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Pleural effusion

  • By transudate/exudate

    • transudate (low LDH, protein)
      • CHF (exertional dyspnea, peripheral edema, elevated BNP, tx with lasix)
      • cirrhosis (EtOH)
      • nephrotic syndrome (get UA)
      • hypoalbuminemia
      • atelectasis (tx with incentive spirometer)
      • Meig's (ascites, ovarian tumor)
      • myxedema (get TSH)
      • peritoneal dialysis
    • exudate (high LDH, protein)
      • esophageal rupture (pH < 6)
      • CSS (hx of asthma, get UA, ANCA)
      • pneumonia (empyema)
      • rheumatoid pleuritis (hx of RA)
      • malignancy (wt loss, nightsweats, get cytology)
      • pancreatitis (EtOH, epigastric pain, amylase > 200)
      • TB (travel hx)
      • lupus (get ANA)
      • drugs (new meds, eosinophilia)
      • uremia (get BMP)
    • Chyle
      • thoracic duct obstruction, tumor, trauma
    • Bloody
      • PE, infarct (get spiral CT, give heparin)
      • malignancy (wt loss, nightsweats, get cytology)
      • trauma
  • By organ system

    • cardio (transudate)
      • CHF
    • pulm
      • PE, infarct
      • pneumonia
      • atelectasis
    • GI (exudate)
      • pancreatitis
      • esophageal rupture
      • thoracic duct obstruction, tumor, trauma
    • renal (exudate)
      • uremia
      • CSS
    • autoimmune (exudate)
      • rheumatoid pleuritis
    • malignancy (exudate, bloody)
    • infectious (exudate)
      • TB
      • pneumonia
    • drugs
  • Light's criteria exudate if

    • protein > 0.5 of serum's
    • LDH > 0.6 of serum's or upper limit of normal
  • Labs

    • thoracocentesis
  • Tx

    • chest tube if empyema or hemothorax

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    Disclaimer: MDHero Workups is for educational use only, and is not meant to replace the clinical judgement of a professional. We do not guarantee the accuracy of any information on this website.