Pleural effusion classification: Difference between revisions
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===Complicated and uncomplicated=== | ===Complicated and uncomplicated=== | ||
Complicated pleural effusion is defined by pleural fluid pH ≤ 7.2 and/or glucose ≤60 mg/dL. The first thoracentesis is the most important diagnostic stage because it allows for a distinction between complicated and non-complicated effusions.26016577<ref name="pmid27401009">{{cite journal| author=Corral-Gudino L, García-Zamalloa A, Prada-González C, Bielsa S, Alexis D, Taboada-Gómez J et al.| title=Development and Validation of the COMPLES Score for Differentiating Between Tuberculous Effusions with Low Pleural pH or Glucose and Complicated Parapneumonic Effusions. | journal=Lung | year= 2016 | volume= 194 | issue= 5 | pages= 847-54 | pmid=27401009 | doi=10.1007/s00408-016-9923-y | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27401009 }} </ref> Examples of complicated pleural effusion are; tuberculous pleural effusion, complicated [[parapneumonic effusion]] and [[empyema]]. | Complicated pleural effusion is defined by pleural fluid pH ≤ 7.2 and/or glucose ≤60 mg/dL. The first thoracentesis is the most important diagnostic stage because it allows for a distinction between complicated and non-complicated effusions.<ref name="pmid26016577">{{cite journal| author=Porcel JM| title=Distinguishing complicated from uncomplicated parapneumonic effusions. | journal=Curr Opin Pulm Med | year= 2015 | volume= 21 | issue= 4 | pages= 346-51 | pmid=26016577 | doi=10.1097/MCP.0000000000000164 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26016577 }} </ref><ref name="pmid27401009">{{cite journal| author=Corral-Gudino L, García-Zamalloa A, Prada-González C, Bielsa S, Alexis D, Taboada-Gómez J et al.| title=Development and Validation of the COMPLES Score for Differentiating Between Tuberculous Effusions with Low Pleural pH or Glucose and Complicated Parapneumonic Effusions. | journal=Lung | year= 2016 | volume= 194 | issue= 5 | pages= 847-54 | pmid=27401009 | doi=10.1007/s00408-016-9923-y | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27401009 }} </ref> Examples of complicated pleural effusion are; tuberculous pleural effusion, complicated [[parapneumonic effusion]] and [[empyema]]. | ||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Prince Tano Djan, BSc, MBChB [2]
Overview
Classification
1. Pleural effusion may be classified according to composition of pleural fluid by Light's criteria into two subtypes:
Exudate and transudate
An increase in plasma osmotic pressure or elevated systemic or pulmonary hydrostatic pressure are alterations that lead to the formation of transudate. In contrast, an exudate results from inflammation and infectious disease of the pleural surface, as seen in tuberculosis and pneumonia with effusion, or other disease of the pleural surface as seen in malignancy, pancreatitis, pulmonary infarction, or systemic lupus erythematosus.
Light's criteria classifies pleural fluid as an exudate if at least one of the following three criteria is fulfilled:[1]
- Pleural fluid protein/serum protein ratio greater than 0.5, or
- Pleural fluid LDH/serum LDH ratio greater than 0.6, or
- Pleural fluid LDH greater than two-thirds the upper limits of the laboratory's normal serum LDH
2. Pleural effusion may also be classified according to the appearance of pleural fluid, severity and etiology of the pleural fluid as follows:
Gross appearance
- Serous fluid (hydrothorax)
- Blood (hemothorax)
- Chyle (chylothorax)
- Pus (pyothorax or empyema)
- Bilious pleural effusion
The diagnosis of bilous pleural effusion can be confirmed with high sensitivity using the combination of two simple tests; 1) determination of the presence of pleural glycoholic acid, and 2) ensuring that the ratio of pleural total bilirubin to serum total bilirubin is >1.[2]
Infectious and noninfectious
Some of the infectious causes are pneumonia, hepatitis, liver abscess, tuberculous pleural effusion, splenic abscess and subphrenic abscess. Some non-infectious causes of pleural effusion include; benign asbestos pleural effusion, pulmonary embolism, radiation therapy, and malignancy (local/metastatic carcinoma, lymphoma, mesothelioma, Leukemia, paraproteinemia)
Complicated and uncomplicated
Complicated pleural effusion is defined by pleural fluid pH ≤ 7.2 and/or glucose ≤60 mg/dL. The first thoracentesis is the most important diagnostic stage because it allows for a distinction between complicated and non-complicated effusions.[3][4] Examples of complicated pleural effusion are; tuberculous pleural effusion, complicated parapneumonic effusion and empyema.
References
- ↑ Light RW, Macgregor MI, Luchsinger PC, Ball WC (1972). "Pleural effusions: the diagnostic separation of transudates and exudates". Ann Intern Med. 77 (4): 507–13. PMID 4642731.
- ↑ Saraya T, Light RW, Sakuma S, Nakamoto Y, Wada S, Ishida M; et al. (2016). "A new diagnostic approach for bilious pleural effusion". Respir Investig. 54 (5): 364–8. doi:10.1016/j.resinv.2016.03.009. PMID 27566385.
- ↑ Porcel JM (2015). "Distinguishing complicated from uncomplicated parapneumonic effusions". Curr Opin Pulm Med. 21 (4): 346–51. doi:10.1097/MCP.0000000000000164. PMID 26016577.
- ↑ Corral-Gudino L, García-Zamalloa A, Prada-González C, Bielsa S, Alexis D, Taboada-Gómez J; et al. (2016). "Development and Validation of the COMPLES Score for Differentiating Between Tuberculous Effusions with Low Pleural pH or Glucose and Complicated Parapneumonic Effusions". Lung. 194 (5): 847–54. doi:10.1007/s00408-016-9923-y. PMID 27401009.