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Pleural effusion

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about whether a fluid is a transudate or an exudate is based not on chemical analysis of the fluid, but an accurate diagnosis of the disease that produces the fluid. The traditional definitions of transudate as a pleural effusion due to systemic factors and an exudate as a pleural effusion due to local factors have been used since 1940 or earlier (Light et al., 1972). Previous to Light's landmark study, which was based on work by Chandrasekhar, investigators unsuccessfully attempted to use other criteria, such as specific gravity, pH, and protein content of the fluid, to differentiate between transudates and exudates. Light's criteria are highly statistically sensitive for exudates (although not very statistically specific). More recent studies have examined other characteristics of pleural fluid that may help to determine whether the process producing the effusion is local (exudate) or systemic (transudate). The table above illustrates some of the results of these more recent studies. However, it should be borne in mind that Light's criteria are still the most widely used criteria.
32: 797: 835: 888: 858: 2666: 785: 259: 1246: 1391:, in which the two pleural surfaces are scarred to each other so that no fluid can accumulate between them. This is a surgical procedure that involves inserting a chest tube, then either mechanically abrading the pleura or inserting the chemicals to induce a scar. This requires the chest tube to stay in until the fluid drainage stops. This can take days to weeks and can require prolonged hospitalizations. If the chest tube becomes clogged, fluid will be left behind and the 385: 690: 870: 778:, nearly as accurate as CT and more accurate than chest X-ray, is increasingly being used at the point of care to diagnose pleural effusions, with the advantage that it is a safe, dynamic, and repeatable imaging modality. To increase diagnostic accuracy of detection of pleural effusion sonographically, markers such as boomerang and VIP signs can be utilized. 758:. The pleural effusion behaves according to basic fluid dynamics, conforming to the shape of pleural space, which is determined by the lung and chest wall. If the pleural space contains both air and fluid, then an air-fluid level that is horizontal will be present, instead of conforming to the lung space. Chest radiographs in the lateral 1359:(either pigtail or surgical). When managing these chest tubes, it is important to make sure the chest tubes do not become occluded or clogged. A clogged chest tube in the setting of continued production of fluid will result in residual fluid left behind when the chest tube is removed. This fluid can lead to complications such as 1331:
Light's criteria as having exudative pleural effusions actually have transudative pleural effusions. Therefore, if a patient identified by Light's criteria as having an exudative pleural effusion appears clinically to have a condition that usually produces transudative effusions, additional testing is needed. In such cases,
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Tubercular pleural effusion is one of the common extrapulmonary forms of tuberculosis. Treatment consists of antituberculosis treatment (ATT). The currently recommended ATT regime is two months of isoniazid, rifampicin, ethambutol and pyrazinamide followed by four months of isoniazid, rifampicin and
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The Rational Clinical Examination Series review found that bilateral effusions, symmetric and asymmetric, are the most common distribution in heart failure (60% of effusions in heart failure will be bilateral). When there is asymmetry in heart failure-associated pleural effusions (either unilateral
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levels in blood and pleural fluid are measured. If the difference between the albumin level in the blood and the pleural fluid is greater than 1.2 g/dL (12 g/L), this suggests that the patient has a transudative pleural effusion. However, pleural fluid testing is not perfect, and the final decision
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and reabsorbed by the lymphatics in the most dependent parts of the parietal pleura, primarily the diaphragmatic and mediastinal regions. Exudative pleural effusions occur when the pleura is damaged, e.g., by trauma, infection, or malignancy, and transudative pleural effusions develop when there is
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An accurate diagnosis of the cause of the effusion, transudate versus exudate, relies on a comparison of the chemistries in the pleural fluid to those in the blood, using Light's criteria. According to Light's criteria (Light, et al. 1972), a pleural effusion is likely exudative if at least one of
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A pleural effusion appears as an area of whiteness on a standard posteroanterior chest X-ray. Normally, the space between the visceral pleura and the parietal pleura cannot be seen. A pleural effusion infiltrates the space between these layers. Because the pleural effusion has a density similar to
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Pleurodesis fails in as many as 30% of cases. An alternative is to place a PleurX Pleural Catheter or Aspira Drainage Catheter. This is a 15Fr chest tube with a one-way valve. Each day the patient or caregivers connect it to a simple vacuum tube and remove from 600 to 1000 mL of fluid, and can be
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The sensitivity and specificity of Light's criteria for detection of exudates have been measured in many studies and are usually reported to be around 98% and 80%, respectively. This means that although Light's criteria are relatively accurate, twenty percent of patients that are identified by
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can be tried, and thoracentesis is avoided unless effusions persist for more than 3 days. In a thoracentesis, a needle is inserted through the back of the chest wall in the sixth, seventh, or eighth intercostal space on the midaxillary line, into the pleural space. The use of
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position (with the patient lying on the side of the pleural effusion) are more sensitive and can detect as little as 50 mL of fluid. Between 250 and 600mL of fluid must be present before upright chest X-rays can detect a pleural effusion (e.g., blunted
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Romero S, Martinez A, Hernandez L, Fernandez C, Espasa A, Candela A, Martin C (2000). "Light's criteria revisited: consistency and comparison with new proposed alternative criteria for separating pleural transudates from exudates".
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were once thought to cause transudative effusions, but have been recently shown to be exudative. The mechanism for the exudative pleural effusion in pulmonary thromboembolism is probably related to increased permeability of the
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Lau, James Siu Ki; Yuen, Chi Kit; Mok, Ka Leung; Yan, Wing Wa; Kan, Pui Gay (2017-11-15). "Visualization of the inferoposterior thoracic wall (VIP) and boomerang signs-novel sonographic signs of right pleural effusion".
1272:. The components of the Starling forces – hydrostatic pressure, permeability, and oncotic pressure (effective pressure due to the composition of the pleural fluid and blood) – are altered in many diseases, e.g., 2834: 2815: 2914: 834: 1978:
Volpicelli, Giovanni; Elbarbary, Mahmoud; Blaivas, Michael; Lichtenstein, Daniel A.; Mathis, Gebhard; Kirkpatrick, Andrew W.; Melniker, Lawrence; Gargani, Luna; Noble, Vicki E. (2012-04-01).
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or one side larger than the other), the right side is usually more involved than the left. The instruments pictured are accurately shaped, however, most hospitals now use safer disposable
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either excessive production of pleural fluid or the resorption capacity is reduced. Light's criteria can be used to differentiate between exudative and transudative pleural effusions.
1261:" are the source of much confusion. Briefly, transudate is produced through pressure filtration without capillary injury while exudate is "inflammatory fluid" leaking between cells. 1738:
Raicevic Mirjana, Nikolovski Srdjan, Golubovic Emilija. Pleural Effusion as a Ventriculo-Peritoneal Shunt Complication in Children (Meeting Abstract). Acta Med Acad. 2019;48(S1):26.
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Anteroposterior Chest X-ray of a pleural effusion. The A arrow shows fluid layering in the right pleural cavity. The B arrow shows the normal width of the lung in the cavity
1403:, it allows them to continue chemotherapy if indicated. Generally, the tube is in for about 30 days, and then it is removed when space undergoes spontaneous pleurodesis. 818: 745:, 2.2–33.8), while the absence of reduced tactile vocal fremitus made pleural effusion less likely (negative likelihood ratio, 0.21; 95% confidence interval, 0.12–0.37). 3323: 784: 2253:
Heffner J, Brown L, Barbieri C (1997). "Diagnostic value of tests that discriminate between exudative and transudative pleural effusions. Primary Study Investigators".
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Gordon, Craig E.; Feller-Kopman, David; Balk, Ethan M.; Smetana, Gerald W. (2010-02-22). "Pneumothorax following thoracentesis: a systematic review and meta-analysis".
887: 609:(most commonly caused by trauma), and accidental infusion of fluids. Less common causes include esophageal rupture or pancreatic disease, intra-abdominal abscesses, 2508:
Light, Richard W. "Ch. 257: Disorders of the Pleura and Mediastinum". In Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J (eds.).
2623:"Is albumin gradient or fluid to serum albumin ratio better than the pleural fluid lactate dehydroginase in the diagnostic of separation of pleural effusion?" 920:
to guide the procedure is now standard of care as it increases accuracy and decreases complications. After removal, the fluid may then be evaluated for:
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times the normal upper limit for serum. Different laboratories have different values for the upper limit of serum LDH, but examples include 200 and 300
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water, it can be seen on radiographs. Since the effusion has greater density than the rest of the lung, it gravitates towards the lower portions of the
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Another common cause is after heart surgery when incompletely drained blood can lead to an inflammatory response that causes exudative pleural fluid.
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Red blood cell counts are elevated in cases of bloody effusions (for example after heart surgery or hemothorax from incomplete evacuation of blood).
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is more accurate for diagnosis and may be obtained to better characterize the presence, size, and characteristics of a pleural effusion. Lung
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Gupta, A. K.; Berry, M. (April 1994). "Ventriculo-peritoneal shunt presenting with recurrent pleural effusion: Report of a new complication".
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Once a pleural effusion is diagnosed, its cause must be determined. Pleural fluid is drawn out of the pleural space in a process called
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Light RW, Macgregor MI, Luchsinger PC, Ball WC (1972). "Pleural effusions: the diagnostic separation of transudates and exudates".
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deviation away from the effusion. A systematic review (2009) published as part of the Rational Clinical Examination Series in the
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Consolidated Guidelines on Tuberculosis Treatment. Module 3: Diagnosis. Rapid diagnostics for tuberculosis detection. 2021 update
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Light R, Macgregor M, Luchsinger P, Ball W (1972). "Pleural effusions: the diagnostic separation of transudates and exudates".
1471:. American Thoracic Society International Conference Abstracts. Vol. 308. American Thoracic Society. pp. A5333–A5333 3313: 3999: 3782: 3537: 2935: 2367:
Cullu, Nesat; Kalemci, Serdar; Karakas, Omer; Eser, Irfan; Yalcin, Funda; Boyaci, Fatma Nurefsan; Karakas, Ekrem (2013).
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repeated daily. When not in use, the tube is capped. This allows patients to be outside the hospital. For patients with
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Roth BJ, O'Meara TF, Gragun WH (1990). "The serum-effusion albumin gradient in the evaluation of pleural effusions".
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showed that dullness to conventional percussion was most accurate for diagnosing pleural effusion (summary positive
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scan of the chest showing a left-sided pleural effusion. The fluid usually settles at the lowest space due to
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levels in the blood and reduced colloid osmotic pressure, is another less common cause of pleural effusion.
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de Menezes Lyra R (1997). "A modified outer cannula can help thoracentesis after pleural biopsy".
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absorption leaving behind only 5–15 millilitres of fluid, which helps to maintain a functional
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Wong CL, Holroyd-Leduc J, Straus SE (Jan 2009). "Does this patient have a pleural effusion?".
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The University of Utah • Spencer S. Eccles Health Sciences Library > WebPath images >
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bacilli, this is the most common cause of pleural effusions in some developing countries),
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Massive left-sided pleural effusion (whiteness) in a patient presenting with lung cancer.
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capillaries at a rate of 0.6 millilitre per kilogram weight per hour, and is cleared by
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Therapeutic aspiration may be sufficient; larger effusions may require insertion of an
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C54. CRITICAL CARE CASE REPORTS: CAUSES AND COMPLICATIONS OF ACUTE RESPIRATORY FAILURE
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causing approximately 75% of all malignant pleural effusions), viral infection, and
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increasing the resistance against lung expansion, resulting in a fully or partially
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Various methods can be used to classify pleural fluid. By the origin of the fluid:
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with symmetric pleural effusions and no chest pain or fever; in these patients,
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Massive pleural effusion, later proven to be hemothorax in a South Indian male.
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factors that influence the formation and absorption of pleural fluid (e.g.,
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Porcel JM, Light RW (2008). "Pleural effusions due to pulmonary embolism".
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Transudative pleural effusions are defined as effusions that are caused by
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The lung expanding within an area of pleural effusion as seen by ultrasound
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Malignancy (either lung cancer or metastases to the pleura from elsewhere)
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Shore, D.; Malhotra, A. (2018-05-01). "Coprothorax: A Feculent Pleura".
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to identify cancer cells, but may also identify some infective organisms
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The ratio of pleural fluid protein to serum protein is greater than 0.5
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Porcel JM, Peña JM, Vicente de Vera C, Esquerda A (Feb 18, 2006). "".
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Galagan et al. Color Atlas of Body Fluids. CAP Press, Northfield, 2006
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A large left-sided pleural effusion as seen on an upright chest X-ray
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The most common causes of exudative pleural effusions are bacterial
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Various kinds of fluid can accumulate in the pleural space, such as
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Treatment depends on the underlying cause of the pleural effusion.
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Conditions associated with transudative pleural effusions include:
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Light RW, Macgregor MI, Luchsinger PC, Ball WC Jr (October 1972).
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The ratio of pleural fluid LDH and serum LDH is greater than 0.6
3329: 3142: 3071: 2819: 1641:"Pleural Effusion in Adults—Etiology, Diagnosis, and Treatment" 1341: 1289: 977: 689: 673: 427: 86: 2186: 399:, additional evaluation is needed to determine its cause, and 3150: 1819:
Saguil, Aaron; Wyrick, Kristen; Hallgren, John (2014-07-15).
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if scarring occurs. Repeated effusions may require chemical (
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Joseph J, Badrinath P, Basran GS, Sahn SA (November 2001).
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Glucose is decreased with cancer, bacterial infections, or
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A pleural effusion as seen on lateral upright chest x-ray
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A pleural effusion is usually diagnosed on the basis of
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Conditions associated with exudative pleural effusions:
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Pleural fluid is secreted by the parietal layer of the
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Respiration; International Review of Thoracic Diseases
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If cancer is suspected, the pleural fluid is sent for
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Other tests as suggested by the clinical situation –
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and culture to identify possible bacterial infections
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on the affected side, decreased vocal resonance and
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A 1756:, Treasure Island (FL): StatPearls Publishing, 1268:factors that alter the pleural equilibrium, or 963:counts and differential white blood cell counts 304:in the lung, which results from the release of 2324: 2322: 621:(ascites and pleural effusion due to a benign 540:Infection (empyema due to bacterial pneumonia) 2936: 2567: 2565: 2507: 2286: 2284: 2131: 2026: 1464: 1019: 1555: 1553: 1249:Instruments for needle biopsy of the pleura. 250:By the underlying cause (see next section). 2319: 1945: 1779: 1513: 735:Journal of the American Medical Association 2943: 2929: 2614: 2562: 2510:Harrison's Principles of Internal Medicine 2281: 2248: 2246: 2244: 2228: 2226: 2111:Merck Manual for Health Care Professionals 2030:The American Journal of Emergency Medicine 1687: 1310:Pleural fluid LDH is greater than 0.6 or 1026: 1012: 881:Pleural effusion as seen behind the heart. 287:, leading to the loss of large amounts of 275:pleural effusion in the United States are 61:is accumulation of excessive fluid in the 30: 3543:Combined pulmonary fibrosis and emphysema 2648: 2638: 2597: 2521: 2519: 2400: 1995: 1856: 1854: 1821:"Diagnostic approach to pleural effusion" 1664: 1638: 1550: 632:Pleural effusions may also occur through 589:Other causes of pleural effusion include 1244: 688: 605:, bleeding (often due to chest trauma), 418:Amylase levels are elevated in cases of 383: 257: 3567:Allergic bronchopulmonary aspergillosis 2373:Diagnostic and Interventional Radiology 2241: 2223: 97:by upsetting the functional vacuum and 4018: 2716: 2672: 2516: 2098: 1851: 39:Diagram of fluid buildup in the pleura 2924: 2138:Current Opinion in Pulmonary Medicine 1951: 1895: 1516:Current Opinion in Pulmonary Medicine 1276:, kidney failure, liver failure, and 2417: 1574:The Lecturio Medical Concept Library 486:for tuberculous DNA may be done, or 411:and cell counts should be measured. 168:in the pleural space), leading to a 4000:Idiopathic pulmonary haemosiderosis 2132:Feller-Kopman, David (2007-07-01). 2080:"UOTW #23 - Ultrasound of the Week" 991: 729:. A large effusion there may cause 13: 3589:Vaping-associated pulmonary injury 2952:Diseases of the respiratory system 2758:World Health Organisation (2021). 1924:Squire's fundamentals of radiology 1645:Deutsches Ă„rzteblatt International 851:, one cause of a pleural effusion. 667: 584: 444:(<7.2) and maybe low in cancer. 310:vascular endothelial growth factor 14: 4042: 2793: 2104: 1494:U.S. National Library of Medicine 646:endoscopic variceal sclerotherapy 634:medical or surgical interventions 627:ovarian hyperstimulation syndrome 2664: 898: 886: 868: 856: 833: 814: 795: 783: 461:and culture should also be done. 308:or inflammatory mediators (e.g. 2751: 2501: 2180: 2125: 2072: 2020: 1971: 1914: 1889: 1812: 1773: 1741: 1594:de Menezes Lyra R (July 1997). 924:Chemical composition including 266: 4005:Pulmonary alveolar proteinosis 2201:10.1001/archinternmed.2009.548 2113:. Merck Sharp & Dohme Corp 1732: 1681: 1639:Jany, B; Welte, T (May 2019). 1587: 1562: 1507: 1482: 1458: 642:coronary artery bypass surgery 1: 3579:Idiopathic pulmonary fibrosis 2189:Archives of Internal Medicine 1452: 613:, asbestos pleural effusion, 468:is possible, examination for 243:Transudative pleural effusion 3562:Respiratory hypersensitivity 3500:Hypersensitivity pneumonitis 2150:10.1097/MCP.0b013e3281214492 1528:10.1097/MCP.0b013e3282fcea3c 1347: 684: 603:systemic lupus erythematosus 379: 7: 3471:Coalworker's pneumoconiosis 2468:Annals of Internal Medicine 1896:Corne; et al. (2002). 1750:"Physiology, Pleural Fluid" 1410: 1401:malignant pleural effusions 494:levels may also be checked. 424:pancreatic pleural effusion 73:. Under normal conditions, 10: 4047: 3324:Acute exacerbation of COPD 2540:10.7326/0003-4819-77-4-507 2480:10.7326/0003-4819-77-4-507 2305:10.7326/0003-4819-77-4-507 2042:10.1016/j.ajem.2017.11.023 1253:Definitions of the terms " 748: 471:Mycobacterium tuberculosis 271:The most common causes of 246:Exudative pleural effusion 3967: 3940: 3870: 3856: 3810: 3768: 3747: 3721: 3624: 3610: 3601: 3530: 3415: 3395: 3278: 3258: 3098: 2978: 2958: 2875: 2801: 1997:10.1007/s00134-012-2513-4 1900:. Churchill Livingstone. 1825:American Family Physician 1786:American Family Physician 1657:10.3238/arztebl.2019.0377 998: 484:polymerase chain reaction 253: 132:, more commonly known as 89:between the parietal and 43: 38: 29: 24: 3387:Diffuse panbronchiolitis 3380:Bronchiolitis obliterans 3246:Laryngotracheal stenosis 3193:Laryngopharyngeal reflux 3171:Laryngopharyngeal reflux 3129:Laryngopharyngeal reflux 3057:Nasal septum perforation 2905:MedlinePlus Encyclopedia 2590:10.1136/thorax.56.11.867 1296:, and viral infection). 1274:left ventricular failure 375:End-stage kidney disease 336:Congestive heart failure 175: 3135:Retropharyngeal abscess 2764:. WHO. pp. 1–104. 2438:10.1378/chest.112.1.296 2267:10.1378/chest.111.4.970 1984:Intensive Care Medicine 1615:10.1378/chest.112.1.296 324:and accumulates in the 291:in urine and resultant 3828:Pulmonary hypertension 3557:Eosinophilic pneumonia 3209:Vocal cord dysfunction 3052:Nasal septum deviation 2627:BMC Pulmonary Medicine 2385:10.5152/dir.2013.13066 2343:10.1378/chest.98.3.546 2084:Ultrasound of the Week 1300:the following exists: 1250: 849:malignant mesothelioma 694: 529:Parapneumonic effusion 392: 346:Severe hypoalbuminemia 263: 3955:Mediastinal emphysema 3734:Healthcare-associated 3664:Legionnaires' disease 3090:Peritonsillar abscess 3062:Nasal septal hematoma 2640:10.1186/1471-2466-2-1 1898:Chest X-Ray Made Easy 1875:10.1001/jama.2008.937 1248: 1172:upper limit for serum 1080:vascular permeability 930:lactate dehydrogenase 705:, and confirmed by a 692: 644:, abdominal surgery, 387: 261: 3702:Mendelson's syndrome 3574:Hamman–Rich syndrome 1437:Subpulmonic effusion 723:pleural friction rub 658:lung transplantation 611:rheumatoid arthritis 566:Boerhaave's syndrome 564:Ruptured esophagus ( 556:Autoimmune disorders 547:Pulmonary infarction 435:rheumatoid pleuritis 372:Obstructive uropathy 239:By pathophysiology: 69:that surrounds each 4026:Disorders of fascia 3975:Respiratory failure 3942:Mediastinal disease 3510:Bird fancier's lung 3085:Adenoid hypertrophy 1690:Pediatric Radiology 1367:from the fluid, or 1286:bacterial pneumonia 843:of a pleural fluid 772:computed tomography 765:costophrenic angles 743:confidence interval 488:adenosine deaminase 363:Peritoneal dialysis 77:is secreted by the 4031:Diseases of pleura 3880:Pleuritis/pleurisy 3833:Pulmonary embolism 3729:Community-acquired 3654:Atypical bacterial 3553:Löffler's syndrome 3334:Status asthmaticus 3319:Chronic bronchitis 3204:Vocal fold paresis 3018:Vasomotor rhinitis 2917:Images from MedPix 2876:External resources 2107:"Pleural Effusion" 2105:Light, Richard W. 1954:"Pleural effusion" 1952:Bell DJ, Jones J. 1702:10.1007/bf02020178 1490:"Pleural effusion" 1432:Pulmonary embolism 1294:pulmonary embolism 1251: 1154:Serum - Effusion 695: 552:Pulmonary embolism 516:pulmonary embolism 420:esophageal rupture 393: 350:Nephrotic syndrome 285:Nephrotic syndrome 264: 144:), or very rarely 4013: 4012: 3963: 3962: 3920:Empyema/pyothorax 3852: 3851: 3848: 3847: 3806: 3805: 3739:Hospital-acquired 3597: 3596: 3461:Caplan's syndrome 3254: 3253: 3199:Vocal fold nodule 3023:Atrophic rhinitis 2899: 2898: 2778:on March 20, 2019 2694:10.1159/000029457 2086:. 22 October 2014 1357:intercostal drain 1243: 1242: 1191:> 0.6 or > 1177:< 0.6 or < 876: 847:specimen showing 823: 650:radiation therapy 354:Acute atelectasis 170:hydropneumothorax 164:(accumulation of 55: 54: 19:Medical condition 4038: 3898:Pleural effusion 3891:Hemopneumothorax 3868: 3867: 3622: 3621: 3608: 3607: 3451:Bauxite fibrosis 3416:External agents/ 3413: 3412: 3344:Exercise-induced 3300:Acute bronchitis 3276: 3275: 2976: 2975: 2945: 2938: 2931: 2922: 2921: 2915:Pleural Effusion 2910:Pleural Effusion 2799: 2798: 2788: 2787: 2785: 2783: 2774:. Archived from 2755: 2749: 2748: 2737:10.1157/13084870 2725:Medicina ClĂ­nica 2720: 2714: 2713: 2676: 2670: 2669: 2668: 2662: 2652: 2642: 2618: 2612: 2611: 2601: 2569: 2560: 2559: 2523: 2514: 2513: 2512:(17th ed.). 2505: 2499: 2498: 2496: 2494: 2459: 2450: 2449: 2421: 2415: 2414: 2404: 2364: 2355: 2354: 2326: 2317: 2316: 2288: 2279: 2278: 2250: 2239: 2238: 2230: 2221: 2220: 2184: 2178: 2177: 2129: 2123: 2122: 2120: 2118: 2102: 2096: 2095: 2093: 2091: 2076: 2070: 2069: 2036:(7): 1134–1138. 2024: 2018: 2017: 1999: 1975: 1969: 1968: 1966: 1964: 1949: 1943: 1942: 1918: 1912: 1911: 1893: 1887: 1886: 1858: 1849: 1848: 1816: 1810: 1809: 1792:(7): 1211–1220. 1777: 1771: 1770: 1769: 1768: 1745: 1739: 1736: 1730: 1729: 1685: 1679: 1678: 1668: 1636: 1627: 1626: 1600: 1591: 1585: 1584: 1582: 1580: 1566: 1560: 1557: 1548: 1547: 1511: 1505: 1504: 1502: 1500: 1486: 1480: 1479: 1477: 1476: 1462: 1321: 1320: 1319: 1315: 1202: 1201: 1200: 1196: 1188: 1187: 1186: 1182: 1174: 1098:Specific gravity 1070:osmotic pressure 1028: 1021: 1014: 996: 995: 992:Light's criteria 890: 878: 877: 860: 837: 825: 824: 799: 787: 739:likelihood ratio 619:Meigs's syndrome 601:disease such as 492:interferon gamma 389:Pleural effusion 368:Meigs's syndrome 297:Pulmonary emboli 262:Pleural effusion 91:visceral pleurae 79:parietal pleural 59:pleural effusion 34: 25:Pleural effusion 22: 21: 4046: 4045: 4041: 4040: 4039: 4037: 4036: 4035: 4016: 4015: 4014: 4009: 3959: 3936: 3872:Pleural disease 3861: 3844: 3802: 3764: 3748:By distribution 3743: 3722:By vector/route 3717: 3615: 3603: 3593: 3548:Pulmonary edema 3526: 3421: 3417: 3404: 3400: 3391: 3356:Cystic fibrosis 3283: 3267: 3263: 3250: 3094: 2968: 2962: 2954: 2949: 2900: 2895: 2894: 2871: 2870: 2810: 2796: 2791: 2781: 2779: 2772: 2756: 2752: 2721: 2717: 2677: 2673: 2663: 2619: 2615: 2570: 2563: 2524: 2517: 2506: 2502: 2492: 2490: 2460: 2453: 2422: 2418: 2365: 2358: 2327: 2320: 2289: 2282: 2251: 2242: 2233: 2231: 2224: 2185: 2181: 2130: 2126: 2116: 2114: 2103: 2099: 2089: 2087: 2078: 2077: 2073: 2025: 2021: 1976: 1972: 1962: 1960: 1950: 1946: 1939: 1919: 1915: 1908: 1894: 1890: 1859: 1852: 1817: 1813: 1778: 1774: 1766: 1764: 1746: 1742: 1737: 1733: 1686: 1682: 1651:(21): 377–386. 1637: 1630: 1598: 1592: 1588: 1578: 1576: 1568: 1567: 1563: 1558: 1551: 1512: 1508: 1498: 1496: 1488: 1487: 1483: 1474: 1472: 1463: 1459: 1455: 1417:Pleural disease 1413: 1387:), or surgical 1350: 1317: 1313: 1312: 1311: 1270:Starling forces 1198: 1194: 1193: 1192: 1184: 1180: 1179: 1178: 1170: 1169: 1153: 1137: 1136:fluid protein/ 1078: 1069: 1065: 1061: 1032: 994: 986:immunoglobulins 901: 894: 891: 882: 879: 869: 864: 861: 852: 838: 829: 826: 815: 810: 800: 791: 788: 751: 699:medical history 687: 670: 668:Pathophysiology 587: 585:Other/ungrouped 502:, cancer (with 382: 322:visceral pleura 269: 256: 178: 134:pleural empyema 99:hydrostatically 67:potential space 20: 17: 12: 11: 5: 4044: 4034: 4033: 4028: 4011: 4010: 4008: 4007: 4002: 3997: 3992: 3987: 3982: 3977: 3971: 3969: 3965: 3964: 3961: 3960: 3958: 3957: 3952: 3946: 3944: 3938: 3937: 3935: 3934: 3928: 3927: 3922: 3917: 3912: 3907: 3902: 3900: 3894: 3893: 3883: 3882: 3876: 3874: 3865: 3858:Pleural cavity 3854: 3853: 3850: 3849: 3846: 3845: 3843: 3842: 3837: 3836: 3835: 3830: 3820: 3814: 3812: 3808: 3807: 3804: 3803: 3801: 3800: 3795: 3790: 3785: 3780: 3774: 3772: 3766: 3765: 3763: 3762: 3757: 3751: 3749: 3745: 3744: 3742: 3741: 3736: 3731: 3725: 3723: 3719: 3718: 3716: 3715: 3714: 3713: 3704: 3690: 3685: 3684: 3683: 3673: 3672: 3671: 3666: 3661: 3651: 3650: 3649: 3644: 3634: 3628: 3626: 3619: 3605: 3599: 3598: 3595: 3594: 3592: 3591: 3586: 3581: 3576: 3571: 3570: 3569: 3559: 3550: 3545: 3540: 3534: 3532: 3528: 3527: 3525: 3524: 3523: 3522: 3520:Lycoperdonosis 3517: 3512: 3507: 3496: 3495: 3494: 3493: 3488: 3483: 3478: 3473: 3468: 3463: 3458: 3453: 3448: 3443: 3438: 3431:Pneumoconiosis 3427: 3425: 3410: 3393: 3392: 3390: 3389: 3384: 3383: 3382: 3372: 3367: 3365: 3359: 3358: 3353: 3351:Bronchiectasis 3348: 3347: 3346: 3341: 3336: 3327: 3321: 3311: 3309: 3303: 3302: 3297: 3295: 3289: 3287: 3273: 3256: 3255: 3252: 3251: 3249: 3248: 3243: 3238: 3236: 3228: 3227: 3222: 3220: 3212: 3211: 3206: 3201: 3196: 3190: 3188: 3180: 3179: 3174: 3168: 3163: 3161:Laryngeal cyst 3158: 3156:Laryngomalacia 3153: 3148: 3146: 3138: 3137: 3132: 3126: 3125: 3124: 3114: 3112: 3104: 3102: 3096: 3095: 3093: 3092: 3087: 3082: 3077: 3075: 3067: 3066: 3065: 3064: 3059: 3054: 3042: 3037: 3032: 3031: 3030: 3025: 3020: 3010: 3008: 3000: 2999: 2994: 2992: 2984: 2982: 2973: 2956: 2955: 2948: 2947: 2940: 2933: 2925: 2919: 2918: 2912: 2897: 2896: 2893: 2892: 2880: 2879: 2877: 2873: 2872: 2869: 2868: 2857: 2846: 2831: 2811: 2806: 2805: 2803: 2802:Classification 2795: 2794:External links 2792: 2790: 2789: 2770: 2750: 2715: 2671: 2613: 2584:(11): 867–70. 2561: 2528:Ann Intern Med 2515: 2500: 2451: 2416: 2356: 2318: 2293:Ann Intern Med 2280: 2240: 2235:"Inflammation" 2222: 2195:(4): 332–339. 2179: 2144:(4): 312–318. 2124: 2097: 2071: 2019: 1990:(4): 577–591. 1970: 1944: 1937: 1913: 1906: 1888: 1850: 1811: 1772: 1740: 1731: 1680: 1628: 1586: 1561: 1549: 1506: 1481: 1456: 1454: 1451: 1450: 1449: 1444: 1439: 1434: 1429: 1424: 1419: 1412: 1409: 1349: 1346: 1328: 1327: 1308: 1305: 1241: 1240: 1234: 1228: 1218: 1217: 1214: 1211: 1204: 1203: 1189: 1175: 1162: 1161: 1160:< 1.2 g/dL 1158: 1155: 1146: 1145: 1142: 1139: 1133: 1132: 1126: 1120: 1113: 1112: 1106: 1100: 1094: 1093: 1090: 1087: 1083: 1082: 1072: 1056: 1052: 1051: 1044: 1037: 1034: 1033: 1031: 1030: 1023: 1016: 1008: 993: 990: 989: 988: 978:fungal culture 970: 964: 961:red blood cell 954: 948: 900: 897: 896: 895: 892: 885: 883: 880: 867: 865: 862: 855: 853: 839: 832: 830: 827: 813: 811: 801: 794: 792: 789: 782: 756:pleural cavity 750: 747: 711:clinical signs 686: 683: 669: 666: 586: 583: 582: 581: 575: 569: 562: 557: 554: 549: 544: 541: 538: 535: 496: 495: 462: 456: 445: 438: 431: 416: 381: 378: 377: 376: 373: 370: 365: 360: 355: 352: 347: 344: 338: 268: 265: 255: 252: 248: 247: 244: 237: 236: 226: 212: 202: 192: 177: 174: 103:collapsed lung 53: 52: 47: 41: 40: 36: 35: 27: 26: 18: 15: 9: 6: 4: 3: 2: 4043: 4032: 4029: 4027: 4024: 4023: 4021: 4006: 4003: 4001: 3998: 3996: 3993: 3991: 3988: 3986: 3983: 3981: 3978: 3976: 3973: 3972: 3970: 3968:Other/general 3966: 3956: 3953: 3951: 3950:Mediastinitis 3948: 3947: 3945: 3943: 3939: 3933: 3930: 3929: 3926: 3923: 3921: 3918: 3916: 3913: 3911: 3908: 3906: 3903: 3901: 3899: 3896: 3895: 3892: 3888: 3885: 3884: 3881: 3878: 3877: 3875: 3873: 3869: 3866: 3864: 3859: 3855: 3841: 3838: 3834: 3831: 3829: 3826: 3825: 3824: 3821: 3819: 3816: 3815: 3813: 3809: 3799: 3796: 3794: 3791: 3789: 3786: 3784: 3781: 3779: 3776: 3775: 3773: 3771: 3767: 3761: 3758: 3756: 3753: 3752: 3750: 3746: 3740: 3737: 3735: 3732: 3730: 3727: 3726: 3724: 3720: 3712: 3708: 3705: 3703: 3699: 3696: 3695: 3694: 3693:noninfectious 3691: 3689: 3686: 3682: 3679: 3678: 3677: 3674: 3670: 3667: 3665: 3662: 3660: 3657: 3656: 3655: 3652: 3648: 3645: 3643: 3640: 3639: 3638: 3635: 3633: 3630: 3629: 3627: 3623: 3620: 3618: 3613: 3609: 3606: 3602:Obstructive / 3600: 3590: 3587: 3585: 3582: 3580: 3577: 3575: 3572: 3568: 3565: 3564: 3563: 3560: 3558: 3554: 3551: 3549: 3546: 3544: 3541: 3539: 3536: 3535: 3533: 3529: 3521: 3518: 3516: 3515:Farmer's lung 3513: 3511: 3508: 3506: 3503: 3502: 3501: 3498: 3497: 3492: 3489: 3487: 3484: 3482: 3479: 3477: 3474: 3472: 3469: 3467: 3464: 3462: 3459: 3457: 3454: 3452: 3449: 3447: 3444: 3442: 3439: 3437: 3434: 3433: 3432: 3429: 3428: 3426: 3424: 3420: 3414: 3411: 3408: 3403: 3398: 3394: 3388: 3385: 3381: 3378: 3377: 3376: 3375:Bronchiolitis 3373: 3371: 3368: 3366: 3364: 3361: 3360: 3357: 3354: 3352: 3349: 3345: 3342: 3340: 3337: 3335: 3331: 3328: 3325: 3322: 3320: 3317: 3316: 3315: 3312: 3310: 3308: 3305: 3304: 3301: 3298: 3296: 3294: 3291: 3290: 3288: 3286: 3281: 3277: 3274: 3271: 3266: 3261: 3257: 3247: 3244: 3242: 3239: 3237: 3235: 3234: 3230: 3229: 3226: 3223: 3221: 3219: 3218: 3214: 3213: 3210: 3207: 3205: 3202: 3200: 3197: 3194: 3191: 3189: 3187: 3186: 3182: 3181: 3178: 3175: 3172: 3169: 3167: 3164: 3162: 3159: 3157: 3154: 3152: 3149: 3147: 3145: 3144: 3140: 3139: 3136: 3133: 3130: 3127: 3123: 3120: 3119: 3118: 3115: 3113: 3111: 3110: 3106: 3105: 3103: 3101: 3097: 3091: 3088: 3086: 3083: 3081: 3078: 3076: 3074: 3073: 3069: 3068: 3063: 3060: 3058: 3055: 3053: 3050: 3049: 3048: 3047: 3043: 3041: 3038: 3036: 3033: 3029: 3026: 3024: 3021: 3019: 3016: 3015: 3014: 3011: 3009: 3007: 3006: 3002: 3001: 2998: 2995: 2993: 2991: 2990: 2986: 2985: 2983: 2981: 2977: 2974: 2971: 2966: 2961: 2957: 2953: 2946: 2941: 2939: 2934: 2932: 2927: 2926: 2923: 2916: 2913: 2911: 2907: 2906: 2902: 2901: 2891: 2887: 2886: 2882: 2881: 2878: 2874: 2867: 2863: 2862: 2858: 2856: 2852: 2851: 2847: 2845: 2841: 2840: 2836: 2832: 2830: 2826: 2822: 2821: 2817: 2813: 2812: 2809: 2804: 2800: 2777: 2773: 2771:9789241550529 2767: 2763: 2762: 2754: 2746: 2742: 2738: 2734: 2730: 2726: 2719: 2711: 2707: 2703: 2699: 2695: 2691: 2687: 2683: 2675: 2667: 2660: 2656: 2651: 2646: 2641: 2636: 2632: 2628: 2624: 2617: 2609: 2605: 2600: 2595: 2591: 2587: 2583: 2579: 2575: 2568: 2566: 2557: 2553: 2549: 2545: 2541: 2537: 2534:(4): 507–13. 2533: 2529: 2522: 2520: 2511: 2504: 2489: 2485: 2481: 2477: 2474:(4): 507–13. 2473: 2469: 2465: 2458: 2456: 2447: 2443: 2439: 2435: 2431: 2427: 2420: 2412: 2408: 2403: 2398: 2394: 2390: 2386: 2382: 2378: 2374: 2370: 2363: 2361: 2352: 2348: 2344: 2340: 2336: 2332: 2325: 2323: 2314: 2310: 2306: 2302: 2299:(4): 507–13. 2298: 2294: 2287: 2285: 2276: 2272: 2268: 2264: 2261:(4): 970–80. 2260: 2256: 2249: 2247: 2245: 2236: 2229: 2227: 2218: 2214: 2210: 2206: 2202: 2198: 2194: 2190: 2183: 2175: 2171: 2167: 2163: 2159: 2155: 2151: 2147: 2143: 2139: 2135: 2128: 2112: 2108: 2101: 2085: 2081: 2075: 2067: 2063: 2059: 2055: 2051: 2047: 2043: 2039: 2035: 2031: 2023: 2015: 2011: 2007: 2003: 1998: 1993: 1989: 1985: 1981: 1974: 1959: 1955: 1948: 1940: 1938:0-674-01279-8 1934: 1930: 1926: 1925: 1917: 1909: 1907:0-443-07008-3 1903: 1899: 1892: 1884: 1880: 1876: 1872: 1869:(3): 309–17. 1868: 1864: 1857: 1855: 1846: 1842: 1838: 1834: 1831:(2): 99–104. 1830: 1826: 1822: 1815: 1807: 1803: 1799: 1795: 1791: 1787: 1783: 1776: 1763: 1759: 1755: 1751: 1744: 1735: 1727: 1723: 1719: 1715: 1711: 1707: 1703: 1699: 1695: 1691: 1684: 1676: 1672: 1667: 1662: 1658: 1654: 1650: 1646: 1642: 1635: 1633: 1624: 1620: 1616: 1612: 1608: 1604: 1597: 1590: 1575: 1571: 1570:"Atelectasis" 1565: 1556: 1554: 1545: 1541: 1537: 1533: 1529: 1525: 1522:(4): 337–42. 1521: 1517: 1510: 1495: 1491: 1485: 1470: 1469: 1461: 1457: 1448: 1445: 1443: 1442:Thoracentesis 1440: 1438: 1435: 1433: 1430: 1428: 1427:Heart failure 1425: 1423: 1420: 1418: 1415: 1414: 1408: 1404: 1402: 1396: 1394: 1390: 1386: 1382: 1378: 1374: 1370: 1366: 1365:lung collapse 1362: 1358: 1353: 1345: 1343: 1337: 1334: 1325: 1309: 1306: 1303: 1302: 1301: 1297: 1295: 1291: 1287: 1283: 1279: 1275: 1271: 1267: 1262: 1260: 1256: 1247: 1239: 1235: 1233: 1229: 1227: 1223: 1220: 1219: 1215: 1213:< 45 mg/dL 1212: 1209: 1206: 1205: 1190: 1176: 1173: 1168: 1164: 1163: 1159: 1157:> 1.2 g/dL 1156: 1151: 1148: 1147: 1143: 1140: 1138:serum protein 1135: 1134: 1130: 1127: 1124: 1121: 1118: 1115: 1114: 1110: 1107: 1104: 1101: 1099: 1096: 1095: 1091: 1088: 1085: 1084: 1081: 1076: 1073: 1071: 1063: 1057: 1054: 1053: 1050: 1049: 1045: 1043: 1042: 1038: 1036: 1035: 1029: 1024: 1022: 1017: 1015: 1010: 1009: 1007: 1006: 1002: 997: 987: 983: 982:viral culture 979: 975: 971: 968: 967:Cytopathology 965: 962: 958: 955: 952: 949: 947: 943: 939: 935: 931: 927: 923: 922: 921: 919: 914: 910: 909:heart failure 906: 905:thoracentesis 899:Thoracentesis 889: 884: 866: 859: 854: 850: 846: 845:cytopathology 842: 836: 831: 812: 808: 804: 798: 793: 786: 781: 780: 779: 777: 773: 768: 766: 761: 757: 746: 744: 740: 736: 732: 728: 724: 720: 716: 715:breath sounds 712: 708: 704: 703:physical exam 700: 691: 682: 679: 675: 665: 663: 662:central lines 659: 655: 651: 647: 643: 639: 635: 630: 628: 624: 623:ovarian tumor 620: 616: 612: 608: 604: 600: 596: 592: 580: 577:Drug-induced 576: 574: 570: 567: 563: 561: 558: 555: 553: 550: 548: 545: 542: 539: 536: 534: 530: 527: 526: 525: 522: 519: 517: 513: 509: 508:breast cancer 505: 501: 493: 489: 485: 481: 480:Kinyoun stain 477: 476:Ziehl–Neelsen 473: 472: 467: 463: 460: 459:Gram staining 457: 454: 450: 446: 443: 440:pH is low in 439: 436: 432: 429: 425: 421: 417: 414: 413: 412: 410: 406: 402: 398: 390: 386: 374: 371: 369: 366: 364: 361: 359: 356: 353: 351: 348: 345: 343: 339: 337: 334: 333: 332: 329: 327: 326:pleural space 323: 319: 315: 311: 307: 303: 298: 294: 290: 286: 282: 278: 277:heart failure 274: 260: 251: 245: 242: 241: 240: 234: 230: 227: 224: 220: 216: 213: 210: 206: 203: 200: 196: 193: 190: 186: 183: 182: 181: 173: 171: 167: 163: 159: 155: 151: 147: 143: 139: 135: 131: 127: 123: 119: 115: 111: 106: 104: 100: 96: 92: 88: 84: 80: 76: 75:pleural fluid 72: 68: 64: 63:pleural space 60: 51: 48: 46: 42: 37: 33: 28: 23: 3897: 3887:Pneumothorax 3840:Lung abscess 3822: 3692: 3681:Pneumocystis 3642:Pneumococcal 3423:lung disease 3419:occupational 3397:Interstitial 3362: 3306: 3292: 3265:lung disease 3231: 3225:Epiglottitis 3215: 3183: 3177:Laryngospasm 3141: 3122:Strep throat 3107: 3070: 3046:nasal septum 3044: 3003: 2987: 2903: 2883: 2859: 2848: 2833: 2814: 2780:. 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1369:fibrothorax 1208:Cholesterol 1060:hydrostatic 741:, 8.7; 95% 707:chest X-ray 607:chylothorax 571:Rheumatoid 504:lung cancer 318:blood clots 312:) from the 302:capillaries 293:low albumin 233:urinothorax 209:chylothorax 199:haemothorax 189:hydrothorax 158:coprothorax 150:urinothorax 142:chylothorax 114:hydrothorax 95:inspiration 50:Pulmonology 4020:Categories 3905:Hemothorax 3707:Aspiration 3669:Chlamydiae 3659:Mycoplasma 3647:Klebsiella 3505:Bagassosis 3491:Byssinosis 3466:Chalicosis 3441:Asbestosis 3436:Aluminosis 3370:Bronchitis 3241:Tracheitis 3217:epiglottis 3166:Laryngitis 3040:Rhinorrhea 2432:(1): 296. 2379:: 116–20. 1767:2024-07-15 1754:StatPearls 1696:(2): 147. 1609:(1): 296. 1475:2024-06-08 1453:References 1255:transudate 1086:Appearance 1077:-Increased 1041:Transudate 1001:Transudate 951:Gram stain 918:ultrasound 841:Micrograph 776:ultrasound 676:by way of 599:autoimmune 474:(either a 122:hemothorax 3980:Influenza 3925:Malignant 3688:Parasitic 3637:Bacterial 3612:Pneumonia 3481:Silicosis 3476:Siderosis 3446:Baritosis 3280:Bronchial 3028:Hay fever 2997:Sinusitis 2861:SNOMED CT 2393:1305-3825 2209:1538-3679 2158:1070-5287 2117:21 August 2050:1532-8171 2006:1432-1238 1837:1532-0650 1798:0002-838X 1710:0301-0449 1377:bleomycin 1348:Treatment 1278:cirrhosis 1144:> 0.5 1131:2.9 g/dL 760:decubitus 685:Diagnosis 678:bulk flow 595:acid-fast 533:pneumonia 500:pneumonia 397:exudative 380:Exudative 342:cirrhosis 306:cytokines 281:cirrhosis 219:pyothorax 130:pyothorax 83:lymphatic 45:Specialty 3995:COVID-19 3788:BOOP-COP 3755:Broncho- 3698:Chemical 3486:Talcosis 3407:fibrosis 3260:Lower RT 3013:Rhinitis 2960:Upper RT 2866:60046008 2745:16510093 2710:45667293 2702:10705257 2659:11914151 2608:11641512 2556:31947040 2411:24100060 2217:20177035 2174:21367134 2166:17534178 2066:41876899 2058:29162443 2014:22392031 1963:July 20, 1883:19155458 1845:25077579 1806:16623208 1762:30020725 1726:28016135 1675:31315808 1544:44337698 1536:18520269 1411:See also 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Index


Specialty
Pulmonology
pleural space
potential space
lung
pleural fluid
parietal pleural
lymphatic
vacuum
visceral pleurae
inspiration
hydrostatically
collapsed lung
serous fluid
hydrothorax
blood
hemothorax
pus
pyothorax
pleural empyema
chyle
chylothorax
urine
urinothorax
feces
coprothorax
pneumothorax
air
hydropneumothorax

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