10. 2—Etiologies of the Pleural Effusions According
Table 2—Etiologies of the Pleural Effusions According Table 4 —Histologic Type of of the Tumors According to
Table 4 —Histologic Type the Tumors According to
to Fluid Color*Color*
to Fluid Pleural Fluid Color*
Pleural Fluid Color*
Bloody Bloody Nonbloody
Nonbloody Bloody
Bloody Nonbloody
Nonbloody
Diagnosis Diagnosis Fluids Fluids
Fluids FluidsTotal Total Histologic Type
Histologic Type Fluids
Fluids Fluids
Fluids Total
Total
msNeoplasms 28 (11) 28 (11) (89) (89) 253 253
225 225 Adenocarcinoma
Adenocarcinoma 11 11 (14)
(14) 67 (86)
67 (86) 78
78
nant Malignant 26 26 167 167 193 193 Mesothelioma
Mesothelioma 8 (24)
8 (24) 25 (76)
25 (76) 33
33
Paramalignant 2 58 60 Undifferentiated carcinoma
alignant 2 58 60 Undifferentiated carcinoma 2 (6)(6)
2 31 (94)
31 (94) 33
33
Tuberculosis 2 (2) 121 (98) 123 Squamous carcinoma 1 (8) 11 (92) 12
losis 2 (2) 121 (98) 123 Squamous carcinoma 1 (8) 11 (92) 12
Parapneumonic/empyema 6 (6) 87 (94) 93 Small cell carcinoma 3 (25) 9 (75) 12
umonic/empyema 6 (6) 87 (94) 93 Small cell carcinoma 3 (25) 9 (75) 12
Transudates 2 (2) 80 (98) 82 Large cell carcinoma 0 11 (100) 11
atesPulmonary embolism 2 (2) 1 (12)80 (98) 7 (88) 82 8 Large cell carcinoma
Lymphoma 0 0 11 9 (100)
(100) 119
ryPosttraumatic
embolism 1 (12) 7 (88) 7 (88) 1 (12) 8 8 Lymphoma
Agnogenic myeloid metaplasia 0 1 (100) 90(100) 91
matic
Trapped lung 7 (88) 2 (40) 1 (12) 3 (60) 8 5 Agnogenic myeloid metaplasia
Melanoma 1 (100)
0 0 1 (100) 11
lung
Pancreatic diseases 2 (40) 1 (25) 3 (60) 3 (75) 5 4 Melanoma
Sarcoma 0 0 1 1 (100)
(100) 11
ic Heart surgery/Dessler syndrome
diseases 1 (25) 1 (33) 3 (75) 2 (67) 4 3 Sarcoma
Unknown 0 0 1 2 (100)
(100) 12
rgery/Dessler syndrome effusion
Benign asbestos pleural 1 (33) 1 (50) 2 (67) 1 (50) 3 2 Unknown
Total 0 26 (13) 2 (100)
167 (87) 2
193
Pseudochylothorax
sbestos pleural effusion 1 (50) 1 (50) 1 (50) 1 (50) 2 2 Total *Data are presented as No. (% within the origin of the tumor) or No.
26 (13) 167 (87) 193
Acute aortic dissection
hylothorax 1 (50) 1 (100)1 (50) 0 2 1
Other benign diseases† 0 39 (100) 1 39 *Data are presented as No. (% within the origin of the tumor) or No.
rtic dissection 1 (100) 0
Undetermined or mixed causes
enign diseases† 0 6 (7) 39 (100) (93) 39
86 92
Total
mined or mixed causes 6 (7) 59 (8) 86 (93) (92) 92 715
656
pleural effusion after cardiac surgery and another
*Data are presented as No.59 (8)
(% within the656 (92) of the effusion) or
etiology 715
No. • pleural effusion myocardial infarction hadand another
patient after after cardiac surgery blood-tinged
悪性腫瘍による胸水でも, 血性なのは11%のみ.
e presented as No. (% within the etiology of the effusion) or and serous effusion, respectively.
†Included six patients with pleural effusion secondary to abdominal patient after myocardial infarction had blood-tinged
surgery, six patients with chylothorax, five patients with uremic serous effusion, respectively. were uncommon
Tuberculosis and transudates
d six patients with pleural effusion secondary to four patients with and causes of BPE. Fluid that was bloody in appearance
abdominal
effusions, five patients with rheumatoid arthritis,
, six patients with chylothorax, five patients with pleuropericar-
systemic erythematous lupus, four patients with viral uremic Tuberculosis and transudates were uncommon
decreased the probability for both diseases (OR,
ns, five patients with with Wegener granulomatosis, two patients with causes of BPE. Fluid that was bloody in appearance
ditis, two patients rheumatoid arthritis, four patients with
0.15; 95% CI, 0.04 to 0.57; p ϭ 0.003 and OR, 0.25;
c erythematous lupus, four patients withwith each of the following: decreased the probability for both diseases (OR,
gallbladder diseases, and one patient viral pleuropericar-
wo patients angioma, ovarian hyperstimulation syndrome, chronic eo-
parietal with Wegener granulomatosis, two patients with 95% CI, 0.06 to 0.95; p ϭ 0.04, respectively).
0.15; 95% CI, 0.04 to 0.57; p ϭ 0.003 and OR, 0.25;
der diseases, and one patient effusion afterof the following: rheu-
sinophilic pneumonia, pleural with each radiation therapy,
matic polymyalgia, and liver transplantation.
angioma, ovarian hyperstimulation syndrome, chronic eo- 95% CI, 0.06 to 0.95; p ϭ 0.04, respectively).
lic pneumonia, pleural effusion after radiation therapy, rheu- Discussion 10
olymyalgia, and liver transplantation.
23. EPEs from the four studies conducted more recently [47•]. The pleural fluid accumulation may be
[2••–4••,56•]. To our knowledge, 10 drugs have been atic (46%) or may be manifested by chest pain
associated with the development of an EPE (Table dyspnea (6%), whereas fever or cough are
3[64–77]). Valproic has also been considered as a cause of rarely [47]. The median duration of the pleur
EPE although, in our opinion, the pleural effusion de- is 3 months Opin Pulm Med 2003, 9:254–260
Curr (range, 1–10 months) with frequ
scribed in the relevant case report was most likely a post- rences, but the long-term prognosis is good
• 結核性胸膜炎でEPEを呈するのは1.3-4%程度.develop pleural fibrosis [47•,6
pneumonic effusion [78]. some patients
Finally, it – 392例のEPEのまとめでは, is ever es-
should be noted that no diagnosis Symptoms of posttraumatic EPE include p
tablished in many cases with EPE. In the series of Ad- 結核性胸膜炎が5.6%, pain, dry cough, and
悪性腫瘍17%, 肺炎随伴性胸水12.5%, dyspnea, pleuritic chest
elman et al. [1••], one third of the patients with EPE low-grade fever. The pleural effusion in po
PE随伴胸水4.3%, were called その他12.8%, 不明39.8%. clinically as long as 50
remained undiagnosed, and they漏出性7.9%,“idio- EPE may be manifested
pathic.” In the 147 patients with EPE reported in the the pleural injury and the fluid, which may
four more recent series, the percentage of idiopathic or straw colored, usually persists for a few w
pleural effusions was 15.6% [2••–4••,56•]. The similar- Effusions occurring during the 30 days a
• EPEを来す薬剤例
Table 3. Drugs that cause EPE
Drug Parenchymal involvement Latency Recovery (up to) Blood eosinophlia
Nitrofurantoin Almost always Hours to days Days Yes
Isotretinoin No 1–6 mo 1–3 mo No
Glicazide Yes 2 wk Days Yes
Datrolene No Յ12 y Several months Yes
Vitamins B6/H No 2 mo 1 wk Yes
Mesalamine Yes 2 wk Several days Yes
Bromocriptine Yes 1.5–2 y 1–3 mo NR
Propylthiouracil No 3d 3 mo No
Fluoxetine No 8 wk 8 wk Yes
Warfarin No 9 mo NR Yes
NR, presence or absence of blood eosinophilia not reported.
40. 各疾患の胸水中ADA
RAによる胸水貯留ではADA上昇を認める
(Annals of the Rheumatic Disease 1988;47:394-7)
Group N ADA(U/L)
I 結核 170 83[43-190]
II 悪性腫瘍 126 8[0-54]
III Parapneumonic 76 14[0-83]
IV その他 60 5[0-38]
V 非特異的 45 8[0-45]
VI 漏出性 100 0[0-17]
VII RA 9 80[52-97]
46. RA性の胸水ではADAは上昇
• RAによる胸水貯留ではADA上昇を認める
(Annals of the Rheumatic Disease 1988;47:394-7)
Group N ADA(U/L)
I 結核 170 83[43-190]
II 悪性腫瘍 126 8[0-54]
III Parapneumonic 76 14[0-83]
IV その他 60 5[0-38]
V 非特異的 45 8[0-45]
VI 漏出性 100 0[0-17]
VII RA 9 80[52-97]
47. 膠原病に伴う胸水
• 胸水中ANA高値はSLE由来の胸水を示唆する
ANA Sn(%) Sp(%) LR(+) Ref
ANA >=40倍 100[52-100] 90[80-95] 9.5[4.9-18] Chest 1994;106:866-71
ANA >=160倍 100[75-100] 94[90-96] 16[9.8-25] Lupus 2007;16:25-7