Pleural effusions
Section snippets
Epidemiology of pleural effusions
Approximately 1.5 million people develop pleural effusions in the United States each year.1 Many different diseases may cause them. In an unpublished series of 2900 consecutive patients submitted to a diagnostic thoracentesis in a University Hospital (Lleida, Spain) during the last 17 years, the leading etiologies of pleural effusions were: cancer (27%), heart failure (20%), pneumonia (18%), tuberculosis (9%), pericardial diseases (3.5%), and cirrhosis (3%). It should be noted that figures for
Pathogenesis of pleural effusions
Normally, the pleural space contains a small amount of fluid (about 0.26 ± 0.1 mL/kg body weight) which allows the lungs to expand and deflate with minimal friction during respiratory movements.4 Pleural fluid normally originates in the capillaries of the parietal pleura, filtrates into the pleural space, and is then absorbed by the parietal pleural lymphatics. Effusions accumulate whenever the rate of pleural fluid formation exceeds that of its reabsorption, usually the result of simultaneous
Approach to patients with pleural effusions
Key elements to uncover the etiology of pleural effusions are clinical evaluation, imaging, pleural fluid analysis, and when applicable pleural biopsy.
Management of selected diseases causing pleural effusions
In this section, salient features of several common causes of pleural effusions will be succinctly reviewed, but a more comprehensive discussion for readers can be found elsewhere.9
Bedside pleural techniques
General practitioners need to be familiar with the basic pleural techniques aimed at diagnosing (diagnostic thoracentesis) and treating (therapeutic thoracentesis and chest catheters) patients with pleural effusions.104 These procedures should ideally be performed with bedside ultrasound guidance for patient safety. A wide variety of portable ultrasound machines can be used for pleural abnormalities visualization. A machine with a convex, microconvex (preferred) or sector probe of 3.5–5 MHz is
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The Eponymous Dr. Richard W. Light: Father of Pleural Medicine
2022, Archivos de BronconeumologiaPleural Fluid Analysis: Are Light's Criteria Still Relevant After Half a Century?
2021, Clinics in Chest MedicineCitation Excerpt :In particular, a protein discordant exudate increases the risk of a false-positive exudate.61 Overall, Light’s criteria misclassify about 25% to 30% of transudates as exudates,5,6 usually by a small margin (eg, median protein ratio of 0.51 and median LDH ratio of 0.63 in a series of 107 misclassified HF-related effusions).64 This miscategorization is especially frequent in patients who have received diuretic treatment or have bloody PFs (>10,000 erythrocytes/μL, which occurs in about 15% of transudates).51,65
Pleural effusion osmolality correlation with pH and glucose level of pleural fluid and its effects on the pleural membrane permeability
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