Day 4- Pleural Effusions
When to do a thoracentesis:
aspiration should NOT be preformed for bilateral effusions in a clinical setting strongly suggestive of a transudate/heart failure
consider thoracentesis if:
suspect exudate
cause unclear
parapneumonic effusion (if <1cm of fluid on lateral decubitus in the context of pneumonia can forgo sampling and instead follow radiographically)
Exudate NYD:
can repeat thoracentesis once for increased sensitivity (sensitivity of pleural fluid cytology for malignancy increases to approx 80% with 2 thoracentesis)
CT chest
refer for pleural biopsy
JAMA: Does this patient have a pleural effusion? (EBM link)
Dullness to conventional percussion (+LR 10)
Asymmetric chest expansion (+LR 8.1)
Reduced vocal resonance (+LR 6.5)
Diminished breath sounds (+LR 4.3)
JAMA: Does this patient have an exudative pleural effusion? (EBM link)
Cholesterol level >55mg/dl (+LR 7.1-250)
Pleural LDH>200u/L (+LR 18)
Pleural: serum cholesterol ratio >0.3 (+LR 14)
JAMA Rational Clinical Exam
