Thoracentesis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]

Synonyms and keywords: Thoracocentesis; pleural tap

Treatment

Interpretation of pleural fluid analysis

Analysis of Pleural Fluid

Pleural effusions are either transudates or exudates based on the biochemical characteristics of the fluid, which usually reflect the physiologic mechanism of its formation.

TRANSUDATIVE EFFUSIONS

Transudates result from imbalances in hydrostatic and oncotic forces and are caused by a limited number of recognized clinical conditions such as heart failure and cirrhosis. Less common causes include nephrotic syndrome, atelectasis, peritoneal dialysis, constrictive pericarditis, superior vena caval obstruction, and urinothorax. Transudative effusions usually respond to treatment of the underlying condition (e.g., diuretic therapy).

EXUDATIVE EFFUSIONS

In contrast, exudates occur when the local factors influencing the accumulation of pleural fluid are altered. Exudates present more of a diagnostic dilemma. Pneumonia, malignancy, and thromboembolism account for most exudative effusions in the U
n clinical practice, exudative effusions can be separated effectively from transudative effusions using Light’s criteria. These criteria classify an effusion as exudate if one or more of the following are present: (1) the ratio of pleural fluid protein to serum protein is greater than 0.5, (2) the ratio of pleural fluid lactate dehydrogenase (LDH) to serum LDH is greater than 0.6, or (3) the pleural fluid LDH level is greater than two thirds of the upper limit of normal for serum LDH.

Light’s criteria are nearly 100 percent senTemplate:Respiratory system surgeries and other procedures