Chest
Clinical InvestigationsThe Serum-Effusion Albumin Gradient in the Evaluation of Pleural Effusions
Section snippets
MATERIALS AND METHODS
The subjects were adult consecutive inpatients from the general medicine service or intensive care unit at Madigan Army Medical Center who had a diagnostic or therapeutic thoracentesis performed between June 1988 and April 1989. The protocol was accepted by the local human utilization review committee. All patients signed a consent form to participate in the study.
The following studies were performed on all pleural fluid samples: albumin; glucose; protein; LDH; cell count; differential cell
RESULTS
Sixty-one patients with pleural effusions were evaluated. One patient was excluded due to the diagnosis of empyema. Another patient was excluded because a simultaneous serum sample was not obtained. Of the 59 remaining patients, 37 were men, and 22 were women. The average age was 61 years (range, 19 to 84 years). Forty-one were defined as having exudates and 18 as transudates. In all cases the diagnosis reached after chart review was the same as that given by the primary physicians. The
DISCUSSION
Despite being studied for over 100 years, the physiology of pleural fluid formation and absorption is still controversial. The most recent accepted model of pleural fluid exchange in the normal state involves formation by filtration through the pleural microvascular endothelium and absorption via stomata in the parietal pleura that drain into subpleural lymphatic vessels. The formation of fluid is powered by the pressure gradient between the microvasculature and pleural space, while absorption
REFERENCES (14)
- et al.
Treatment of congestive heart failure: its effect on pleural fluid chemistry
Chest
(1989) - et al.
Serum-ascites albumin concentration gradient: a physiologic approach to the differential diagnosis of ascites
Gastroenterology
(1983) - et al.
Superiority of the serum-ascites albumin difference over the ascites total protein concentration in separation of transudative and exudative ascites
Am J Med
(1984) Pleural diseases
(1983)The pleura
Am Rev Respir Dis
(1988)- et al.
Pleural effusion: the diagnostic separation of transudates and exudates
Ann Intern Med
(1972) Total proteins in serous fluids in cardiac failure
S Afr Med J
(1965)
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The opinions and assertions contained herein are the private views of the authors and do not necessarily reflect the views of the Department of Defense.
Manuscript received October 19; revision accepted February 13.
Reprint requests: Dr. Roth, Department of Clinical Investigation, Box 454, Madigan Army Medical Center, Tacoma, WN 98431-5454