Pleural effusion characterization

 Q: All of the following almost always cause transductive pleural effusion EXCEPT? 

A) Heart failure

B) Hepatic hydrothorax

C) Nephrotic syndrome 

D) Peritoneal dialysis

E) Pulmonary embolism

Answer: E

Characteristic of pleural fluid is one of the basics which guide towards establishing the diagnosis. Few conditions are known to cause ALMOST ALWAYS transudative pleural effusion. It includes:

• CSF leak into pleural space (after trauma or spinal surgery or VP shunt) 
• Heart failure
• Hepatic hydrothorax
• Hypoalbuminemia
•  Misplaced central line 
• Nephrotic syndrome
• Peritoneal dialysis 
• Urinothorax

Few conditions usually cause exudative pleural effusion but transductive is possible:

• Amyloidosis
• Chylothorax
• Constrictive pericarditis
• Hypothyroidism
• Malignancy
• Pulmonary embolism
• Late Sarcoidosis
• Superior vena caval syndrome

#procedures

#pulmonary 

References:

1. Porcel JM, Azzopardi M, Koegelenberg CF, Maldonado F, Rahman NM, Lee YC. The diagnosis of pleural effusions. Expert Rev Respir Med. 2015;9(6):801-815. doi:10.1586/17476348.2015.1098535

2. Saguil A, Wyrick K, Hallgren J. Diagnostic approach to pleural effusion. Am Fam Physician. 2014;90(2):99-104.