Stage | Stage 1 (uncomplicated/simple) | Stage 2 (complicated/fibropurulent*) | Stage 3 (complicated/organizing*) |
Timing | Early (days) | Late (days to weeks) | Late (weeks to months) |
Pleural fluid characteristics | Exudative characteristics¶ Low to moderately elevated WBC LDH level <1000 international units/L Normal pH and glucose levels No bacterial organisms | Exudative characteristics¶ High WBC LDH >1000 international units/L pH <7.20 Glucose <40 mg/dL (2.2 mmol/L) OR Bacterial organisms present | Fluid may be difficult to obtain Bacterial organisms may or may not be present |
Imaging characteristics | Generally small to moderate in size Free-flowing | Generally large and free-flowing, loculated, and/or with associated pleural thickening with contrast enhancement | May be large, loculated, and/or with pleural thickening (may be extensive and demonstrate a pleural rind) Pleural calcification may be evidentΔ |
Treatment | Typically resolves with antibiotic therapy alone Drain if symptomatic | Antibiotics PLUS drainage◊ Fibrinolytics/DNase may be required§ | Antibiotics PLUS drainage Fibrinolytics/mucolytics or VATS may be required§¥ |
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