Pleural effusions – 7/25/17

Symptoms: Dyspnea, cough, and pleuritic chest pain

Exam: Decreased breath sounds, dullness to percussion, decreased tactile fremitus

Indications for thoracentesis: Any new unexplained effusion

Light’s criteria:

  • Pleural protein/Serum protein > 0.5
  • Pleural LDH/Serum LDH > 0.6
  • Pleural LDH > 2/3 ULN

Examples of transudates:

  • Heart failure
  • Nephrotic syndrome
  • Hepatic hydrothorax
  • Low albumin

Examples of exudates:

  • Parapneumonic effusions
  • Malignancy
  • TB
  • PE
  • Autoimmune disease (RA, SLE)

Uncomplicated effusion – pH > 7.2, glucose > 60, free flowing, < 1/2 hemithorax – treat the underlying cause, no need for chest tube

Complicated effusion – pH < 7.2, glucose < 60, can be > 1/2 hemithorax or loculated – treat the underlying cause and would benefit from chest tube

Empyema – complicated effusion with positive gram stain and culture – place a chest tube

Malignant effusions – if re-accumulating rapidly, can place a long-term chest tube or do a pleurodesis with talc

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