Transudate

Abstract: The first step in the evaluation of patients with pleural effusion is to determine whether the effusion is a transudate or an exudate. An exudative effusion is diagnosed if the patient meets Light's criteria. The serum to pleural fluid protein or albumin gradients may help better categorize the occasional transudate misidentified as an exudate by these criteria. If the patient has a transudative effusion, therapy should be directed toward the underlying heart failure or cirrhosis. If the patient has an exudative effusion, attempts should be made to define the etiology. Pneumonia, cancer, tuberculosis, and pulmonary embolism account for most exudative effusions. Many pleural fluid tests are useful in the differential diagnosis of exudative effusions. Other tests helpful for diagnosis include helical computed tomography and thoracoscopy.

Abstract: A pleural effusion is an excessive accumulation of fluid in the pleural space. It can pose a diagnostic dilemma to the treating physician because it may be related to disorders of the lung or pleura, or to a systemic disorder. Patients most commonly present with dyspnea, initially on exertion, predominantly dry cough, and pleuritic chest pain. To treat pleural effusion appropriately, it is important to determine its etiology. However, the etiology of pleural effusion remains unclear in nearly 20% of cases. Thoracocentesis should be performed for new and unexplained pleural effusions. Laboratory testing helps to distinguish pleural fluid transudate from an exudate. The diagnostic evaluation of pleural effusion includes chemical and microbiological studies, as well as cytological analysis, which can provide further information about the etiology of the disease process. Immunohistochemistry provides increased diagnostic accuracy. Transudative effusions are usually managed by treating the underlying medical disorder. However, a large, refractory pleural effusion, whether a transudate or exudate, must be drained to provide symptomatic relief. Management of exudative effusion depends on the underlying etiology of the effusion. Malignant effusions are usually drained to palliate symptoms and may require pleurodesis to prevent recurrence. Pleural biopsy is recommended for evaluation and exclusion of various etiologies, such as tuberculosis or malignant disease. Percutaneous closed pleural biopsy is easiest to perform, the least expensive, with minimal complications, and should be used routinely. Empyemas need to be treated with appropriate antibiotics and intercostal drainage. Surgery may be needed in selected cases where drainage procedure fails to produce improvement or to restore lung function and for closure of bronchopleural fistula.

Abstract: Pleural effusion is an accumulation of fluid in the pleural space that is classified as transudate or exudate according to its composition and underlying pathophysiology. Empyema is defined by purulent fluid collection in the pleural space, which is most commonly caused by pneumonia. A lung abscess, on the other hand, is a parenchymal necrosis with confined cavitation that results from a pulmonary infection. Pleural effusion, empyema, and lung abscess are commonly encountered clinical problems that increase mortality. These conditions have traditionally been managed by antibiotics or surgical placement of a large drainage tube. However, as the efficacy of minimally invasive interventional procedures has been well established, image-guided small percutaneous drainage tubes have been considered as the mainstay of treatment for patients with pleural fluid collections or a lung abscess. In this article, the technical aspects of image-guided interventions, indications, expected benefits, and complications are discussed and the published literature is reviewed.

Abstract: The aetiology based classification of pericardial disease comprises: infectious pericarditis; pericarditis in systemic autoimmune diseases; type 2 (auto)immune pericarditis; metabolic disorders; trauma; tumours; pericardial cysts; and congenital defects.1 This classification has major therapeutic consequences that will be elaborated upon in this article, with the focus on practical management of pericardial syndromes and specific underlying diseases. ### Pericardial syndromes The diagnosis of acute pericarditis relies on clinical findings, ECG changes, and echocardiography (table 1).2,3 Chronic pericardial inflammation includes effusive, adhesive, and constrictive forms, lasting three months or more. Recurrent pericarditis may be intermittent (symptom-free interval without treatment) or incessant (discontinuation of anti-inflammatory treatment always ensures a relapse). View this table: Table 1 Diagnostic pathway and sequence of performance in acute pericarditis.2,3 Pericardial effusion occurs as transudate (hydropericardium), exudate, pyopericardium or haemopericardium, or a mixture of these. Large effusions generally indicate more serious disease and are common with neoplasia, tuberculosis, hypercholesterolaemia, uraemic pericarditis, myxoedema, and parasitoses.2,4 Patients can be asymptomatic if effusion develops slowly. Many pregnant women develop a minimal to moderate clinically silent hydropericardium by the third trimester. Fetal pericardial fluid can be detected by echocardiography after 20 weeks’ gestation and is normally 2 mm or less in depth. More fluid should raise questions of hydrops fetalis, Rh disease, hypoalbuminaemia, and immunopathy or maternally transmitted mycoplasmal or other infections, and neoplasia.3 Echocardiography reveals the size of effusions: (1) small (echo-free space in diastole < 10 mm); (2) moderate (at least ⩾ 10 mm posteriorly); (3) large (⩾ 20 mm); or (4) very large (⩾ 20 mm with compression of the heart).2 Presence of fibrin, clot, tumour, air, and calcium can also be detected. Pericardial effusion must be differentiated from pleural fluid, ascites, atelectasis, or epicardial fat. Transoesophageal echocardiography is useful in loculated pericardial effusions, intrapericardial clots, metastases, and pericardial thickening. …