PLEURAL EFFUSIONS-EXUDATE

SUMMARY

1. Bacterial pneumonia is the most common cause, or lung abscess. If there is > 10mm of fluid from the lung surface to the chest wall, the patient may require diagnostic thoracocentesis.

2. Complicated effusion: locations on imaging, pH < 7.20, glucose < 60 mg/dL, positive Gram stain or C/S. These require chest tube drainage.

3. Empyema: treatment options include tube thoracostomy with I/V antibiotics, intrapleural tPA & DNase for persistent loculations, VATS or open thoracostomy with decortication.

4. Malignancy: second common cause. Most common cancers: lung, breast, lymphoma. In a pleural based malignancy, repeat cytologic examination has as high as yield as pleural biopsy.

5. Other causes: mesothelioma, PE, viral infection, TB.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].