Pleural effusions

Chest x-ray Useful for detection of cardiac enlargement, pulmonary edema, and pleural effusions. 

Chest x-ray Bilateral pleural effusions and cardiomegaly Echocardiogram EF = 35%... 

The transcellular fluid includes the viscous components of the peritoneum, pleural space, and pericardium, as well as the cerebrospinal fluid, joint space fluid, and the gastrointestinal (GI) digestive juices. Although the transcellular fluid normally accounts for about 1% of TBW, this amount can increase significantly during various illnesses favoring fluid collection in one of these spaces (e.g., pleural effusions or ascites in the peritoneum). The accumulation of fluid in the transcellular space is often referred to as third spacing. To review the calculations of the body fluid compartments in a representative patient, see Patient Encounter 1. 

Pulmonary Interstitial fibrosis, pulmonary nodules, pleuritis, pleural effusions... 

Voriconazole is started in the patient along with 1 mg/kg per day of methylprednisolone to control the graft-versus-host disease. Her tacrolimus dose was also decreased by 70% with the addition of voriconazole and a recent tacrolimus blood level of 1 0 ng/mL. Unfortunately, the patient remains febrile with worsening respiratory pain. A repeat CT scan of the lung demonstrates new nodules, and pleural effusion in the right lung. 

Involves removal of fluid in the pleural cavity via a needle. The fluid then is assayed for presence cancerous cells. This procedure has low sensitivity and depends on the presence of a pleural effusion... 

Stage IV = Growth involving one or both ovaries with distant metastasis beyond the pelvis (i.e. if pleural effusion present, confirm cytology or any parenchymal liver metastasis equals stage IV). 

Moderate emetogenic potential take with meals and a full glass of water edema periorbital edema is characteristic pleural effusions, ascites, or pulmonary edema also occur rash diarrhea neutropenia, thrombocytopenia (sometimes difficult to distinguish from CML-induced cytopenias) increased liver function tests... 

Human pleural effusion Ammonium acetate RP trap LCQ DECA SEQUEST (Tyan et al., 2005b)... 

Tyan, Y.C., Wu, H.Y., Lai, W.W., Su, W.C., Liao, PC. (2005b). Proteomic profiling of human pleural effusion using two-dimensional nano liquid chromatography tandem mass spectrometry. J. Proteome Res. 4, 1274-1286. 

Chomej, P., et al., Differential analysis of pleural effusions by fuzzy logic based analysis of cytokines, Respir. Med., 98, 308, 2004. 

Suggested Alternatives for Differential Diagnosis Abdominal aneurysm, aortic dissection, pleural effusion, subarachnoid hemorrhage, superior vena cava syndrome, hantavirus pulmonary syndrome, mediastinitis, fulminate mediastinal tumors pneumonia, gastroenteritis, meningitis, ecthyma, rat bite fever, spider bite, leprosy, plague, tularemia, coccidioidomycosis, diphtheria, glanders, histoplasmosis, psittacosis, typhoid fever, and rickettsial pox. 

Suggested Alternatives for Differential Diagnosis Bronchitis, pneumonia, meningitis, gastroenteritis, septic shock, congestive heart failure and pulmonary edema, pleural effusion, costochondritis, prostatitis, adult respiratory distress syndrome (ARDS), HIV infection and AIDS, and Q fever. 

Signs and Symptoms Pneumonia with or without bacteremia. Pulmonary abscesses, fluid (pleural effusion) and pus (empyema) in the chest cavity may occur. In acute cases pus is discharged from the nose. There are ulcers in the mucous membranes of the nose and possibly the pharynx. 

Extra-articular involvement may include rheumatoid nodules, vasculitis, pleural effusions, pulmonary fibrosis, ocular manifestations, pericarditis, cardiac conduction abnormalities, bone marrow suppression, and lym-phadenopathy. 

Ventricular hypertrophy can be demonstrated on chest x-ray or ECG. Chest x-ray may also show pleural effusions or pulmonary edema. 

Pruritus, jaundice, palmar erythema, spider angiomata, hyperpigmentation Gynecomastia, reduced libido Ascites, edema, pleural effusion, and respiratory difficulties Malaise, anorexia, and weight loss Encephalopathy Laboratory tests Hypoalbuminemia Elevated prothrombin time Thrombocytopenia Elevated alkaline phosphatase... 

TABLE A5-8 Drugs That May Induce Pleural Effusions and Fibrosis ... 

Pulmonary infections In pulmonary infections, pneumonia, pulmonary abscesses, and pleural effusion can occur Chest X rays vdl show localized infection in the lobes of the lungs. 

Pleural effusions, fluid occurring between the parietal pleura and the visceral pleura, which is often transient and quickly absorbed, may or may not be induced by exposure to asbestos they are therefore also not strictly a part of asbestosis but can be associated as a symptom. Other symptoms include pleurisy (inflammation of the pleura), pain, and breathlessness. 

Respiratory Effects. Pleural effusions and alveolar infiltrations were noted in a man who had washed his hair with an unknown amount of diesel fuel (Barrientos et al. 1977). The relative contributions from inhalation and dermal exposure could not be distinguished in this case. There was no throat irritation in six volunteers following a 15-minute exposure to a concentration reported to be 140 mg/m of deodorized kerosene vapor (Carpenter et al. 1976). The authors used a hot nichrome wire for the volatilization of their test material and reported that the concentration was probably the "highest attainable concentration at which vapor analysis is representative of liquid analysis." The air saturating concentration of kerosene is considered to approximate 100 mg/m (room temperature and 760 mmHg) and is dependent on the constituents of the mixture. 

Toxicology. ANTU dust causes pulmonary edema and pleural effusion in animals. 

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