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

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Definitions

              • Transudate: Plasma ultrafiltrate with low cell and protein content
              • Rate of pleural fluid production exceeds reabsorption
              • Diagnostic criteria
                • < 1,000 cells/mm³; lymphocytes, mesothelial cells
                • Light criteria
                  • Ratio of pleural fluid:serum protein < 0.5
                  • Ratio of pleural fluid:serum lactate dehydrogenase (LDH) < 0.6
                  • Pleural fluid LDH < 2/3 of upper limit of normal serum value

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • Ultrasonographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Physiologic Features

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Ferreiro L et al: Advances in pleural effusion diagnostics. Expert Rev Respir Med. 14(1):51-66, 2020
                                          2. Hallifax RJ et al: State-of-the-art: radiological investigation of pleural disease. Respir Med. 124:88-99, 2017
                                          3. Santamarina MG et al: Multidetector CT for evaluation of the extrapleural space. Radiographics. 37(5):1352-70, 2017
                                          4. Walker SP et al: Nonmalignant pleural effusions: a prospective study of 356 consecutive unselected patients. Chest. 151(5):1099-105, 2017
                                          5. Ayres J et al: Imaging of the pleura. Semin Respir Crit Care Med. 31(6):674-88, 2010
                                          6. Abramowitz Y et al: Pleural effusion: characterization with CT attenuation values and CT appearance. AJR Am J Roentgenol. 192(3):618-23, 2009
                                          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

                                                      • Transudate: Plasma ultrafiltrate with low cell and protein content
                                                      • Rate of pleural fluid production exceeds reabsorption
                                                      • Diagnostic criteria
                                                        • < 1,000 cells/mm³; lymphocytes, mesothelial cells
                                                        • Light criteria
                                                          • Ratio of pleural fluid:serum protein < 0.5
                                                          • Ratio of pleural fluid:serum lactate dehydrogenase (LDH) < 0.6
                                                          • Pleural fluid LDH < 2/3 of upper limit of normal serum value

                                                    IMAGING

                                                    • General Features

                                                      • Radiographic Findings

                                                        • CT Findings

                                                          • Ultrasonographic Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Physiologic Features

                                                                    • Gross Pathologic & Surgical Features

                                                                      • Microscopic Features

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                DIAGNOSTIC CHECKLIST

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Ferreiro L et al: Advances in pleural effusion diagnostics. Expert Rev Respir Med. 14(1):51-66, 2020
                                                                                  2. Hallifax RJ et al: State-of-the-art: radiological investigation of pleural disease. Respir Med. 124:88-99, 2017
                                                                                  3. Santamarina MG et al: Multidetector CT for evaluation of the extrapleural space. Radiographics. 37(5):1352-70, 2017
                                                                                  4. Walker SP et al: Nonmalignant pleural effusions: a prospective study of 356 consecutive unselected patients. Chest. 151(5):1099-105, 2017
                                                                                  5. Ayres J et al: Imaging of the pleura. Semin Respir Crit Care Med. 31(6):674-88, 2010
                                                                                  6. Abramowitz Y et al: Pleural effusion: characterization with CT attenuation values and CT appearance. AJR Am J Roentgenol. 192(3):618-23, 2009