CXR上可以看到的最少量(ml):
(a) PA: 300~500, (b) Lat.: 75, (c)
Decubitus: 25 per 1cm
Indications for thoracentesis: Asymmetry,
Fever, Pleuritic chest pain, failure to resolve
Light’s criteria (98% Se, 83%
Sp; 三項符合一項就夠)
(a) PF/serum protein > 0.5, (b) PF/serum
LDH > 0.6 ,(c) PF LDH > 2/3 ULN of serum LDH
但會把25%的transudate誤判成exudate, 故仍強烈懷疑transudate時改用Sp較高的test:
(a) Serum-PF Alb-gradient < 1.2 (87% Se, 92% Sp)
(b)
PF cholesterol >45 and PF LDH >200 (90% Se, 98% Sp)
Transudate: CHF, cirrhosis
(hepatic hydrothorax), nephrotic syndrome, CAPD, myxedema, SVC-obstruction,
pul.embolism(少)
Exudate: Infection,
malignancy, pul.embolism, collagen-vascular disease (RA, SLE, Wegener’s, Churg-Strauss), GI (pancreatitis, esophageal rupture,
abdomominal abscess), Others
(見麻2-11)
Parapneumonic: Underlying bacterial lung infection (pneumonia or abscess)
定義Complicated = (+) gram stain/ culture or pH < 7.2 or glucose < 60
定義Empyema = Gross pus
Tintinalli: Gross pus + [(+) gram stain/ culture or
pH < 7.1 or glucose < 40 or LDH>1000]
õ Complicated parapneumonic及empyema(exudative stage)需要thoracostomy drainage
# Amylase: Esophageal
rupture, pancreatic, malignancy
Glucose < 60: Malignancy, infection, RA
|
Etiology
|
WBC
|
RBC
|
pH
|
Glc
|
|
|
CHF
|
<
1,000
|
<
5,000
|
Normal
|
Serum
|
Bilateral
|
|
Cirrhosis
|
Right,
禁chest tube
|
||||
|
Parapneumonic
Uncomplicated
|
5~40,000
|
$
|
$
|
|
|
|
Parapneumonic
Complicated
|
<
7.2
|
<
60
|
Drainage
|
||
|
Empyema
|
25~100,000
|
<
7.1
|
<
40
|
||
|
TB
|
5~10,000
lymp
|
<10,000
|
Normal
|
Serum
|
AFB,
ADA
|
|
Malignancy
|
1~100,000
lymp
|
<100,000
|
Cytology
|
||
|
PE
|
1~50,000
|
no
infarct à transudate
|
|||
|
RA/SLE
|
1~20,000
|
<1,000
|
$
|
RA
$$$
SLE
nl
|
|
|
Pancreatitis
|
1~50,000
|
<10,000
|
Normal
|
Serum
|
Left
# Amylase
|
|
Esophageal
rupture
|
<5,000
>50,000
|
$$$
|
$$
|
(From
Tintinalli)
Empyema Piperacillin-tazobactam 3.375~4.5 gm q6h
or
Imipenem 0.5~1 gm q6h