结核性胸膜炎(英文)

VII. Treatment
1. anti-tuberculous chemotherapy in the same way as pul. tuberculosis 2. drainage of pleural fluid 3. corticosteroids ---- controversial
IV. Lab. Examinations
1. Chest X-ray Fluid is not visible when less than
300 ml. CT is needed in a few cases.
2. Ultrasonic examination More accurate than X-rays. Can provide vital information for thoracentesis.
VIII. Prognosis
Good in most cases.
Home Work
1. Read Chapter 13 (p135~141) carefully. 2. Review Chapter 9 (p84~104)
3. Thoracentesis and fluid examination ---essential (1)Fluid routine ---- exudate
specific gravity > 1.018; WBC > 500/cmm, predominated by polymorphs at early stage and lymphocytes later;
ret来自百度文库ospective, exclusive.
VI. Differential diagnosis
See Table 2-13-1 in p136
Transudate
1. Heart diseases 2. Kidney diseases 3. Liver diseases 4. Malnutrition 5. Endocrine diseases
Exudate
1. tumorous diseases 2. bacterial infection
empyema – purulent fluid reactive pleural fluid 3. connective tissue diseases 4. parasite infection, such as paragonimiasis 5. others
protein > 3gram/dl.
(2) Acid-fast staining for acid-fast bacilli (not sensitive). (3) Culture for tuberculous bacilli (time consuming). (4) Others: culture for bacteria, cytological exam, etc.
III. Clinical Features
Symptoms
1. Age, often seen in young people, but also in elderly people 2. Fever, typically 37-38C, but can be >39C 3. Chest pain, more severe when there is only little fluid. 4. Breathlessness, when there is a lot of fluid.
Tuberculous Pleural Effusion
For Grade 2000
I. Etiology and Pathogenesis
Etiology : Mycobacterium tuberculosis Discovered by Dr.Koch in 1882 Acid-fast
Pathogenesis :two theories Delayed hypersensitive reaction Pleural infection
Physical signs
1. Inspection: fullness of chest in the involved side. 2. Palpation: trachea shifts to the other side, weakness of vocal fremitus . 3. Percussion: dullness in the involved side. 4. Auscultation: disappearance of breathing sound
II. Pathology
Pleural congestion with cell infiltration, unilateral in most cases.
In the early stage, polymorphs predominate.
Typically, lymphocytes predominate. Tuberculous nodules Exudative effusion
4. Pleural needle biopsy ---- tub. granuloma 5. Others: Eos. count, liver function, immunoglobulin, ……
V. Diagnosis
symptoms + physical signs + fluid exam.