RT Book, Section
A1 Sahn, Steven A.
A1 Huggins, John T.
A2 Grippi, Michael A.
A2 Elias, Jack A.
A2 Fishman, Jay A.
A2 Kotloff, Robert M.
A2 Pack, Allan I.
A2 Senior, Robert M.
A2 Siegel, Mark D.
SR Print(0)
ID 1122363242
T1 Malignant Pleural Effusions
T2 Fishman's Pulmonary Diseases and Disorders, 5e
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-179672-9
LK accessmedicine.mhmedical.com/content.aspx?aid=1122363242
RD 2024/04/23
AB A  malignant  pleural  effusion  is  diagnosed  by  detecting  exfoliated  malignant  cells  in  pleural  fluid  or  demonstrating  these  cells  in  pleural  tissue  obtained  by  percutaneous  pleural  biopsy,  thoracoscopy,  thoracotomy,  or  at  autopsy.  In  a  number  of  patients,  even  though  the  pleural  effusion  is  caused  by  the  malignancy,  neoplastic  cells  cannot  be  detected  in  pleural  fluid  or  pleural  tissue  and,  in  fact,  probably  are  not  present  in  these  tissues.  It  is  logical  to  categorize  these  pleural  effusions  associated  with  malignancy,  in  which  there  is  no  direct  pleural  involvement  with  tumor  and  no  other  cause  for  the  effusion  is  found,  as  paramalignant  effusions  (Table  77-1).  Lymphatic  obstruction  appears  to  be  the  most  common  mechanism  for  the  development  of  a  paramalignant  effusion.  Other  local  effects  of  the  tumor  causing  a  paramalignant  effusion  are  bronchial  obstruction  resulting  in  pneumonia  or  atelectasis.  Furthermore,  it  is  important  for  the  clinician  to  recognize  that  effusions  can  result  from  systemic  effects  of  the  tumor  and  adverse  effects  of  therapy.