportion of the staphylococcus in hospital- • Thus, at the primary treatment stage, the above
acquired pleural infection and gram-negative two kinds of bacteria needs to be covered
bacteria is higher, and the proportion of (vancomycin, linezolid, carbapenem, third
methicillin-resistant staphylococcus aureus generation cephalosporin and others), as well as
(MRSA) can reach up to 25%; while the anaerobion (metronidazole or clindamycin)
proportion of streptococcus in hospital-acquired
infection is very low. • Antibiotic treatment needs 3–4 weeks in general
THORACOCENTESIS AND CHEST
DRAINAGE TUBE PLACEMENT
• Studies have found that medical thoracoscopy treatment has been effective for
complicated parapneumonic effusion treatment for approximately 90% of
patients.
• Medical thoracoscopy can separate the membrane and adhesive band, remove
infected tissues, absorb the adhesive band, wash the thoracic cavity, and place
the chest drainage tube under direct vision, allowing it to be beneficial to
disease treatment.
• Thoracoscopy treatment is suggested when conservative medical treatment
fails.
OPERATION
• The operation decisions for these patients are subjective due to failure on
explicit indicators for operation opportunity confirmation. It is suggested to
consider operative treatment when patients continue to develop sepsis with
pleural effusion after antibiotic treatment and chest drainage.
• If conservative treatment exceeds 3–7 days (28) and antibiotics, pleural fluid
drainage + intrapleural injection and other treatments fail to receive good
effects, or there is evidence that the empyema is forming, operative treatment
can be considered.
• However, large-scale and high-quality prospective studies have confirmed the
objective indicators and optimal node for operative treatment.
SUPPORTIVE TREATMENT