5/17/16 AM Report: Exudative Pleural Effusions

Teaching Pearls

  • Think TB and malignancy in the differential for lymphocytic exudative pleural effusions
  • Right sided unilateral exudative effusion in a foreigner/traveler – consider entameoba histolytica, echinococcus, paragonimus
  • Pleural Color
    • Pale Yellow –> Transudate
    • Red/Bloody –> Malignancy
    • White –> chylothorax
    • Brown –> long standing bloody effusion, amoebic liver rupture “anchovy paste”
    • Black –> fungal infections
    • yellow-green –> Rheumatoid pleurisy
  • Rheumatoid pleurisy and complicated parapneumonic effusions cause the lowest pleural glucose
  • The yield of pleural fluid culture is low, pleural biopsy yield for TB is ~90%

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