AM Report 3/22/17: Pleural Effusion

Most common etiologies for BLOODY pleural effision:

  • Trauma
  • Malignancy
  • Pulmonary infarct
  • Post-cardiac injury

Lights Criteria: one criteria = EXUDATIVE effusion

  1. Pleural total protein / serum total protein > 0.5
  2. Pleural LDH / serum LDH > 0.6
  3. Pleural LDH ≥ 2/3 ULN for serum LDH

* Lights criteria is SENSITIVE, but NOT SPECIFIC – you do not want to miss an exudative effusion, so you want to a low false negative rate.

* For patients with a high suspicion for transudative effusion, but meets Lights criteria (i.e. CHF following initiation of diuresis), check serum albumin and pleural albumin (if serum – pleural < 1.2 mg/dL, confirms diagnosis of exudative effusion).

Transudative Effusions (not a complete list):

  • CHF (~90%)
  • Cirrhosis (hepatic hydrothorax)
  • Severe hypoalbuminemia
  • Nephrotic syndrome
  • Peritoneal dialysis
  • Myexedma
  • Constrictive pericarditits
  • SVC syndrome

Exudative Effusion (not a complete list):

  • Infection (PNA/TB)
  • Malignancy
  • CTD
  • Pancreatitis
  • Trauma
  • PE/Pulmonary infarct
  • Post heart surgery
  • Esophageal rupture

If exudative effusion, start with cell count/diff

  • PMNs > 50% – parapneumonic, PE, pancreatitis
  • Lymphs > 50% – Cancer, TB, fungal, post-surgery
  • Eosinophils >10% – Hemothorax, drug reaction, parasite infection

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