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Related Concept Videos

Pleural Effusion I: Introduction01:25

Pleural Effusion I: Introduction

Pleural effusion is an abnormal fluid accumulation in the pleural cavity, a narrow space between the lungs and the chest wall. It is not a disease per se but rather a symptom or indication of an underlying disease. In normal circumstances, this space contains a small amount of fluid (5 to 15 mL), a lubricant facilitating the non-frictional movement of the pleural surfaces.
There are two main types of pleural effusion: transudative and exudative. They are differentiated using Light's criteria,...
Pleural Effusion II: Symptoms and Management01:28

Pleural Effusion II: Symptoms and Management

Pleural Effusion Overview
A pleural effusion is the abnormal collection of fluid between the parietal and visceral pleura layers of tissue that form the lining of the lungs and chest cavity. It can occur independently or due to surrounding parenchymal diseases, such as infection, malignancy, or inflammatory conditions.
Clinical Manifestations:
Endoscopic Studies II: Thoracocentesis01:26

Endoscopic Studies II: Thoracocentesis

Thoracentesis(Thoracocentesis), commonly known as pleural tap, is a medical procedure where a 22 gauge needle is inserted into the pleural space, the area between the lung and chest wall. This procedure is commonly performed to diagnose or treat various respiratory disorders.
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
Pleura of the Lungs01:13

Pleura of the Lungs

The lungs are nestled in a cavity, shielded by the pleura. The pleura, a form of serous membrane, wraps around each lung. This membrane arrangement consists of two layers: the visceral and parietal pleurae. The visceral pleura lines the surface of the lungIn contrast, the parietal pleura is the outer layer and contacts to the thoracic wall, the mediastinum, and the diaphragm. The hilum is the point of connection between the visceral and parietal layers. The space between the parietal and...

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Related Experiment Video

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Point-of-Care Lung Ultrasound in Adults: Image Acquisition
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Pleural fluid analysis in chylous pleural effusion.

Vishal Agrawal1, Peter Doelken1, Steven A Sahn1

  • 1Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, SC.

Chest
|March 15, 2008
PubMed
Summary

Chylous pleural effusions from thoracic duct leaks are typically lymphocyte-predominant and protein-discordant exudates. Other effusions with high triglycerides or chylomicrons suggest additional contributing conditions impacting management.

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Area of Science:

  • Pulmonology
  • Thoracic Surgery
  • Diagnostic Medicine

Background:

  • Chyle, a fluid rich in lymphocytes, can cause pleural effusion due to thoracic duct leakage.
  • Chylous effusions often present as exudates despite having transudative protein concentrations.
  • Inflammation is typically absent in effusions caused solely by thoracic duct leaks.

Purpose of the Study:

  • To characterize chylous pleural effusions resulting from thoracic duct leaks.
  • To differentiate effusions caused solely by chyle leakage from those with coexisting conditions.
  • To investigate the diagnostic criteria for chylous effusions, including lactate dehydrogenase (LDH) and protein levels.

Main Methods:

  • Retrospective review of 876 thoracenteses.
  • Identification of effusions with elevated triglycerides (> 110 mg/dL) or chylomicrons.
  • Classification of effusions as transudates, concordant exudates, or protein-discordant exudates, with assessment of lymphocyte predominance.

Main Results:

  • Twenty-two effusions met criteria for elevated triglycerides or chylomicrons.
  • Eleven effusions were classified as lymphocyte-predominant, protein-discordant exudates; two were linked to chylous ascites.
  • Seven effusions were transudates and four were concordant exudates, associated with non-chyle-related causes.

Conclusions:

  • Chylous effusions from isolated thoracic duct leaks are characterized as lymphocyte-predominant, protein-discordant exudates.
  • Transudative protein levels or elevated LDH in chylous effusions indicate coexisting conditions.
  • Identifying these coexisting conditions is crucial for appropriate management of chylous effusions.