Pleural effusion Transudative The most common causes of transudative pleural effusion in the United States are heart failure and cirrhosis. Nephrotic syndrome, leading to the loss of large amounts of albumin in urine and resultant low albumin levels in the blood and reduced colloid osmotic pressure, is another less common cause of pleural effusion. Pulmonary emboli were once thought to cause transudative effusions, but have been recently shown to be exudative. The mechanism for the exudative pleural effusion in pulmonary thromboembolism is probably related to increased permeability of the capillaries in the lung, which results from the release of cytokines or inflammatory mediators (e.g. vascular endothelial growth factor) from the platelet-rich blood clots. The excessive interstitial lung fluid traverses the visceral pleura and accumulates in the pleural space. Conditions associated with transudative pleural effusions include: * Congestive heart failure * Liver cirrhosis * Severe hypoalbuminemia * Nephrotic syndrome * Acute atelectasis * Myxedema * Peritoneal dialysis * Meigs's syndrome * Obstructive uropathy * End-stage kidney disease Exudative Pleural effusion Anteroposterior Chest X-ray of a pleural effusion. The A arrow shows fluid layering in the right pleural cavity. The B arrow shows the normal width of the lung in the cavity When a pleural effusion has been determined to be exudative, additional evaluation is needed to determine its cause, and amylase, glucose, pH and cell counts should be measured. * Red blood cell counts are elevated in cases of bloody effusions (for example after heart surgery or hemothorax from incomplete evacuation of blood). * Amylase levels are elevated in cases of esophageal rupture, pancreatic pleural effusion, or cancer. * Glucose is decreased with cancer, bacterial infections, or rheumatoid pleuritis. * pH is low in empyema (<7.2) and maybe low in cancer. * If cancer is suspected, the pleural fluid is sent for cytology. If cytology is negative, and cancer is still suspected, either a thoracoscopy, or needle biopsy of the pleura may be performed. * Gram staining and culture should also be done. * If tuberculosis is possible, examination for Mycobacterium tuberculosis (either a Ziehl–Neelsen or Kinyoun stain, and mycobacterial cultures) should be done. A polymerase chain reaction for tuberculous DNA may be done, or adenosine deaminase or interferon gamma levels may also be checked. The most common causes of exudative pleural effusions are bacterial pneumonia, cancer (with lung cancer, breast cancer, and lymphoma causing approximately 75% of all malignant pleural effusions), viral infection, and pulmonary embolism. Another common cause is after heart surgery when incompletely drained blood can lead to an inflammatory response that causes exudative pleural fluid. Conditions associated with exudative pleural effusions: * Parapneumonic effusion due to pneumonia * Malignancy (either lung cancer or metastases to the pleura from elsewhere) * Infection (empyema due to bacterial pneumonia) * Trauma * Pulmonary infarction * Pulmonary embolism * Autoimmune disorders * Pancreatitis * Ruptured esophagus (Boerhaave's syndrome) * Rheumatoid pleurisy * Drug-induced lupus Other/ungrouped Other causes of pleural effusion include tuberculosis (though stains of pleural fluid are only rarely positive for acid-fast bacilli, this is the most common cause of pleural effusions in some developing countries), autoimmune disease such as systemic lupus erythematosus, bleeding (often due to chest trauma), chylothorax (most commonly caused by trauma), and accidental infusion of fluids. Less common causes include esophageal rupture or pancreatic disease, intra-abdominal abscesses, rheumatoid arthritis, asbestos pleural effusion, mesothelioma, Meigs's syndrome (ascites and pleural effusion due to a benign ovarian tumor), and ovarian hyperstimulation syndrome. Pleural effusions may also occur through medical or surgical interventions, including the use of medications (pleural fluid is usually eosinophilic), coronary artery bypass surgery, abdominal surgery, endoscopic variceal sclerotherapy, radiation therapy, liver or lung transplantation, insertion of ventricular shunt as a treatment method of hydrocephalus, and intra- or extravascular insertion of central lines.
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complications of Fibrous dysplasia of bone
complications of Ehlers–Danlos syndromes
complications of Lesch–Nyhan syndrome
complications of Prader–Willi syndrome
complications of Cat-scratch disease
complications of Mesothelioma
complications of Kallmann syndrome