Pleural Effusion

Question 1

What is Lights criteria to determine if an effusion is an exudate?

Answer 1

1. Pleural protein / serum protein >0.5
2. Pleural LDH >200 or >2/3 upper limit of normal
3. Pleural LDH / serum LDH > 0.6

Need 1 criteria to be classified as exudate

Question 2

What can cause discordant finding among Lights criteria and what is the way to go around it?

Answer 2

Ongoing diuresis during HF

Can check serum pleural fluid gradient if >1.2 then most likely transudate

Question 3

What are examples of exudate?

Answer 3

Infection
Neoplasm
Autoimmune
Pulmonary infection
Hemothorax
Asbestos effusion
Post coronary bypass
Pancreatitis

Question 4

What are examples of transudate?

Answer 4

Heart failure
Constructive pericarditis
SVC obstruction
Hypoalbuminia
Nephrotic syndrome
Cirrhosis
Malnutrition

Question 5

If pleural fluid with lymphocytosis of >80%, pH<7.0, glucose<60, and ADA elevated, what is likely diagnosis?

What would be the best way to diagnose if only pleural fluid on CXR?

Answer 5

TB effusion

Pleural biopsy

Question 6

If bloody pleural fluid, (RBC>5000-10000) what should be suspected?

Answer 6

Malignancy, pulmonary infarction, asbestos related

Question 7

If pleural fluid with nucleated cells, >50,000, what should you suspect?

Answer 7

Complicated parapneumonic infections, empyema

Question 8

If elevated lymphocytes in pleural fluid, what should one suspect?

Answer 8

TB
Lymphoma
Chronic rheumatoid pleuritis
Esophageal rupture

Question 9

If pleural fluid amylase to serum amylase >1, what should one suspect?

Answer 9

Pancreatic disease
Esophageal rupture
Cancer

Question 10

If mass and pleural effusion on CXR and patient w constitutional symptoms (weight loss, hemoptysis, etc.), tap done with cytology negative, what is the next step?

Answer 10

Repeat cytology

Question 11

If mass and pleural effusion on CXR and patient w constitutional symptoms (weight loss, hemoptysis, etc.), tap done twice with cytology negative, what is the next step?

Answer 11

Thorascopy

Question 12

If person found to have pleural/serum protein >0.5 of pleural fluid,
But not sure what it is diagnosis, what should one do?

Answer 12

Thoracoscopy

Question 13

What is the management of a parapneumonic effusion when pH<7.2 or pleural fluid glucose <60?

Answer 13

Chest tube drainage

Question 14

What type of coverage should empiric antibiotics have for empyema treatment?

Answer 14

Anaerobes coverage

Question 15

If a patient w a malignant pleural effusion causing dyspnea, what can help for symptom relief?

Answer 15

Indwelling pleural catheter

Spontaneous obliteration after 6wks or chemical pleurodesis

Question 16

If a person w a moderate pleural effusion associated a pneumonia, what is next step of management?

Answer 16

Thoracentesis

Question 17

What should be excluded in a person w a nephrotic syndrome and an associated pleural effusion?

Answer 17

PE because PE and renal vein thrombosis occur with patients w nephrotic syndrome

Question 18

Young woman w pleural effusion that was characterized by discordant Lights criteria results and found to be chylothorax. What is the cause?

Answer 18

LAM