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Pleural Effusion

Diagnostic evaluation of pleural effusion in adults by Dr. Kailash Bajaj Check out full internal medicine board review course details: https://excellentmedicallectures.com/ Take home points: According to the traditional Light's Criteria Rule, if at least one of the three criteria is fulfilled, the fluid is defined as an exudate. -Combining results of two or more tests into a diagnostic rule, increases sensitivity at the expense of decreasing specificity of the rule. This is important so that exudates not be missed. -The cause of a pleural effusion may not be evident in 25% of patients. Most undiagnosed pleural effusions are exudative, because the differential diagnosis of a transudative effusion is limited. -Pleural fluid cytological examination has a sensitivity of 60% for pleural malignancy and malignant effusions seldom resolve spontaneously. -Uncomplicated parapneumonic effusions from pulmonary embolism, tuberculous pleurisy, and postcardiac injury syndrome may resolve spontaneously after several weeks. A parapneumonic effusion is considered complicated if: has a pH ＜7.2 and/or positive culture or Gram stain, a low glucose level ＜40 mg/dL or a serum LDH ＞1000 (non-specific). Apart from Complicated parapneumonic effusion or empyema, a low glucose ＜ 60 can be seen in Rheumatoid pleurisy, malignancy, TB, Lupus and esophageal rupture Measure adenosine deaminase (ADA) to distinguish between malignant and tuberculous pleurisy when an exudative effusion is lymphocytic, but initial cytology and smear and culture for TB are negative