Thoracentesis - Pleural Fluid Analysis
Transudate ...
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Description

Thoracentesis - Pleural Fluid Analysis

Transudate (due to Starling forces) vs. Exudate (due to increased capillary leak) 

Light’s Criteria: Exudate if ≥ 1 criteria present (98% Sn, 83% Sp)

 • Pleural fluid protein / serum protein > 0.5

 • Pleural fluid LDH / serum LDH > 0.6

 • Pleural fluid LDH > 2/3 ULN of serum LDH (i.e. > 140)

NB: Diuretics cause ~25% of transudates to be misclassified as exudates

If ≥ 1 of these, it’s an exudate with 98% Sn and 70% Sp:

 • Pleural fluid protein > 2.9, LDH > 95, cholesterol > 45

More Specific Criteria for Confirming Exudate:

 • Pleural fluid cholesterol > 60 (54% Sn, 92% Sp)

 • Serum albumin – pleural albumin ≤ 1.2 (87% Sn, 92% Sp)

 • Pleural NT-proBNP < 2,300pg/mL (>80% Sn, >70% Sp)

Other tests: Adenosine deaminase, amylase, triglyceride, cholesterol, Gram stain/culture, cell count, IFN-γ, NT-proBNP, pH, tumor markers

Complicated Parapneumonic Effusion / Empyema = (+) Gram Stain / Cx / purulent OR pH <7.2 OR glu <60 → drainage



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