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MUHAMMAD ILYAS
Transudate Exudate
Cause non-inflammatory inflammatory,tumor
Apperance light yellow yellow, purulent
Specific gravity <1.018 >1.018
Coagulability unable able
Revalta test negative positive
Protein content <30g/L >30g/L
ΘP. To serum Pre < 0.5 > 0.5
LDH < 200 I U/ L > 200 I U / L
Θ P. To s < 0.6 > 0.6
Cell count < 100×10 6/ L > 500×10 6 / L
Differential cell Lymphocyte Different
Pleural Fluid Analysis
• Thoracentesis: Transudate vs. Exudate
• 1. Gross Appearance
• 2. Cell Count & Differential
• 3. Gm Stain, C & S
• 4. Cytology
• 5. LDH
• 6. Protein
• 7. Glucose, Amylase
Clinical Manifestations
• Pain
• Cough
• Dyspnea
• Dullness to Percussion
• Diminished or Absent Vocal Resonance
• Diminished or Absent Tactile Vocal
Fremitus
• Friction Rub
Upright…Meniscus
Supine…Unilateral
increased density
Decubitus…Effusion
layered on downside
Massive Pleural Effusion
• Large Effusions that prevent contact
between the Visceral & Parietal Pleura
during respiration are seldom
associated with pleuritic chest pain.
- Plain Radiographs
• Upright PA on inspiration
- Detect other pathologies: pneumonia, cardiac, etc.
- Partially collapsed lung
- Tension Pneumothorax
• Trachea and mediastinum deviate contralaterally
• Ipsilateral depressed hemi-diaphragm
- Chest CT
- Not routine
- Only to assess the need for surgery (thoracotomy)
Treatment
• Small pneumothorax
Resolve over days to weeks
Supplemental oxygen and observation
Tension pneumothorax
– Immediate decompression via chest tube or
needle thoracostomy
Spontaneous pneumothorax
– Asymptomatic – outpatient, f/u with serial CXR
– Symptomatic – inpatient, chest tube
– Recurrent pneumothorax – CT to evaluate need
for thoracotomy
– Needle decompression
• Simple large-bore needle
• Mid, anterior chest
• 2nd or 3rd rib space
• NOT right next to Sternum