Pleural effusion due to perforated esophagus

Q: Pleural effusion due to perforated esophagus would be? (selected one)

 A) exudative
B) transudative


Answer: A

Pleural effusion developed after esophageal perforation would probably be an exudative. Other marker would be lactate dehydrogenase (LDH) > 1000 international units/L. Most importantly, and diagnostic would be pleural fluid to serum amylase ratio >1. 

#pulmonary
#surgical-critical-care
#gastroenterology


References:

Good JT Jr, Antony VB, Reller LB, et al. The pathogenesis of the low pleural fluid pH in esophageal rupture. Am Rev Respir Dis 1983; 127:702. 

Drury M, Anderson W, Heffner JE. Diagnostic value of pleural fluid cytology in occult Boerhaave's syndrome. Chest 1992; 102:976.

Jon Arne Søreide and Asgaut Viste Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2011 19:66