pleural effusion

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Introduction

Pleural effusions are classified as transudative or exudative.

Etiology

Pathology

Clinical manifestations

Laboratory

thoracentesis

* see Light's criteria

* in the setting of heart failure, only one of the criteria may be met, i,e. mixed transudative & exudative effusion

pleural biopsy

* useful if tuberculin skin test negative

* adenosine deaminase in pleural fluid is preferable to pleural biopsy for tuberculosis if pleural fluid lymphocytes > 75%

* lymphocyte predominant pleural fluid with pH < 7.4 & low pleural fluid glucose suggests pleural tuberculosis (see Management: for pleural fluid lymphocytosis)

* 2 non-diagnostic thoracenteses should be performed prior to pleural biopsy for diagnosis of malignancy[3]

* thoracoscopy with direct visualization & pleural biopsy after 2 non-diagnostic thoracenteses for exudative pleural effusions in an auto mechanic at risk for asbestos exposure & mesothelioma[3]

Radiology

Complications

Management

More general terms

More specific terms

Additional terms

References

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  2. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 771
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    Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  4. Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 1146
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    Light RW. Clinical practice. Pleural effusion. N Engl J Med. 2002 Jun 20;346(25):1971-7. PMID: https://www.ncbi.nlm.nih.gov/pubmed/12075059
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  9. 9.0 9.1 9.2 Davies HE et al for the BTS Pleural Disease Guideline Group Management of pleural infection in adults: British Thoracic Society pleural disease guideline 2010. Thorax 2010 Aug;65(Suppl 2):ii41-53 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20696693 corresponding NGC guideline withdrawn Dec 2015
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    Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
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