{"id":1495,"date":"2019-04-07T15:32:55","date_gmt":"2019-04-07T12:32:55","guid":{"rendered":"http:\/\/www.internalmed-journal.in.ua\/?p=1495"},"modified":"2019-06-21T01:01:48","modified_gmt":"2019-06-20T22:01:48","slug":"%d0%b2%d0%be%d0%bf%d1%80%d0%be%d1%81-%d0%b4%d0%b8%d1%84%d1%84%d0%b5%d1%80%d0%b5%d0%bd%d1%86%d0%b8%d0%b0%d0%bb%d1%8c%d0%bd%d0%be%d0%b9-%d0%b4%d0%b8%d0%b0%d0%b3%d0%bd%d0%be%d1%81%d1%82%d0%b8%d0%ba%d0%b8","status":"publish","type":"post","link":"http:\/\/www.internalmed-journal.in.ua\/en\/archives\/1495","title":{"rendered":"Issues of differential diagnosis of pleural effusions"},"content":{"rendered":"

Prof. Shevchenko O.S., PHD Shevchenko R.S., PHD Todoriko L.D.*, PHD Pohorielova O.O<\/strong><\/p>\n

Kharkiv National medical University.<\/p>\n

*Higher State Educational Establishment \u00abBukovinian State Medical University\u00bb.<\/p>\n

Pleural effusions are a frequent complication of various diseases. However, despite their prevalence, diagnosis and differential diagnosis of effusions remains a challenge. The presence of pleural effusion can be confirmed radiologically, as well as with CT and ultrasound. However, to prescribe the appropriate therapy, it is not enough simply to determine the presence of effusion \u2014 it is necessary to conduct differential diagnosis of transudate and exudate and determine the etiology of effusion. In this article, the features of complaints, anamnesis, X-ray picture, ultrasound and CT diagnostics, analysis of pleural fluid under various pathological conditions are systematized. Diagnostic biochemical markers, allowing to establish the etiology of effusion, are considered. Only an integrated approach and taking into account the markers of pathological processes will allow to correctly diagnose and prescribe the treatment timely.<\/p>\n

Key Words: <\/strong>pleural effusion, diagnostics, biochemical markers.<\/p>\n

https:\/\/dx.doi.org\/10.15407\/internalmed2019.01.013<\/a><\/h5>\n

Download.PDF<\/a><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
1. Incekara FO, Tikici SK, Nomenoglu H. Pleural Effusions. Insights in Chest Diseases 2018;1:1-7. doi: 10.21767\/2577-0578.10040.
\nhttps:\/\/doi.org\/10.21767\/2577-0578.10040<\/a><\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
2. Bhatnagar R, Maskell N. The Modern Diagnosis and Treatment of Pleural Effusions. BMJ 2015; 26-30. doi:10.1136\/bmj.h4520.
\nhttps:\/\/doi.org\/10.1136\/bmj.h4520<\/a>
\nPMid:26350935<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
3. Feller-Kopman D, Light R. Pleural Disease. The New England Journal of Medicine. 2018;378:740-51. doi:10.1056\/nejmra1403503.
\nhttps:\/\/doi.org\/10.1056\/NEJMra1403503<\/a>
\nPMid:29466146<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
4. Psallidas I, Kalomenidis I, Porcel JM, Robinson BW, Stathopoulos GT. Malignant pleural effusion: from bench to bedside. Eur Respir Rev. 2016;25:189-98. doi:10.1183\/16000617.0019-2016.
\nhttps:\/\/doi.org\/10.1183\/16000617.0019-2016<\/a>
\nPMid:27246596<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
5. Rahman NM, Kahan BC, Miller RF, Gleeson FV, Nunn AJ, Maskell NA. A clinical score (RAPID) to identify those at risk for poor outcome at presentation in patients with pleural infection. Chest. 2014;145:848-55. doi:10.1378\/chest.13-1558.
\nhttps:\/\/doi.org\/10.1378\/chest.13-1558<\/a>
\nPMid:24264558<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
6. Scarci M, Abah U, Solli P, Page A, Waller D, van Schil P, Melfi P, Ralph A, Athanassiadi K, Sousa M, Cardillo G. EACTS expert consensus statement for surgical management of pleural empyema. Eur J Cardiothorac Surg. 2015;48:642-53. doi:10.1093\/ejcts\/ezv272.
\nhttps:\/\/doi.org\/10.1093\/ejcts\/ezv272<\/a>
\nPMid:26254467<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
7. Porcel JM, Valencia H, Bielsa S. Factors inf luencing pleural drainage in parapneumonic effusions. Rev Clin Esp. 2016;216:361-6. doi:10.1016\/j.rce.2016.04.004.
\nhttps:\/\/doi.org\/10.1016\/j.rce.2016.04.004<\/a>
\nPMid:27161381<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
8. Hooper CE, Edey AJ, Wallis A, Clive AO, Morley A, White P, Medford A, Harvey J, Darby M, Zahan-Evans N, Nick A. Maskell. Pleural Irrigation Trial (PIT): a randomised controlled trial of pleural irrigation with normal saline versus standard care in patients with pleural infection. Eur Respir J 2015;46:456-63. doi:10.1183\/09031936.00147214
\nhttps:\/\/doi.org\/10.1183\/09031936.00147214<\/a>
\nPMid:26022948<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
9. Taghizadeh N, Fortin M, Tremblay A. US hospitalizations for malignant pleural effusions: data from the 2012 National Inpatient Sample. Chest. 2017;151:845-54. doi:10.1016\/j.chest.2016.11.010
\nhttps:\/\/doi.org\/10.1016\/j.chest.2016.11.010<\/a>
\nPMid:27876589<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
10. Porcel JM, Gasol A, Bielsa S, Civit C, Light RW, Salud A. Clinical features and survival of lung cancer patients with pleural effusions. Respirology. 2015;20:654-9. doi:10.1111\/resp.12496.
\nhttps:\/\/doi.org\/10.1111\/resp.12496<\/a>
\nPMid:25706291<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
11. Clive AO, Kahan BC, Hooper CE, Bhatnagar R, Morley AJ, Zahan-Evans N, Bintcliffe OJ, Boshuizen RC, Fysh ET, Tobin CL, Medford AR, Harvey JE, van den Heuvel M, Lee YC, Maskell NA. Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score. Thorax. 2014;69:1098-104. doi:10.1136\/thoraxjnl-2014-205285.
\nhttps:\/\/doi.org\/10.1136\/thoraxjnl-2014-205285<\/a>
\nPMid:25100651 PMCid:PMC4251306<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
12. Hallifax RJ, Corcoran JP, Psallidas I, Rahman NM. Medical thoracoscopy: survey of current practice – how successful are medical thoracoscopists at predicting malignancy? Respirology. 2016;21:958-60. doi:10.1111\/resp.12725.
\nhttps:\/\/doi.org\/10.1111\/resp.12725<\/a>
\nPMid:26714585<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
13. Kheir F, Shawwa K, Alokla K, Omballi M, Alraiyes AH. Tunneled pleural catheter for the treatment of malignant pleural effusion: a systematic review and metaanalysis. Am J Ther. 2016;23(6):e1300-e1306. doi:10.1097\/mjt.0000000000000197.
\nhttps:\/\/doi.org\/10.1097\/MJT.0000000000000197<\/a>
\nPMid:25654292<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
14. Fysh ET, Tremblay A, Feller-Kopman D, Mishra EK, Slade M, Garske L, Clive AO, Lamb C, Boshuizen R, Benjamin JNg, Rosenstengel AW, Yarmus L, Rahman NB, Maskell NA, Lee YG. Clinical outcomes of indwelling pleural catheter related pleural infections: an international multicenter study. Chest. 2013;144:1597-602. doi:10.1378\/chest.12-3103.
\nhttps:\/\/doi.org\/10.1378\/chest.12-3103<\/a>
\nPMid:23828305<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
15. Bhatnagar R, Zahan Evans N, Kearney C, Edey AJ, Stadon LJ, Tremblay A, Maskell AN. A novel drug eluting indwelling pleural catheter for the management of malignant effusions. Am J Respir Crit Care Med. 2018;197:136-8. doi:10.1164\/rccm.201701-0097le.
\nhttps:\/\/doi.org\/10.1164\/rccm.201701-0097LE<\/a>
\nPMid:28574275<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
16. Wahidi MM, Reddy C, Yarmus L, Feller-Kopman D, Musani A, Shepherd WR, Lee H, Bechara R, Lamb C, Shofer S, Mahmood K, Michaud G, Puchalski G, Rafeq S, Cattaneo SM, Mullon J, Leh S, Mayse M, Thomas SM, Peterson B, Richard W. LightRandomized trial of pleural f luid drainage frequency in patients with malignant pleural effusions: the ASAP Trial. Am J Respir Crit Care Med. 2017;195:1050-7. doi:10.1164\/rccm.201607-1404oc.
\nhttps:\/\/doi.org\/10.1164\/rccm.201607-1404OC<\/a>
\nPMid:27898215<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
17. Walker SP, Morley AJ, Stadon L, Fonseka DD, Arnold DT, Medford AR, Maskell NA. Nonmalignant pleural effusions: a prospective study of 356 consecutive unselected patients. Chest. 2017;151:1099-105. doi:10.1016\/j.chest.2016.12.014.
\nhttps:\/\/doi.org\/10.1016\/j.chest.2016.12.014<\/a>
\nPMid:28025056<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
18. Patil M, Dhillon SS, Attwood K, Saoud M, Alraiyes AH, Harris K. Management of benign pleural effusions using indwelling pleural catheters: a systematic review and metaanalysis. Chest. 2017;151:626-35. doi:10.1016\/j.chest.2016.10.052.
\nhttps:\/\/doi.org\/10.1016\/j.chest.2016.10.052<\/a>
\nPMid:27845052<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
19. Chen A, Massoni J, Jung D, Crippin J. Indwelling tunneled pleural catheters for the management of hepatic hydrothorax: a pilot study. Ann Am Thorac Soc. 2016;13:862-6. doi:10.1513\/annalsats.201510-688bc.
\nhttps:\/\/doi.org\/10.1513\/AnnalsATS.201510-688BC<\/a>
\nPMid:27015392<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
20. Majid A, Kheir F, Fashjian M, Chatterji S, Fernandez-Bussy S, Ochoa S, Cheng G, Folch E. Tunneled pleural catheter placement with and without talc poudrage for treatment of pleural effusions due to congestive heart failure. Ann Am ThoracSoc. 2016;13:212-6. doi:10.1513\/annalsats.201507-471bc.
\nhttps:\/\/doi.org\/10.1513\/AnnalsATS.201507-471BC<\/a>
\nPMid:26598967<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
21. Bintcliffe OJ, Lee GY, Rahman NM, Maskell NA. The management of benign noninfective pleural effusions. Eur Respir Rev. 2016;25:303-16. doi:10.1183\/16000617.0026-2016.
\nhttps:\/\/doi.org\/10.1183\/16000617.0026-2016<\/a>
\nPMid:27581830<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
22. Bintcliffe OJ, Hallifax RJ, Edey A, Feller-Kopman D, Lee YC, Marquette CH, Tschopp J, West D, Rahman NB, Maskell NA. Spontaneous pneumothorax: time to rethink management? Lancet Respir Med. 2015;3:578-88. doi:10.1016\/s2213-2600(15)00220-9.
\nhttps:\/\/doi.org\/10.1016\/S2213-2600(15)00220-9<\/a><\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
23. Parikh P, Odhwani J, Ganagajalia C. Study of 100 Cases of Pleural Effusions with Reference to Diagnostic Approach. Int J Adv Med. 2016;3:328-331. doi:10.18203\/2349-3933.ijam20161085.
\nhttps:\/\/doi.org\/10.18203\/2349-3933.ijam20161085<\/a><\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
24. DeBiasi EM, Pisani MA, Murphy TE, Araujo K,Kookoolis A, Christine Argento A, Puchalski J. Mortality among Patients with Pleural Effusion Undergoing Thoracocentesis. ERJ Express. 2015;1-8. doi:10.1183\/09031936.00217114.
\nhttps:\/\/doi.org\/10.1183\/09031936.00217114<\/a>
\nPMid:25837039 PMCid:PMC4857137<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
25. Puchalski JT, Argento AC, Murphy TE, Araujo KL, Oliva IB, Rubinowitz AN, Pisani MA. Etiologies of bilateral pleural effusions. Respir Med. 2013; 107:284-291. doi:10.1016\/j.rmed.2012.10.004.
\nhttps:\/\/doi.org\/10.1016\/j.rmed.2012.10.004<\/a>
\nPMid:23219348 PMCid:PMC5421548<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
26. Johan PE, Lassus, Siril\u00e4-WarisK, Markku S, Nieminen, Tolonen J, Tarvasm\u00e4ki T, Peuhkurinen K, Melin J, Pulkki K, Harjola VK.Long-term survival after hospitalization for acute heart failure – differences in prognosis of acutely decompensated chronic and new-onset acute heart failure. Int J Cardiol. 2013;168: 458-462. doi:10.1016\/j.ijcard.2012.09.128.
\nhttps:\/\/doi.org\/10.1016\/j.ijcard.2012.09.128<\/a>
\nPMid:23073273<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
27. Kookoolis AS, Puchalski JT, Murphy TE. Mortality of hospitalized patients with pleural effusions. J Pulm Respir Med. 2014;4:184. doi:10.4172\/2161-105x.1000184.
\nhttps:\/\/doi.org\/10.4172\/2161-105X.1000184<\/a>
\nPMid:25977841 PMCid:PMC4428160<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
28. Ibitoye BO, Idowu BM, Ogunrombi AB. Ultrasonography. 2018;37:254-260. doi:10.14366\/usg.17050.
\nhttps:\/\/doi.org\/10.14366\/usg.17050<\/a>
\nPMid:29228764 PMCid:PMC6044225<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
29. Na MJ. Diagnostic tools of pleural effusion. Tuberc Respir Dis (Seoul). 2014;76:199-210. doi:10.4046\/trd.2014.76.5.199.
\nhttps:\/\/doi.org\/10.4046\/trd.2014.76.5.199<\/a>
\nPMid:24920946 PMCid:PMC4050067<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
30. Light RW. Pleural diseases. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2013<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
31. Joshua A, Shetty L, Pare V. Variations in dimensions and shape of thoracic cage with aging: an anatomical review. Anat J Afr. 2014;3:346-355.<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
32. Hassan M, Rizk R. Pleural effusion volume estimation by thoracic ultrasound. Chest 2016;149(4 Suppl):A439. doi:10.1016\/j.chest.2016.02.457.
\nhttps:\/\/doi.org\/10.1016\/j.chest.2016.02.457<\/a><\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
33. Ashton-Cleary DT. Is thoracic ultrasound a viable alternative to conventional imaging in the critical care setting? Br J Anaesth. 2013;111:152-160. doi:10.1093\/bja\/aet076.
\nhttps:\/\/doi.org\/10.1093\/bja\/aet076<\/a>
\nPMid:23585400<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
34. Mercaldi CJ, Lanes SF. Ultrasound guidance decreases complications and improves the cost of care among patients undergoing thoracentesis and paracentesis.Chest. 2013;143(2):532-538. doi:10.1378\/chest.12-0447.
\nhttps:\/\/doi.org\/10.1378\/chest.12-0447<\/a>
\nPMid:23381318<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
35. Hibbert RM, Atwell TD, Lekah A, Patel MD, Carter RE, McDonald JS, Rabatin JT. Safety of ultrasoundguided thoracentesis in patients with abnormal preprocedural coagulation parameters.Chest. 2013;144(2):456-463. doi:10.1378\/chest.12-2374.
\nhttps:\/\/doi.org\/10.1378\/chest.12-2374<\/a>
\nPMid:23493971<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
36. Cincin A, Abul Y, Ozben B,Tanrikulu A,Topaloglu N, Ozgul G, Karakurt D, Oktay A. Pleural fluid amino-terminal brain natriuretic peptide in patients with pleural effusions. Respir Care . 2013;58(2):313-319. doi:10.4187\/respcare.01818.
\nhttps:\/\/doi.org\/10.4187\/respcare.01818<\/a>
\nPMid:22710710<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
37. Shen Y, Yang T, Jia L. A potential role for D-dimer in the diagnosis of tuberculous pleural effusion. Eur Rev Med Pharmacol Sci. 2013;17(2):201-205. doi:10.5772\/54955.
\nhttps:\/\/doi.org\/10.5772\/54955<\/a><\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
38. Puchalski JT, Argento AC, Murphy TE, Araujo KL, Oliva IB, Rubinowitz AN, Pisani MA. Etiologies of bilateral pleural effusions. Respir Med. 2013;107(2):284-291. doi:10.1016\/j.rmed.2012.10.004.
\nhttps:\/\/doi.org\/10.1016\/j.rmed.2012.10.004<\/a>
\nPMid:23219348 PMCid:PMC5421548<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
39. Zanforlin A, Gavelli G, Oboldi D, Galletti S. Ultrasound-guided thoracenthesis: the V-point as a site for optimal drainage positioning. Eur Rev Med Pharmacol Sci. 2013;17(1):25-28. doi:10.1111\/den.12051.
\nhttps:\/\/doi.org\/10.1111\/den.12051<\/a>
\nPMid:23490055<\/td>\n<\/tr>\n
<\/td>\n<\/tr>\n
40. Puchalski JT, Argento AC, Murphy TE, Araujo KLB, Pisani MA. The safety of thoracentesis in patients with uncorrected bleeding risk. Ann Am Thorac Soc. 2013;10(4):336-341. doi:10.1513\/annalsats.201210-088oc.
\nhttps:\/\/doi.org\/10.1513\/AnnalsATS.201210-088OC<\/a>
\nPMid:23952852 PMCid:PMC3960907<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n","protected":false},"excerpt":{"rendered":"

Prof. Shevchenko O.S., PHD Shevchenko R.S., PHD Todoriko L.D.*, PHD Pohorielova O.O Kharkiv National medical University. *Higher State Educational Establishment \u00abBukovinian State Medical University\u00bb. Pleural effusions are a frequent complication of various diseases. However, despite their prevalence, diagnosis and differential diagnosis of effusions remains a challenge. The presence of pleural effusion can be confirmed radiologically,…<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[17,9,34,47],"tags":[],"translation":{"provider":"WPGlobus","version":"2.12.2","language":"en","enabled_languages":["uk","en","ru"],"languages":{"uk":{"title":true,"content":true,"excerpt":false},"en":{"title":true,"content":true,"excerpt":false},"ru":{"title":true,"content":true,"excerpt":false}}},"jetpack_sharing_enabled":true,"jetpack_featured_media_url":"","_links":{"self":[{"href":"http:\/\/www.internalmed-journal.in.ua\/en\/wp-json\/wp\/v2\/posts\/1495"}],"collection":[{"href":"http:\/\/www.internalmed-journal.in.ua\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/www.internalmed-journal.in.ua\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/www.internalmed-journal.in.ua\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/www.internalmed-journal.in.ua\/en\/wp-json\/wp\/v2\/comments?post=1495"}],"version-history":[{"count":5,"href":"http:\/\/www.internalmed-journal.in.ua\/en\/wp-json\/wp\/v2\/posts\/1495\/revisions"}],"predecessor-version":[{"id":1617,"href":"http:\/\/www.internalmed-journal.in.ua\/en\/wp-json\/wp\/v2\/posts\/1495\/revisions\/1617"}],"wp:attachment":[{"href":"http:\/\/www.internalmed-journal.in.ua\/en\/wp-json\/wp\/v2\/media?parent=1495"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/www.internalmed-journal.in.ua\/en\/wp-json\/wp\/v2\/categories?post=1495"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/www.internalmed-journal.in.ua\/en\/wp-json\/wp\/v2\/tags?post=1495"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}