Pleural Fluid

Question 1

What is the source of pleural fluid?

Answer 1

• Pleural fluid is obtained from the pleural cavity
• Which is located between the parietal pleural membrane lining the chest wall and the visceral pleural membrane covering the lungs.

Question 2

What can cause the milky appearance of pleural fluid?

Answer 2

presence of chylous material from thoracic duct leakage or to pseudochylous material.

Question 3

What is the correlation between clear, pale yellow pleural fluid appearance

Answer 3

• Typically associated with normal conditions.

Question 4

What disorder is correlated with turbid, white pleural fluid appearance?

Answer 4

• Correlated with microbial infection, specifically tuberculosis.

Question 5

What disorders are correlated with bloody pleural fluid appearance?

Answer 5

• Correlated with hemothorax
• Hemorrhagic effusion
• Pulmonary embolus
• Tuberculosis
• Malignancy

Question 6

What could milky pleural fluid appearance indicate in terms of underlying disorders?

Answer 6

• Could indicate the presence of chylous material from thoracic duct leakage
• Or pseudochylous material from chronic inflammation.

Question 7

What disorder is associated with brown pleural fluid appearance?

Answer 7

“Rupture of amoebic liver abscess.”

Question 8

What disorder is correlated with black pleural fluid appearance?

Answer 8

• Black pleural fluid appearance is correlated with Aspergillus disorder.

Question 9

What disorder is associated with pleural fluid that appears viscous?

Answer 9

• Malignant mesothelioma, which is characterized by increased hyaluronic acid in the pleural fluid.

Question 10

What is the key difference in the distribution of blood between hemothorax and hemorrhagic effusion?

Answer 10

• Hemothorax has an uneven distribution of blood
• Whereas hemorrhagic effusion has an even distribution.

Question 11

What is the key difference in hematocrit levels between hemothorax and hemorrhagic effusion?

Answer 11

• Hemorrhagic effusion has pleural fluid with a hematocrit (PF Hct) <1/2 of whole blood (WB Hct)
• While hemothorax has PF Hct >1/2 of WB Hct.

Question 11

What percentage of hematocrit is typically found in whole blood?

Answer 11

• Whole blood typically contains 50% hematocrit.

Question 12

What is the hematocrit level in pleural fluid for hemothorax?

Answer 12

• In hemothorax, the pleural fluid has a hematocrit of 40%.

Question 13

What is the hematocrit level in pleural fluid for hemorrhagic effusion?

Answer 13

• In hemorrhagic effusion, the pleural fluid has a hematocrit of 20%

Question 14

What is the hematocrit level of the bloody pleural fluid in a hemorrhagic effusion?

Answer 14

• In a hemorrhagic effusion is 50%.

Question 15

What are the causes of milky pleural fluid, specifically in the case of chylous effusion and pseudochylous effusion?

Answer 15

• The causes of milky pleural fluid in chylous effusion are Thoracic Duct Leakage
• While pseudochylous effusion is typically caused by chronic inflammation or infection.

Question 16

What are the different appearances of pleural fluid in chylous effusion and pseudochylous effusion?

Answer 16

• Milky pleural fluid can have a white appearance in chylous effusion
• A milky appearance with a green tinge or “Gold paint” appearance in pseudochylous effusion.

Question 17

What is the key difference in the composition of leukocytes between chylous effusion and pseudochylous effusion

Answer 17

• In chylous effusion, there is an increase in lymphocytes
• Whereas pseudochylous effusion contains mixed cells.

Question 18

What is the key difference between chylous effusion and pseudochylous effusion in terms of cholesterol crystal presence

Answer 18

• In milky pleural fluid, chylous effusion is characterized by the absence of cholesterol crystals
• While pseudochylous effusion is associated with the presence of cholesterol crystals.

Question 19

What is the key difference in triglyceride levels between chylous effusion and pseudochylous effusion?

Answer 19

• With chylous effusion typically has triglyceride levels greater than 110 mg/dL
• Whereas pseudochylous effusion has triglyceride levels less than 50 mg/dL.

Question 20

What staining result would you expect when using Sudan III stain on milky pleural fluid in the case of chylous effusion and pseudochylous effusion?

Answer 20

• In the case of chylous effusion, the Sudan III staining is expected to be positive
• Whereas in pseudochylous effusion, the staining is typically negative (although it may occasionally show a weak positive result).

Question 21

What is the significance of the presence of neutrophils in pleural fluid?

Answer 21

• Neutrophils in pleural fluid may indicate conditions such as pancreatitis or pulmonary infarction.

Question 22

What is the significance of the presence of lymphocytes in pleural fluid?

Answer 22

• Tuberculosis
• Viral infections
• Autoimmune disorders
• Malignancy.

Question 23

What is the significance of mesothelial cells seen in pleural fluid?

Answer 23

• Are generally considered normal and non-clinically significant.
• However, a decreased presence of mesothelial cells may be associated with tuberculosis.

Question 24

What is the significance of the presence of plasma cells in pleural fluid?

Answer 24

• Particularly tuberculosis.

Question 25

What is the significance of malignant cells seen in pleural fluid?

Answer 25

• The possibility of primary adenocarcinoma and small-cell carcinoma
• As well as the potential for metastatic carcinoma.