• a presumptive diagnosis in 55%,
• with the remaining 20% having a nondiagnostic pleural fluid analysis. (excluding possible diagnoses)
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Value of Pleural Fluid Analysis
• fungal
mg/dL)
• lupus pleuritis (lupus erythematosus cells)
• chylothorax (triglycerides > 110 mg/dL or presence of chylomicrons)
• esophageal rupture (increased salivary amylase and pH < 7.00)
• most common causes • Less common causes
• metastatic carcinoma • Wegener's ranulomatosis
• rheumatoid arthritis
from a nonlung primary • septic emboli
tumor.
nail syndrome
lymphoma, and leukemia • uremic pleurisy
• pulmonary embolism
• constrictive pericarditis
• drug-induced lung disease
• hypothyroidism
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• Bilateral Effusions
• Diseases Below the Diaphragm
• Interstitial Lung Disease
• Pulmonary Nodules
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1. Pleural Fluid as the Only Abnormality With Primary Disease in the Chest
(extrapulmonic primary carcinomas, lymphoma) • lupus pleuritis
• constrictive pericarditis • yellow nail syndrome
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3.Diseases Below the Diaphragm
• the initial pleural fluid analysis is either definitively or presumptively diagnostic in 80% of patients and is valuable clinically in about 90% of cases.
• infections
– tuberculous and viral
• benign asbestos pleural effusion (BAPE)
pleurisy
• lymphatic abnormalities
• malignancy
– chylothorax and yellow
– cancer, non-Hodgkin's
• Lymphangioleiomyomat osis
• viral and mycoplasma pneumonias
• Waldenström's macroglobulinemia
• sarcoidosis
• Pneumocystis carinii pneumonia
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5.Pulmonary Nodules
Diagnosis and Management of Pleural Effusions
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Diagnosis of Pleural Effusions
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Chest Radiograph
• Pleural Fluid as the Only Abnormality With Primary Disease in the Chest
• transudates
• exudates
• hepatic hydrothorax • pancreatic disease
• nephrotic syndrome • chylous ascites
• urinothorax
• subphrenic abscess
• peritoneal dialysis • splenic abscess or infarction
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Diagnoses that can be definitively
• empyema (pus)
• peritoneal dialysis (total
• malignancy
protein < 0.5 g/dl and
• tuberculous
glucose 200 to 400
2.Bilateral Effusions
• transudative effusions • exudative effusions
• congestive heart failure • malignancy
• nephrotic syndrome • hypoalbuminemia • peritoneal dialysis
• sarcoidosis
• tulPleural Fluid Analysis
• In a prospective study of 78 patients with new-onset pleural effusion,
• a definitive diagnosis was established by the initial pleural fluid analysis in 25% ,
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4.Interstitial Lung Disease
• congestive heart failure
• rheumatoid arthritis • asbestos-induced
disease (BAPE and asbestosis)
• lymphangitic carcinomatosis