会计学ContentsIntroductionAnatomyofthePleuralSpaceThelymphaticvesselsintheparietalpleuraareindirectcommunicationwiththepleuralspacebymeansofstomas.Thesestomasaretheonlyroutethroughwhichcellsandlargeparticlescanleavethepleuralspace.Althoughthereareabundantlymphaticsinthevisceralpleura,theselymphaticsdonotappeartoparticipateintheremovalofparticulatematterfromthepleuralspace.Figure1.AnatomyofthepleuralspaceSC:SystemiccapillariesPC:PulmonarycapillariesFigure2.pleuralfluidsturnoverPFenterthepleuralspacethroughparietal&visceralpleurae,AndleavepleuralspacethroughlymphaticsinparietalpleuraMechanismofpleuralfluidsturnoverPathophysiologyAtransudativepleuraleffusionoccurswhenalterationsinthesystemicfactorsthatinfluencepleuralfluidmovementresultinapleuraleffusion.Examplesareelevatedvisceralpleuralcapillarypressurewithleftheartfailure,elevatedparietalpleuralcapillarypressurewithrightheartfailure,anddecreasedserumoncoticpressurewiththenephroticsyndrome,hepaticcirrhosis.Incontrast,exudativepleuraleffusionsoccurwhenthepleuralsurfacesthemselvesarealtered.Inflammationofthepleura,leadingtoincreasedproteininthepleuralspace,isthemostcommoncauseofexudativepleuraleffusions.EtiologyandPathogenesisClinicalManifestationsPhysicalExaminationsRadiographicAppearanceAposteroanteriorandlateralchestradiographofpleuraleffusionbluntingoftheposteriorcostophrenicanglePleuralfluidissaidtobeloculatedwhenitdoesnotshiftfreelyinthepleuralspaceasthepatient’spositionischanged.Loculatedpleuraleffusionsoccurwhenthereareadhesionsbetweenthevisceralandparietalpleurae.Bothultrasoundandcomputedtomography(CT)haveprovedusefulinmakingthisdifferentiation.ApproachtothePatientwithPleuralEffusionAppearanceofthePleuralFluidCloudyorturbid-eithercellsanddebrisorhighlipidlevelsPostcentrifugation–Ifsupernatantturbid,duetohighlipidlevelsTurbidsupernatant-measurepleuralfluidtriglyceridelevelTriglyceridelevel>110mg/dl–chylothoraxTriglyceridelevel<50mg/dlandcholesterol>250mg-pseudochylothorax50mg/dl<Triglyceridelevel<110m