Pleural Effusion Medical Slides

Present the three criteria (any one positive = exudate): (1) pleural fluid protein/serum protein >0.5, (2) pleural fluid LDH/serum LDH >0.6, (3) pleural fluid LDH >2/3 upper limit of normal serum LDH. Note the 98% sensitivity but 83% specificity — approximately 25% of CHF effusions are misclassified as exudative, especially after diuresis. In these cases, use the serum-effusion albumin gradient (>1.2 g/dL suggests transudate).

Present the ACCP 2000 categories: Category 1 (small, free-flowing, no tap needed), Category 2 (>10 mm, negative Gram stain/culture, pH >7.20), Category 3 (positive Gram stain/culture, or pH <7.20, or loculated — requires drainage), Category 4 (frank pus/empyema — requires drainage ± fibrinolytics). Reference the MIST2 trial showing TPA-DNase improved drainage and reduced surgical referral in complicated parapneumonic effusions.

Present the TIME1 trial comparing indwelling pleural catheter (IPC) versus talc pleurodesis — equivalent dyspnea relief at 6 months. IPC advantages: outpatient management, no hospitalization, effective in trapped lung. Pleurodesis advantages: no ongoing catheter care, lower infection risk (IPC infection rate ~5%). Decision framework: trapped lung → IPC; expandable lung + limited life expectancy → either option based on patient preference; good performance status + longer prognosis → talc pleurodesis.