PLEURAL EFFUSION

Transudates (plasma ultrafiltrate) vs Exudates (protein-rich fluid from capill. permeability)

With exudate, tot. fluid [prot]/serum [prot]> 0.5 & fluid LDH > 60% serum LDH

Diff Dx:

  1. Transudate
  1. CHF : R>L
  2. Pulmonary Embolus : in 25% of cases
  3. Cirrhosis: us. R-sided; can be huge, even w/o ascites
  1. Exudate
  1. Pneumonia : usually bacterial with PMN's
  2. Ca: lymphocytic, often hemorrhagic with malignant cells; lung > breast > lymphoma
  3. Pulmonary Embolus : in 75% of cases; may be hemorrhagic
  4. TB : lymphocytic; usually with no parenchymal abnormalities on CXR; 10% smear(+), 25% culture(+), 50-75% on pleural biopsy
  5. Rheumatoid Arthritis : often very low glucose (<15); LDH may be very high; may have cholesterol or crystals
  6. SLE : low C3 & C4 in fluid; often bilateral, small; may have LE cell
  7. Drugs : uncommon; eosinophilic; drug-induced lupus resembles 'f' above
  8. Dressler's Syndrome : pleuropericarditis post-MI, trauma, or pericardial surgery
  9. Benign, Asbestos related : often serosanguinous
  10. Pancreatitis : amylase in fluid; typically L-sided
  11. Intra-abdominal Abscess : PMN's; glucose > 60; sterile
  12. Esophageal Perforation : rapidly 'ing exudate, often with air-fluid levels; high salivary amylase level; us. acute presentation w/severe pain, toxicity, prostration