Pleural Effusion

Pulmonary Pleural Disease:

Case Disscussion

Patient is seen in hospital for Pneumonia. X-ray confirms Pneumonia. Shows Pleural Effusion as well and thoracentesis is done. Results as below. 

What is the diagnosis? 

Exudative Effusion. Neutrophilic Predominance. 

Other labs include 

What other tests are to be done? 

  •  pH: 7.30
  • Cytology: Pending
  • Cell count : WBC 12000, with N of 80 %
  • Amylase : Normal
  • Glucose level: Normal 
What is the next step? 

Case 2
54 YO M  is seen for SOB. Physical exam is consistent with Pleural Effusion. Also has HFrEF of 35 %. 
Recently diagnosed and treated for pneumonia (HCAP). All cultures were negative though. 

CXR at various times has been the following. 


Work up reveals transudative fluid on this instance on previous instances. 

What is the Likely Cause?
  • HFrEF
  • PE
To rule out PE, 3 days after fluid removal, CTPE is done. Shows the following finding. 

Dec 2016

Patient had such effusion in Nov 2016 as well

Given such a rapid collection of fluid in Right side, what other DDx should be considered?
  • Trap Lung
How is Trap Lung Diagnosed?

How should this case be managed with such rapid fluid collection?
  • Repeat USG Thoracentesis: Would not be enough as fluid will reaccumulate
  • CT placement: Usually is done if the fluid was exudative effusion or had complicated parapneumonic effusion
  • Pleurex Catheter placement for daily pleural fluid drainage : Usually is used for palliative intervention for malignant effusion, but can be used on these situations as well.