胸水
WordNet
- a substance that oozes out from plant pores (同)exudation
- of or relating to the pleura or the walls of the thorax; "pleural muscles"
- the thin serous membrane around the lungs and inner walls of the chest
PrepTutorEJDIC
- 浸出液
- ろく膜の,胸膜の
- ろく膜,胸膜
UpToDate Contents
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English Journal
- Inhibitory Effect of Helicteres gardneriana Ethanol Extract on Acute Inflammation.
- de Melo JO, de Arruda LL, Baroni S, Truiti Mda C, Caparroz-Assef SM, Cuman RK, Bersani-Amado CA.SourceLaboratory of Inflammation, Department of Pharmacology and Therapeutics, State University of Maringá, Maringá, PR, Brazil.
- Evidence-based complementary and alternative medicine : eCAM.Evid Based Complement Alternat Med.2012;2012:141947. Epub 2011 Oct 19.
- The anti-inflammatory effect of an ethanol extract of Helicteres gardneriana (Nees) Castiglioni was assayed in experimental models of pleurisy and microcirculation in situ. Treatment of animals with 500 mg/kg body weight reduced the exudate volume (35% reduction) induced by intrapleural injection
- PMID 22028731
- Getting the most from pleural fluid analysis.
- Sahn SA.AbstractVirtually, every pulmonary disease and most non-pulmonary diseases may be associated with a pleural effusion. The presence of a pleural effusion allows the clinician to "diagnose" or narrow the differential diagnosis and aetiology of the fluid collection. However, pleural fluid analysis (PFA) in isolation rarely provides a definitive diagnosis. This review discusses the rationale for evaluating patients with a pleural effusion. If the clinician obtains a detailed history, performs a comprehensive physical examination, reviews pertinent blood tests, and evaluates the chest imaging findings prior to thoracentesis, there should be a high likelihood of establishing a firm clinical diagnosis, based on the appropriate pleural fluid analysis. This manuscript reviews the clinical presentation, chest imaging findings, duration, and natural course of specific pleural effusions, to help narrow the range of pre-thoracentesis diagnoses. A diagnosis of transudative effusion confirms an imbalance in hydrostatic and oncotic pressures, normal pleura, and a limited differential diagnosis, which is typically apparent from the clinical presentation. Exudates are the result of infections, malignancies, inflammation, impaired lymphatic drainage, or the effects of drugs, and pose a greater diagnostic challenge. The differential diagnosis for a pleural exudate can be narrowed if LDH levels exceed 1000 IU/L, the proportion of lymphocytes is > 80%, pleural fluid pH is < 7.30, or there is pleural eosinophilia of > 10%.
- Respirology (Carlton, Vic.).Respirology.2011 Nov 7. doi: 10.1111/j.1440-1843.2011.02100.x. [Epub ahead of print]
- Virtually, every pulmonary disease and most non-pulmonary diseases may be associated with a pleural effusion. The presence of a pleural effusion allows the clinician to "diagnose" or narrow the differential diagnosis and aetiology of the fluid collection. However, pleural fluid analysis (PFA) in iso
- PMID 22059482
Japanese Journal
- 気管支内腔病変と両側胸水を伴った肺サルコイドーシスの1例
- 小嶋 圭介,柏原 光介,岩越 一,野津手 大輔,濱本 淳二,藤井 一彦,興梠 博次
- 気管支学 : 日本気管支研究会雑誌 31(6), 386-391, 2009-11-25
- 背景.今回我々は気管支内腔病変と両側胸水貯留を呈した肺サルコイドーシスの1例を経験した.症例.27歳男性.乾性咳嗽,労作時呼吸困難を主訴に当科紹介入院となった.胸部X線,CTでは両側縦隔・肺門リンパ節腫脹,両側胸水貯留を認めた.胸水は滲出性でリンパ球優位であった.気管支鏡検査では気管支壁に粘膜不整および小結節影を認め,BALFではリンパ球数,CD4/8比の増加を認めた.肺胞および気管支粘膜の生検組 …
- NAID 110007482914
- Multiple Myeloma Presenting Initially with Pleural Effusion and a Unique Paraspinal Tumor in the Thorax
- Yokoyama Toshinobu,Tanaka Atutoshi,Kato Seiya,Aizawa Hisamichi
- Internal Medicine 47(21), 1917-1920, 2008
- … We herein report an extremely rare case of a patient with IgD-lambda positive multiple myeloma presenting with myelomatous pleural effusion and ascites. … His chest radiograph findings on admission revealed a left pleural effusion, and later, bilateral involvement. … The cytological examination demonstrated myeloma cells in the pleural effusion and ascites, and histologically, in the pleura, an abdominal subcutaneous tumor and bone was observed. …
- NAID 130000079591
Related Links
- Transudative pleural effusions are defined as effusions that are caused by systemic factors that alter the pleural equilibrium, or Starling forces. The components of the Starling ...
Related Pictures
![Pheumothorax = collapsed lung](https://1mg.info/0/1/e/0076.jpg)
![EXUDATE = accumulation of fluid due to](https://1mg.info/0/1/e/0077.jpg)
![Management](https://1mg.info/0/1/e/0078.jpg)
![transudate, exudate, pleural effusion](https://1mg.info/0/1/e/0079.jpg)
![front](https://1mg.info/0/1/e/0080.jpg)
★リンクテーブル★
[★]
- 英
- pleural effusion, pleural fluid
- 同
- 胸膜滲出液 pleural exudate
- 関
- 胸水貯留
概念
- 胸膜腔内の液体。
- 元々は壁側胸膜で産生され、胸膜腔に開口部を有する壁側胸膜のリンパ管から排出されると考えられている。
- 生理的に少量20ml程度の胸水が存在し、壁側胸膜と臓側胸膜との摩擦を低減させ、呼吸運動を円滑にする作用がある。
- 病的な状態の存在により、産生と排出のバランスが崩れると胸水が貯留する。
組成
- IMD.457
量
|
0.1-0.2 ml/kg
|
細胞数
|
1000-5000 /ul
|
mesothelial cells
|
3-70%
|
monocytes
|
30-75%
|
lymphocytes
|
2-30%
|
granulocyte
|
10%
|
蛋白
|
1-2 g/dl
|
アルブミン
|
50-70%
|
糖
|
血糖と同じ
|
LDH
|
血清レベルの50%以下
|
pH
|
血清よりややアルカリ性
|
種類
|
漏出性胸水
|
滲出性胸水
|
外観
|
透明
|
混濁
|
比重
|
<1.015
|
>1.018
|
タンパク
|
<2.5 g/dL
|
>3.0 g/dL
|
LDH
|
<200単位
|
>200単位
|
Rivalta反応
|
(-)
|
(+)
|
原因疾患
- 漏出性胸水:うっ血性心不全が多い
- 滲出性胸水:結核性胸膜炎と癌性胸膜炎が半数以上
漏出性胸水(transudative pleural effusion)と滲出性胸水(exsudative pleural effusion)の鑑別
Lightの基準(Light's criteria) (Chest 1995;107:1604)
- 以下いずれかに合致する場合、滲出性胸水と判断する。感度98%、特異度83%。ただし、25%の例で漏出性胸水が滲出性胸水と判定される場合があるので、特異度の高い検査で確認する。
- 1. 胸水蛋白/血清蛋白>0.5
- 2. 胸水LDH/血清LDH>0.6
- 3. 胸水LDH>血清LDH上限の2/3
より特異度の高い検査
- 血清Alb-胸水≦1.2 ならば滲出性胸水である。(感度87%、特異度92%)
- 血清TP-胸水TP≦3.1 ならば滲出性胸水である。(感度84%、特異度91%)
- 胸水コレステロール > 45mg/dLかつ 胸水LDH > 200 (感度90%、特異度98%)
漏出性胸水
原因による分類
- 静水圧↑:うっ血性心不全、収縮性心膜炎、アミロイドーシス
- 血漿膠質浸透圧↓:ネフローゼ症候群、肝硬変、低栄養
滲出性胸水
身体所見
- 肺肝境界:(右肺ならば)上昇
- 心濁音境界:(十分に貯留していれば)消失
-
検査
- CPAがdullであれば300mlの胸水貯留が示唆される
診断
- 胸水の有無についての診察と画像検査で確定できる。
- 原因については、スクリーニング検査を追加する必要がある。
治療
[★]
- 関
- decoction、effusion、leachate、transudate、transudation
[★]
- 関
- (n.)pleura 胸膜