![]() No diagnosis is ever obtained in as many as one third of patients with eosinophilic pleural effusion. The presence of air or blood in the pleural space is a common cause. In purulent fluids, leukocyte count is commonly much lower than expected because dead cells or other debris account for much of the turbidity. Malignancy, trauma, parapneumonic effusion, pulmonary embolismĪ fluid hematocrit 10,000 per mm 3 (10 ×3 10 9 per L) 3Ī pleural fluid protein level > 3 mg per dL suggests an exudate, but when taken alone this parameter misclassifies more than 10 percent of exudates and 15 percent of transudates. Most patients who meet the criteria for an exudative effusion with LDH but not with protein levels have either parapneumonic effusions or malignancy. Very high levels of pleural fluid LDH (> 1,000 U per L) typically are found in patients with complicated parapneumonic pleural effusion and in about 40 percent of those with tuberculous pleurisy. Two thirds of upper limits of normal for serum LDH In the United States, ADA is not routinely requested because of the low prevalence of tuberculous pleurisy.Īctively dividing mesothelial cells can mimic an adenocarcinoma. ![]() Tuberculosis (> 90 percent), empyema (60 percent), complicated parapneumonic effusion (30 percent), malignancy (5 percent), rheumatoid arthritis 5 Another approach to the classification of pleural effusions is to apply continuous or multilevel likelihood ratios ( Table 3 11). ![]() This lower sensitivity may be caused by the fact that a single test is employed as opposed to the three-test combination of the standard criteria described above. 10 However, neither protein nor albumin gradients alone should be the primary test used to distinguish transudative effusions from exudative effusions because they result in the incorrect classification of a significant number of exudates. 9 A serum-effusion albumin gradient greater than 1.2 g per dL also can indicate that the pleural effusion is most likely a true transudative effusion. 8 In these circumstances, if the difference between protein levels in the serum and the pleural fluid is greater than 3.1 g per dL, the patient should be classified as having a transudative effusion. Light’s criteria are nearly 100 percent sensitive at identifying exudates, but approximately 20 percent of patients with pleural effusion caused by heart failure may fulfill the criteria for an exudative effusion after receiving diuretics. Malignancy, tuberculosis, anaerobic bacterial pneumonia Lung cancer, pulmonary embolism, tuberculosis Pleural effusion secondary to yellow nail syndrome* ![]() Hepatic hydrothorax, ovarian cancer, Meigs’ syndromeĭyspnea on exertion, orthopnea, peripheral edema, elevated jugular venous pressure Hemothorax, chylothorax, duropleural fistula Lupus pleuritis, pneumonia, pulmonary embolism Pleural effusion secondary to ovarian hyperstimulation syndrome Pneumonia, tuberculosis, primary effusion lymphoma, Kaposi sarcoma Pleural effusion secondary to esophageal perforation Hepatic hydrothorax, spontaneous bacterial empyema Pleural effusion secondary to coronary artery bypass graft surgery or Dressler’s syndrome Mesothelioma, benign asbestos pleural effusion Tuberculous empyema, pyothorax-associated lymphoma, trapped lung Postoperative pleural effusion, subphrenic abscess, pulmonary embolism
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