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Pleural Effusion, Exudative
Helen T. Winer-Muram, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Definitions

              • Proteinaceous fluid in pleural space from increased pleural permeability
              • Pleural inflammation &/or lymphatic obstruction
              • Pleural fluid analysis
                • Pleural fluid protein:serum protein > 0.5
                • Pleural fluid LDH:serum LDH > 0.6
                • Pleural fluid LDH > 2/3 upper limit of serum LDH
              • Parapneumonic pleural effusion refers to pleural effusion associated with pulmonary infection
                • Empyema: pH < 7.0; glucose < 40 mg/dL

            IMAGING

            • General Features

              • Radiographic Findings

                • Fluoroscopic Findings

                  • CT 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. Heffner JE et al: Diagnostic utility and clinical application of imaging for pleural space infections. Chest. 137(2):467-79, 2010
                                                2. Mishra EK et al: Advances in the investigation and treatment of pleural effusions. Expert Rev Respir Med. 4(1):123-33, 2010
                                                3. Sahn SA: Pleural diseases. Semin Respir Crit Care Med. 31(6):647-8, 2010
                                                4. Abramowitz Y et al: Pleural effusion: characterization with CT attenuation values and CT appearance. AJR Am J Roentgenol. 192(3):618-23, 2009
                                                5. Quint LE: Thoracic complications and emergencies in oncologic patients. Cancer Imaging. 9 Spec No A:S75-82, 2009
                                                6. Hampson C et al: Diagnosis and management of parapneumonic effusions. Semin Respir Crit Care Med. 29(4):414-26, 2008
                                                7. 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

                                                          TERMINOLOGY

                                                          • Definitions

                                                            • Proteinaceous fluid in pleural space from increased pleural permeability
                                                            • Pleural inflammation &/or lymphatic obstruction
                                                            • Pleural fluid analysis
                                                              • Pleural fluid protein:serum protein > 0.5
                                                              • Pleural fluid LDH:serum LDH > 0.6
                                                              • Pleural fluid LDH > 2/3 upper limit of serum LDH
                                                            • Parapneumonic pleural effusion refers to pleural effusion associated with pulmonary infection
                                                              • Empyema: pH < 7.0; glucose < 40 mg/dL

                                                          IMAGING

                                                          • General Features

                                                            • Radiographic Findings

                                                              • Fluoroscopic Findings

                                                                • CT 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. Heffner JE et al: Diagnostic utility and clinical application of imaging for pleural space infections. Chest. 137(2):467-79, 2010
                                                                                              2. Mishra EK et al: Advances in the investigation and treatment of pleural effusions. Expert Rev Respir Med. 4(1):123-33, 2010
                                                                                              3. Sahn SA: Pleural diseases. Semin Respir Crit Care Med. 31(6):647-8, 2010
                                                                                              4. Abramowitz Y et al: Pleural effusion: characterization with CT attenuation values and CT appearance. AJR Am J Roentgenol. 192(3):618-23, 2009
                                                                                              5. Quint LE: Thoracic complications and emergencies in oncologic patients. Cancer Imaging. 9 Spec No A:S75-82, 2009
                                                                                              6. Hampson C et al: Diagnosis and management of parapneumonic effusions. Semin Respir Crit Care Med. 29(4):414-26, 2008
                                                                                              7. Arenas-Jiménez J et al: Evaluation of CT findings for diagnosis of pleural effusions. Eur Radiol. 10(4):681-90, 2000