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Exudative Pleural Effusion
Claudio Silva, MD, MSc, MBA
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Definitions

                • Accumulation of pleural fluid with high protein content
                • Increased pleural permeability due to pleural inflammation &/or lymphatic obstruction
                • Pleural fluid analysis (Light criteria)
                  • Pleural fluid protein:serum protein > 0.5
                  • Pleural fluid LDH:serum LDH > 0.6
                  • Pleural fluid LDH > 2/3 of upper limit of serum LDH
                • Parapneumonic pleural effusion refers to pleural effusion associated with adjacent pulmonary infection
                  • Empyema: pH < 7.0; glucose < 40 mg/dL

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Ultrasonographic Findings

                        • Nuclear Medicine Findings

                          • Imaging Recommendations

                            DIFFERENTIAL DIAGNOSIS

                              PATHOLOGY

                              • General Features

                                • Gross Pathologic & Surgical Features

                                  • Microscopic Features

                                    • Laboratory Findings

                                      CLINICAL ISSUES

                                      • Presentation

                                        • Demographics

                                          • Natural History & Prognosis

                                            • Diagnosis

                                              • Treatment

                                                DIAGNOSTIC CHECKLIST

                                                • Image Interpretation Pearls

                                                  Selected References

                                                  1. Shkolnik B et al: Diagnostic accuracy of thoracic ultrasonography to differentiate transudative from exudative pleural effusion. Chest. 158(2):692-7, 2020
                                                  2. Ali MS et al: Pleuroscopy or video-assisted thoracoscopic surgery for exudative pleural effusion: a comparative overview. J Thorac Dis. 11(7):3207-16, 2019
                                                  3. Jany B et al: Pleural effusion in adults-etiology, diagnosis, and treatment. Dtsch Arztebl Int. 116(21):377-86, 2019
                                                  4. Skok K et al: Malignant pleural effusion and its current management: a review. Medicina (Kaunas). 55(8), 2019
                                                  5. Feller-Kopman D et al: Pleural disease. N Engl J Med. 378(8):740-51, 2018
                                                  6. Raptis CA et al: Mediastinal and pleural MR imaging: practical approach for daily practice. Radiographics. 38(1):37-55, 2018
                                                  7. Hallifax RJ et al: State-of-the-art: radiological investigation of pleural disease. Respir Med. 124:88-99, 2017
                                                  8. Porcel JM et al: Accuracy of fluorodeoxyglucose-PET imaging for differentiating benign from malignant pleural effusions: a meta-analysis. Chest. 147(2):502-12, 2015
                                                  9. Heffner JE et al: Diagnostic utility and clinical application of imaging for pleural space infections. Chest. 137(2):467-79, 2010
                                                  10. Mishra EK et al: Advances in the investigation and treatment of pleural effusions. Expert Rev Respir Med. 4(1):123-33, 2010
                                                  11. Sahn SA: Pleural diseases. Semin Respir Crit Care Med. 31(6):647-8, 2010
                                                  12. Abramowitz Y et al: Pleural effusion: characterization with CT attenuation values and CT appearance. AJR Am J Roentgenol. 192(3):618-23, 2009
                                                  13. Quint LE: Thoracic complications and emergencies in oncologic patients. Cancer Imaging. 9 Spec No A:S75-82, 2009
                                                  14. Hampson C et al: Diagnosis and management of parapneumonic effusions. Semin Respir Crit Care Med. 29(4):414-26, 2008
                                                  15. Arenas-Jiménez J et al: Evaluation of CT findings for diagnosis of pleural effusions. Eur Radiol. 10(4):681-90, 2000
                                                  Related Anatomy
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                                                  Related Differential Diagnoses
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                                                  References
                                                  Tables

                                                  Tables

                                                  KEY FACTS

                                                  • Terminology

                                                    • Imaging

                                                      • Top Differential Diagnoses

                                                        • Pathology

                                                          • Clinical Issues

                                                            • Diagnostic Checklist

                                                              TERMINOLOGY

                                                              • Definitions

                                                                • Accumulation of pleural fluid with high protein content
                                                                • Increased pleural permeability due to pleural inflammation &/or lymphatic obstruction
                                                                • Pleural fluid analysis (Light criteria)
                                                                  • Pleural fluid protein:serum protein > 0.5
                                                                  • Pleural fluid LDH:serum LDH > 0.6
                                                                  • Pleural fluid LDH > 2/3 of upper limit of serum LDH
                                                                • Parapneumonic pleural effusion refers to pleural effusion associated with adjacent pulmonary infection
                                                                  • Empyema: pH < 7.0; glucose < 40 mg/dL

                                                              IMAGING

                                                              • General Features

                                                                • Radiographic Findings

                                                                  • CT Findings

                                                                    • MR Findings

                                                                      • Ultrasonographic Findings

                                                                        • Nuclear Medicine Findings

                                                                          • Imaging Recommendations

                                                                            DIFFERENTIAL DIAGNOSIS

                                                                              PATHOLOGY

                                                                              • General Features

                                                                                • Gross Pathologic & Surgical Features

                                                                                  • Microscopic Features

                                                                                    • Laboratory Findings

                                                                                      CLINICAL ISSUES

                                                                                      • Presentation

                                                                                        • Demographics

                                                                                          • Natural History & Prognosis

                                                                                            • Diagnosis

                                                                                              • Treatment

                                                                                                DIAGNOSTIC CHECKLIST

                                                                                                • Image Interpretation Pearls

                                                                                                  Selected References

                                                                                                  1. Shkolnik B et al: Diagnostic accuracy of thoracic ultrasonography to differentiate transudative from exudative pleural effusion. Chest. 158(2):692-7, 2020
                                                                                                  2. Ali MS et al: Pleuroscopy or video-assisted thoracoscopic surgery for exudative pleural effusion: a comparative overview. J Thorac Dis. 11(7):3207-16, 2019
                                                                                                  3. Jany B et al: Pleural effusion in adults-etiology, diagnosis, and treatment. Dtsch Arztebl Int. 116(21):377-86, 2019
                                                                                                  4. Skok K et al: Malignant pleural effusion and its current management: a review. Medicina (Kaunas). 55(8), 2019
                                                                                                  5. Feller-Kopman D et al: Pleural disease. N Engl J Med. 378(8):740-51, 2018
                                                                                                  6. Raptis CA et al: Mediastinal and pleural MR imaging: practical approach for daily practice. Radiographics. 38(1):37-55, 2018
                                                                                                  7. Hallifax RJ et al: State-of-the-art: radiological investigation of pleural disease. Respir Med. 124:88-99, 2017
                                                                                                  8. Porcel JM et al: Accuracy of fluorodeoxyglucose-PET imaging for differentiating benign from malignant pleural effusions: a meta-analysis. Chest. 147(2):502-12, 2015
                                                                                                  9. Heffner JE et al: Diagnostic utility and clinical application of imaging for pleural space infections. Chest. 137(2):467-79, 2010
                                                                                                  10. Mishra EK et al: Advances in the investigation and treatment of pleural effusions. Expert Rev Respir Med. 4(1):123-33, 2010
                                                                                                  11. Sahn SA: Pleural diseases. Semin Respir Crit Care Med. 31(6):647-8, 2010
                                                                                                  12. Abramowitz Y et al: Pleural effusion: characterization with CT attenuation values and CT appearance. AJR Am J Roentgenol. 192(3):618-23, 2009
                                                                                                  13. Quint LE: Thoracic complications and emergencies in oncologic patients. Cancer Imaging. 9 Spec No A:S75-82, 2009
                                                                                                  14. Hampson C et al: Diagnosis and management of parapneumonic effusions. Semin Respir Crit Care Med. 29(4):414-26, 2008
                                                                                                  15. Arenas-Jiménez J et al: Evaluation of CT findings for diagnosis of pleural effusions. Eur Radiol. 10(4):681-90, 2000