每日一题_2023.02.09

A 77-year-old man with metastatic lung adenocarcinoma presented to the emergency department with a 2-week history of dyspnea. Imaging studies showed a pleural effusion on the right side, previously known liver metastases and perihepatic fluid, and new intrahepatic dilatation of the biliary ducts. A chest tube was placed, and the color of the drained pleural fluid was olive brown. What additional pleural-fluid test is most likely to reveal the diagnosis?

一名77岁男性转移性肺腺癌患者因呼吸困难2周到急诊科就诊。影像学检查显示右侧胸腔积液，既往已知的肝转移灶和肝周积液，以及新的肝内胆管扩张。放置胸管，引流的胸腔积液呈橄榄色。哪些其他胸腔积液检查最有可能揭示诊断?

A. Bacterial gram stain and culture 细菌革兰染色和培养

B. Bilirubin 胆红素

C. Cytology 细胞学

D. Fungal stain and culture 真菌染色与培养

E. Triglycerides 甘油三酸酯

答案解析：

正确答案是胸腔积液胆红素水平。胸腔积液检查显示总胆红素水平为8.2 mg / dl，直接胆红素水平为7.5 mg / dl。胸水甘油三酯水平正常，培养和细胞学检查结果为阴性。诊断为胆汁性胸腔。胆汁流入胸膜腔时发生胆汁性胸腔。在此例中，其机制被认为是肝转移引起的膈肌缺损。

正确答案：B