Pleural Fluid Small amount of fluid (plasma filtrate) in the pleural space that

facilitates movement of the two membranes (visceral and

parietal) against each other

Pleural Effusion Fluid accumulation in the pleural cavities → imbalance of fluid

production and reabsorption

Specimen Collection Thoracentesis → Pleural Fluid Analysis

Transudates Exudates

Pathophysiology systemic conditions → ↑ capillary localized disorders → ↑

hydrostatic pressure or ↓ plasma vascular permeability or
oncotic pressure interfere with lymphatic
resorption

↑ Hydrostatic pressure, ↓ Oncotic Invasion of microbes

pressure ↓
↓ Initiation of inflammatory
Fluid unable to remain within the reaction
intravascular space ↓
↓ Vasodilation
Fluid shifts into interstitial space ↓
Increase capillary
permeability
↓
Leak of plasma protein
↓
Decreased oncotic pressure
↓
Fluid shift into interstitial
space

Lung Involvement usually bilateral more often unilateral

Light’s Criteria Able to meet ≥1 criteria:

(98% sensitivity, 80%
specificity) (1) pleural fluid/serum
protein ratio greater than
0.5
(2) pleural fluid/serum LD
ratio greater than 0.6
(3) pleural fluid LD level
greater than two-thirds of
the serum upper limit of
normal
Laboratory Differences

Disease Conditions Congestive heart failure Pneumonia

Cirrhosis Cancer
Hypoalbuminemia Pulmonary embolism
Nephrotic syndrome Viral infection
Pulmonary embolism Tuberculosis
Autoimmune disorders
References:

Urinalysis and Body Fluids (6th Ed.)

Henry’s Clinical Diagnosis and Management by Laboratory Methods (24th ed.)