Causes of pleural effusion 1, pulmonary tuberculosis, tuberculous pleurisy: tuberculosis mostly has symptoms of systemic toxicity, such as afternoon hypothermia, fatigue, night sweats, weight loss, insomnia, palpitations, etc., may be accompanied by hemoptysis symptoms, or as the first symptom, check the blood tuberculosis antibody positive, X-ray examination shows that the lesions are mostly in the upper lobe of both lungs, uneven density, polymorphic, multifocal, multi-calcification, few nodular aggregates, may have cavities or intrapulmonary dissemination, sputum Tuberculosis bacilli can be found in the sputum. Tuberculous pleurisy pleural fluid cytology classification is dominated by mononuclear cells, and pleural fluid ADA is increased. 2, pleural effusion caused by heart failure: seen in patients with left ventricular failure, generally have other symptoms and signs of heart failure, such as progressive exertional dyspnea, telescopic breathing, nocturnal paroxysmal dyspnea, peripheral edema, jugular venous anger, bilateral pulmonary rales or gallop rhythm, after the improvement of heart failure symptoms, pleural effusion can mostly subside on its own. In addition to pleural effusion, there may be heart enlargement on chest X-ray. Pleural effusion is often bilateral and leaky. 3.Pleural effusion caused by hypoproteinemia: serum albumin is low, and the nature of pleural effusion is mostly leaky. 4.Malignant pleural effusion: except for primary pleural mesothelioma, most of them are caused by metastasis of lung cancer, breast cancer and other parts of the tumor, most patients have no fever, chest tightness, shortness of breath, weakness, emaciation, fast progress of disease, pleural effusion is mostly bloody, LDH>200U/L, pleural fluid exfoliated cells, CEA and other tests can assist in diagnosis. 5, rheumatic immune disease caused by pleural effusion: rheumatoid arthritis and SLE and other connective tissue diseases can be complicated by pleural effusion, but the patient has obvious joint symptoms, pleural effusion is often a small amount, pleural fluid sugar content is very low, rheumatoid factor and other autoantibodies are often positive, may also be complicated by interstitial lung lesions. 6, pneumonia and pleural effusion: rapid onset, may have fever, chest pain, cough, cough, shortness of breath symptoms, X-ray examination with the presence of pneumonia, early pleural fluid more straw yellow, high white blood cells, mainly neutrophils, protein > 25g/l, pleural fluid smear and culture can find pathogenic bacteria, antibiotic treatment is effective. 7, lung abscess: rapid onset, high fever, coughing a lot of thick sputum, blood leukocytes and neutrophils increased, antibiotic treatment is effective. The cavity is mostly located in the lower lobe of the lung, the surrounding inflammatory infiltration is more serious, and there are often fluid planes in the cavity, while tuberculosis cavity mostly occurs in the upper lobe of the lung, the cavity wall is thinner, and there are fewer fluid planes in the cavity. 8, lymphoma: fever, emaciation, anemia are common, pleural involvement may appear pleural effusion, and intrathoracic lymph nodes are mostly unilateral or bilateral asymmetric enlargement, often involving mediastinal lymph nodes. Lymph node and bone marrow aspiration can be helpful for diagnosis. Clinical manifestations of pleural effusion: 1. It may be asymptomatic if the effusion is less than 300ml, but respiratory distress may be obvious in moderate or large amounts. In the case of a small amount of effusion, there may be no positive signs; in the case of medium or large amount of effusion, the respiratory movement of the affected side is weakened, the fibrillation disappears, the percussion of the effusion area is turbid or solid, the breath sounds on auscultation are weakened or disappeared, and the trachea and mediastinum are shifted to the healthy side. Diagnosis of pleural effusion is based on: 1. chest tightness, chest pain and shortness of breath. 2. When the amount of pleural effusion is small, there may be no positive signs; when the amount of effusion is large, the respiratory movement on the affected side is weakened, the fibrillation disappears, the percussion is turbid or solid, the breath sounds are weakened or disappeared, and the trachea, mediastinum and heart are shifted to the healthy side. 3.X-ray examination: the angle of the rib diaphragm becomes blunt when a small amount of fluid is accumulated, a large dense shadow is seen in medium amount of fluid, and the “diaphragm” on the affected side is elevated in fluid at the bottom of the lung, and the pleural fluid can flow when the body position is changed. 4.Ultrasonic examination: liquid level segment can be seen. 5, thoracentesis to extract fluid, pleural fluid examination routine, biochemical, immunological and cytological. It can be clearly identified as exudate or leaky fluid, which helps to diagnose the cause of the disease.