What percentage of patients in a prospective trial experienced an improvement in dyspnea with thoracentesis?
73% of patients experienced an improvement in dyspnea.
In patients with a large pleural effusion, what symptom, besides dyspnea, may be caused by the distortion of the lung with volume loss?
Cough.
Pain fibers responsible for pleuritic chest pain are primarily located in the _____ pleura, but are also recognized in the visceral pleura and adhesions.
parietal
What is the approximate annual incidence of malignant pleural effusions in the United States?
200,000 cases per year.
What is the most common cause of transudative pleural effusions?
Congestive heart failure (CHF).
When should a diagnostic thoracentesis be performed on a patient with free pleural fluid?
When the fluid measures more than 10 mm on a lateral decubitus film, ultrasound, or chest CT scan.
Under what conditions should thoracentesis be performed without delay in a patient with suspected CHF-related effusion?
If the patient is febrile, has pleuritic chest pain, or if the effusions are not of comparable size on both sides.
A pleural fluid NT-proBNP level greater than _____ is 94% sensitive and 91% specific for a CHF-related effusion.
1500 pg/mL
If a patient appears to have a transudative effusion clinically but meets exudative criteria, how can a transudative etiology be verified using serum and pleural fluid protein concentrations?
If the difference between the serum and pleural fluid protein concentration exceeds 3.1 g/dL.
A reduced pleural fluid glucose level (<60 mg/dL) narrows the diagnostic possibilities to what seven conditions?
Parapneumonic effusion, malignant effusion, tuberculous effusion, rheumatoid effusion, hemothorax, paragonimiasis, or eosinophilic granulomatosis with polyangiitis (EGPA).
In a patient with a parapneumonic effusion, a pleural fluid glucose level less than _____ should prompt consideration for tube thoracostomy.
40 mg/dL (2.22 mmol/L)
Most patients with pleural effusion secondary to systemic lupus erythematosus (SLE) will have a pleural fluid glucose level greater than what value?
80 mg/dL (4.44 mmol/L).
A pleural fluid white blood cell count greater than _____ is most common with empyemas and parapneumonic effusions.
$10,000/\mu L$
What are the three most common causes of exudative pleural effusions?
Pneumonia, malignancy, and pulmonary embolism.
What is the best screening test for lupus pleuritis?
Measurement of the antinuclear antibody (ANA) titer in the pleural fluid.
What is the recommended imaging modality for distinguishing a parenchymal lung abscess from an empyema with an air-fluid level?
Chest CT with contrast enhancement.
Which imaging modality is currently less satisfactory than ultrasound or CT for evaluating pleural effusions due to limitations from respiratory and cardiac motion?
Magnetic resonance imaging (MRI).
For which two diagnoses is a closed-needle biopsy of the pleura most useful?
Malignant and tuberculous pleural effusions.
In diagnosing tuberculous pleuritis, combining histology and culture from a closed pleural biopsy can achieve a sensitivity as high as what percentage?
0.92
The demonstration of _____ on a pleural biopsy is virtually diagnostic of tuberculous pleuritis.
granulomas
In a patient with suspected malignant pleural effusion, a prudent approach is to obtain a pleural biopsy only if the _____ obtained at the initial thoracentesis is nondiagnostic.
cytology
For a patient with a pleural effusion that remains undiagnosed after thoracentesis and needle biopsy, in whom malignancy is strongly suspected, what is the recommended procedure?
Thoracoscopy.
Diuretic use in a patient with CHF can cause a transudative effusion to meet Light’s criteria for an exudate. How can the transudative origin be confirmed using albumin levels?
If the serum minus the pleural fluid albumin concentration is greater than 1.2 g/dL.
What is the treatment of choice for a patient with refractory hepatic hydrothorax?
Liver transplantation.
