Group 3 HEI

Start up How much fluid (mL) does each pleural space contain as normal? .

 pH 7.Normal pleural physiology ‡ Each pleural space produces and reabsorbs up to 15 mL of fluid per day.6 of serum.60 .  glucose 0. ‡ Normal pleural fluid chemistries:  LDH < 0.6 to 0. and contains about 10 mL of fluid at any one time.8 of serum. not apparent on imaging.5 of serum.  protein < 0.

6 3.Transudate or exudate? Light s criteria: 1.5 2. pleural fluid LDH > 2/3 ULN for serum Presence of any of Light's criteria exudate Meet none of Light s criteria transudate BUT the above criteria misidentify ~25% of transudates as exudates ULN: upper limit of normal . pleural fluid LDH/serum LDH >0. pleural fluid protein/serum protein >0.

nephrosis Yes Exudate Serum protein ± PF protein > 3. cirrhosis.PLEURAL EFFUSION Thoracentesis Presence of any of Light's criteria Yes No Maybe exudate Transudate Patient with CHF or cirrhosis No No Yes Treat CHF.1 g/dL Further diagnostic procedures .

Transudative effusion ‡ Transudative effusions are caused by some combination of hydrostatic pressure and plasma oncotic pressure. increase the formation and/or decrease reabsorption of pleural fluid .

usually cardiomegaly on CXR ‡ Constrictive pericarditis ‡ Cirrhosis ( hepatic hydrothorax ): often right-sided (2/3) & massive (even without marked ascites) ‡ Nephrotic syndrome: usually small. malignancy (lymphatic obstruction). asymptomatic ‡ Other: PE (usually exudate).Causes ‡ Congestive heart failure (40%): 80% bilateral. CAPD . myxedema.Transudates . bilateral.

Exudative effusion ‡ Exudative effusions are caused by local processes increased capillary permeability exudation of fluid. and other serum constituents. cells. protein. .

paragonimiasis) ‡ Malignancy (15%): primary lung cancer most common. breast. lymphoma. echinococcosis. viral. metastases (esp. parasitic (eg. SLE ‡ Trauma ‡ Surgery . mesothelioma ‡ Pulmonary embolism (10%): exudate (75%) > transudate (25%) ‡ Collagen vascular disease: RA.).Exudates Causes ‡ Lung parenchymal infection (25%)  bacterial  mycobacterial  fungal. amebiasis. etc.

SLE. ‡ Your question? . PE... RA.Questions ‡ Cirrhosis ( hepatic hydrothorax ): often causes right-sided pleural effusion WHY? ‡ Abbreviations: CXR. CHF. CAPD.

References ‡ Harrison's Principles of Internal Medicine. 17th edition ‡ Merck Manuals Online Medical Library ‡ Pocket Medicine. 33rd Edition . 3rd edition ‡ Washington Manual of Medical Therapeutics.

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