[Contribution of pleural fluid analysis to the diagnosis of pleural effusion]. / Contribución del análisis del líquido pleural al diagnóstico de los derrames pleurales.
Med Clin (Barc)
; 145(4): 171-7, 2015 Aug 21.
Article
em Es
| MEDLINE
| ID: mdl-25433793
ABSTRACT
Analysis of pleural fluid can have, on its own, a high diagnostic value. In addition to thoracocentesis, a diagnostic hypothesis based on medical history, physical examination, blood analysis and imaging tests, the diagnostic effectiveness will significantly increase in order to establish a definite or high probable diagnosis in a substantial number of patients. Differentiating transudates from exudates by the classical Light's criteria helps knowing the pathogenic mechanism resulting in pleural effusion, and it is also useful for differential diagnosis purposes. An increased N-terminal pro-brain natriuretic peptide, both in the fluid and in blood, in a due clinical context, is highly suggestive of heart failure. The presence of an increased inflammatory marker, such as C-reactive protein, together with the presence of over 50% of neutrophils is highly suggestive of parapneumonic pleural effusion. If, in these cases, the pH is<7.20, then the likelihood of complicated pleural effusion is high. There remains to be demonstrated the usefulness of other markers to differentiate complicated from uncomplicated effusions. An adenosine deaminase > 45 U/L and>50% lymphocytes is suggestive of tuberculosis. If a malignant effusion is suspected but the cytological result is negative, increased concentrations of some markers in the pleural fluid can yield high specificity values. Increased levels of mesothelin and fibruline-3 are suggestive of mesothelioma. Immunohistochemical studies can be useful to differentiate reactive mesothelial cells, mesothelioma and metastatic adenocarcinoma. An inadequate use of the information provided by the analysis of pleural fluid would results in a high rate of undiagnosed effusions, which is unacceptable in current clinical practice.
Palavras-chave
Analysis of pleural fluid; Análisis del líquido pleural; Derrame pleural; Derrame pleural neoplásico; Derrame pleural paraneumónico; Derrame pleural tuberculoso; Diagnosis of pleural effusion; Diagnóstico del derrame pleural; Malignant pleural effusion; Parapneumonic pleural effusion; Pleural effusion; Tuberculous pleural effusion
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Derrame Pleural
/
Líquidos Corporais
/
Toracentese
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
Idioma:
Es
Ano de publicação:
2015
Tipo de documento:
Article