Disease | Diagnostic pleural fluid tests |
Empyema | Purulent fluid, putrid odor, positive culture |
Malignancy | Positive cytology |
Tuberculous pleurisy | Positive AFB stain, culture |
Esophageal rupture | High salivary isoenzyme form of amylase, low pH (often as low as 6), ingested vegetable or meat fragments |
Fungal-related effusions | Positive fungal stain, culture |
Chylothorax | Triglycerides >110 mg/dL, chylomicrons by lipoprotein electrophoresis |
Cholesterol effusion | Cholesterol >200 mg/dL with a cholesterol to triglyceride ratio >1, cholesterol crystals under polarizing light |
Hemothorax | Ratio of pleural fluid to blood hematocrit >0.5 |
Urinothorax | Urine odor, pleural fluid creatinine to serum ratio always >1 but diagnostic if >1.7 |
Peritoneal dialysis | Protein <0.5 mg/dL and pleural fluid to serum glucose ratio >1 in peritoneal dialysis patient |
Extravascular migration or misplacement of a central venous catheter | Pleural fluid to serum glucose ratio >1, pleural fluid gross appearance mirrors infusate (eg, milky white if lipids infused) |
Rheumatoid pleurisy | Cytologic evidence of elongated macrophages and distinctive multinucleated giant cells (tadpole cells) in a background of amorphous debris |
Glycinothorax | Measurable glycine after bladder irrigation with glycine-containing solutions |
Cerebrospinal fluid leakage into pleural space | Detection of beta-2 transferrin |
Parasite-related effusions | Detection of parasites |
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