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Results for “EXUDATES AND TRANSUDATES”

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PubMed2004

Ultrasound as an alternative to aspiration for determining the nature of pleural effusion, especially in older people.

Sonography was performed by two expert radiologists separately after selecting 80 patients (45 men and 35 women) whose pleural fluids had been aspirated and examined by the lab. The radiologists were given no clinical information concerning the patients, and the result compared with lab results. The radiologists evaluated three criteria in determining the nature of the pleural effusion: septation, echogenicity, and thickening of pleura by more than 3 mm. The study showed that the pleural effusion with septation or internal echogenicity is always an exudate. Also sonographic evidence of thickened pleura (more than 3 mm) is highly suggestive of an exudate. Although an anechoic effusion is more probably evidence of a transudate, we have seen it in 14% of patients with exudates. The lab results showed that there were 29 patients with transudates and 51 with exudates, and in ultrasound results there were 34 with transudates and 46 with exudates. A transudate is always without echogenicity, while exudates can be with or without echogenicity. It was therefore concluded that sonography is useful in determining the nature of pleural effusion.

Aging↗
PubMed2002

Role of biochemical tests in the diagnosis of large pericardial effusions.

STUDY OBJECTIVES: To determine the biochemical characteristics of large pericardial effusions in various disease states, and to assess their utility as diagnostic tools. SETTING: An academic university hospital in the Western Cape, South Africa. DESIGN: Consecutive, prospective case series. PATIENTS: One hundred ten hospital patients > 12 years old, who presented to the echocardiography department with large pericardial effusions, and 12 control subjects who underwent open-heart surgery (coronary artery bypass graft or aortic valve replacement). MEASUREMENTS: Fluid was sent for examination of biochemistry, adenosine deaminase, microbiology, hematology, and cytology. The etiology of each pericardial fluid sample was established using predetermined criteria. RESULTS: The biochemistry of pericardial exudates differed significantly from pericardial transudates. Light' s criteria (whereby an exudate is defined as having one or more of the following: pleural fluid/serum protein ratio > 0.5; pleural fluid/serum lactate dehydrogenase [LDH] ratio > 0.6; and/or pleural fluid LDH level > 200 U/L) were applied to pericardial fluids and demonstrated to be the most reliable diagnostic tool for identifying pericardial exudates. The corresponding sensitivity was 98%. CONCLUSION: Although laboratory tests are a useful guideline when assessing the etiology and pathophysiology of pericardial effusions, the majority of large, clinically significant pericardial effusions result from exudative causes.

Bilirubin↗
PubMed2003

Association between inflammatory mediators and the fibrinolysis system in infectious pleural effusions.

The response of the fibrinolytic system to inflammatory mediators in empyema and complicated parapneumonic pleural effusions is still uncertain. We prospectively analysed 100 patients with pleural effusion: 25 with empyema or complicated parapneumonic effusion, 22 with tuberculous effusion, 28 with malignant effusion and 25 with transudate effusion. Inflammatory mediators, tumour necrosis factor-alpha (TNF-alpha), interleukin-8 (IL-8) and polymorphonuclear elastase, were measured in serum and pleural fluid. Fibrinolytic system parameters, plasminogen, tissue-type plasminogen activator (t-PA) and urokinase PA, PA inhibitor type 1 (PAI 1) and PAI type 2 concentrations and PAI 1 activity, were quantified in plasma and pleural fluid. The Wilcoxon signed-rank test was used to compare plasma and pleural values and to compare pleural values according to the aetiology of the effusion. The Pearson correlation coefficient was used to assess the relationship between fibrinolytic and inflammatory markers in pleural fluid. Significant differences were found between pleural and plasma fibrinolytic system levels. Pleural fluid exudates had higher fibrinolytic levels than transudates. Among exudates, tuberculous, empyema and complicated parapneumonic effusions demonstrated higher pleural PAI levels than malignant effusions, whereas t-PA was lowest in empyema and complicated parapneumonic pleural effusions. PAI concentrations correlated with TNF-alpha, IL-8 and polymorphonuclear elastase when all exudative effusions were analysed, but the association was not maintained in empyema and complicated parapneumonic effusions. A negative association found between t-PA and both IL-8 and polymorphonuclear elastase in exudative effusions was strongest in empyema and complicated parapneumonic effusions. Blockage of fibrin clearance in empyema and complicated parapneumonic effusions was associated with both enhanced levels of PAIs and decreased levels of t-PA.

Empyema, Pleural↗