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Pleural diseases 

Pleural diseases
Chapter:
Pleural diseases
Author(s):

Robert J.O. Davies

, Fergus V. Gleeson

, Y.C. Gary Lee

, Jose Porcel

, and Fraser Brims

DOI:
10.1093/med/9780199204854.003.1817_update_001

Update:

Investigation—enhanced discussion of distinction between transudative and exudative effusions, use of measurement of ADA activity in diagnosis of tuberculosis, and tumour biomarkers.

Specific causes of effusion and pleural diseases—expanded notes on rheumatoid arthritis, SLE, benign asbestos pleural effusion, benign asbestos-related pleural plaques, and rounded atelectasis.

Pneumothorax—comments on use of diagnostic ultrasound, the role of suction for continuing air leak, the timing of surgery, and use of endobronchial valves.

A relevant case history from Oxford Case Histories in Respiratory Medicine has been added to this chapter.

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date: 21 October 2020

Case History—A 40 yr old woman with pleuritic chest pain.

This is a common clinical problem which can complicate a range of lung and systemic diseases. Most cases can be diagnosed by pleural fluid analysis and pleural biopsy, with Light’s criteria making it possible to discriminate between transudates and exudates. These state that a pleural effusion is an exudate if any of the following are present: (1) pleural fluid to serum protein ratio greater than 0.5; (2) pleural fluid lactate dehydrogenase (LDH) greater than two-thirds of the upper limit of normal serum LDH; (3) pleural fluid to serum LDH ratio greater than 0.6....

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