Review
Diagnostic utility of pleural fluid eosinophilia

https://doi.org/10.1016/0002-9343(84)90542-4Get rights and content

Abstract

It has been stated that pleural fluid eosinophilia (defined as greater than 10 percent eosinophils in the pleural white cell differential count) is not helpful in the diagnosis of exudative effusions. By review of the recent literature, it was found that pleural fluid eosinophilia was associated most often with idiopathic effusions or with air previously introduced into the pleural space. Also, a high proportion of “idiopathic” and benign asbestos effusions were characterized by pleural fluid eosinophilia, a previously unrecognized phenomenon. The diagnostic utility of finding eosinophils in the pleural space was assessed from its impact on prior probabilities of disease. Estimates of pretest likelihoods of malignant versus nonmalignant pleural effusions and the prevalence of eosinophilia in effusions of known cause were obtained from extensive literature review. These were modified by using Bayes' rule to estimate the revised probability of disease in the presence of an eosinophilic effusion. The presence of pleural fluid eosinophilia considerably reduced the probability of malignancy or tuberculosis and increased the likelihood of an underlying benign disorder. Pleural fluid eosinophilia is a useful finding that can aid in the diagnosis of an exudative pleural effusion.

References (46)

  • SA Sahn

    The differential diagnosis of pleural effusions (medical progress)

    West J Med

    (1982)
  • GD Campbell et al.

    Eosinophilic pleural effusion

    Am Rev Respir Dis

    (1964)
  • AI Spriggs et al.

    The cytology of effusions; pleural, pericardial, and peritoneal, and of cerebrospinal fluid

  • D Kokkola et al.

    Aetiology and findings in eosinophilic pleural effusions

    Scand J Respir Dis

    (1974)
  • A Leff et al.

    Pleural effusion from malignancy

    Ann Intern Med

    (1978)
  • DE Dines et al.

    The value of cells in the pleural fluid in the differential diagnosis of effusions

  • RW Light et al.

    Cells in the pleural fluid: their value in differential diagnosis

    Arch Intern Med

    (1973)
  • JS Chapman

    The reaction of serous cavities to blood

    J Lab Clin Med

    (1955)
  • T Pettersson et al.

    Diagnostic value of differential leukocyte counts in pleural effusions

    Acta Med Scand

    (1981)
  • UN Kumar et al.

    Posttraumatic pleural fluid and blood eosinophilia

    JAMA

    (1975)
  • AI Spriggs

    Pleural eosinophilia due to pneumothorax

    Acta Cytol (Baltimore)

    (1979)
  • DM Eddy et al.

    The art of diagnosis: solving the clinicopathological exercise

    N Engl J Med

    (1982)
  • GA Gorry et al.

    The diagnostic importance of the normal finding

    N Engl J Med

    (1978)
  • Cited by (137)

    • Eosinophilic Pleural Effusion Induced by Paliperidone Palmitate: Case Report and Literature Review

      2022, Journal of the Academy of Consultation-Liaison Psychiatry
      Citation Excerpt :

      Eosinophilic pleural effusions (EPEs), first described by Harmsen in 1894, are defined as pleural fluids with at least 10% eosinophils in the nucleated cell count and represent approximately 10% of exudative pleural effusions.1–6

    • A case of a patient with neurofibromatosis type I who developed pneumothorax and eosinophilic pleural effusion after suffering from COVID-19 pneumonia

      2021, Radiology Case Reports
      Citation Excerpt :

      However, to the best of our knowledge, this is the first case report to describe an eosinophilic pleural effusion after COVID-19 pneumonia. Eosinophilic pleural effusion has been reported to be most often associated with air previously introduced into the pleural space [12]. In this case, as shown in (Fig. 1), pneumothorax and pleural effusion developed after improvement of aspiration pneumonia.

    • Eosinophilic Pleural Effusions

      2021, Encyclopedia of Respiratory Medicine, Second Edition
    • Idiopathic eosinophilic pleurisy: A practical diagnostic approach

      2021, Respiratory Medicine Case Reports
      Citation Excerpt :

      An eosinophilic pleural effusion, which is the most frequent manifestation of eosinophilic pleurisy, is defined as a pleural effusion with eosinophils accounting for more than 10% of the white blood cells [4]. Although the incidence rate of eosinophilic pleural effusion differs depending on the report, it is estimated that 5–9% [3–5] of exudative pleural effusions are eosinophilic pleural effusions, suggesting that they are certainly not rare in daily clinical practice. A prospective cohort study of 476 patients whose pleural effusions were analyzed showed that the cumulative survival was significantly better in patients with eosinophilic pleural effusions than in those with non-eosinophilic pleural effusions [3], but the rate of malignant etiology was not significantly different between them [3].

    View all citing articles on Scopus
    1

    From the Department of Internal Medicine, Respiratory Division, the Johns Hopkins Hospitals, Baltimore, Maryland.

    2

    From the Department of Internal Medicine, Respiratory Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

    Current address: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Louisiana State University Medical Center, New Orleans, Louisiana 70112.

    View full text