Thread by @DrJaredDyer

#MRPearls Have you ever gotten a chest x-ray that showed a pleural effusion and you questioned what further evaluation that you should proceed with? (1/18) @VCU_IMRes #tweetorial

#MRPearls What are the most common causes of pleural effusions? (2/18)

#MRPearls This chart from @NEJM demonstrates that pleural effusions remain a common occurrence in daily practice with the most common causes in the US being CHF, pneumonia, and cancer. (3/18) @mkashiouris

#MRPearls Common physical exam findings in the setting of pleural effusion include dullness to percussion, absence of fremitus, and diminished breath sounds. (4/18)

#MRPearls So the burning question becomes do I need to do a thoracentesis? (5/18)

#MRPearls Is the pleural effusion clinically significant (>10mm think on US or lateral decubitus radiography)? This is a nice algorithm from @NEJM to determine whether thoracentesis should be obtained. (6/18)

#MRPearls Do not forget that a thoracentesis is not benign. There have been several studies reporting incidences of pneumothorax ranging between 0-3%. (7/18) ncbi.nlm.nih.gov/pmc/articles/P…

#MRPearls The initial evaluation of the pleural fluid starts with the appearance and odor as they can provide useful information regarding possible etiologies. (8/18)

#MRPearls What tests should you order with your thoracentesis? (9/18)

#MRPearls Tests that are routinely performed on pleural fluid include cell count and diff, pH, protein, LDH, and glucose. However, should also consider ordering pleural cholesterol and albumin. (10/18)

#MRPearls Now what do I with these labs? (11/18)

#MRPearls Must determine whether transudative vs. exudative. Traditional Light’s Criteria developed in 1972 had a 97.5% sensitivity and 80% specificity. However, there has been development of abbreviated versions that have similar diagnostic accuracy. (12/18)

#MRPearls There has also been the development of the two-test and three rule, where only one criterion has to be met to define an exudative pleural effusion. @uptodate (13/18)
ncbi.nlm.nih.gov/pubmed?term=91…

#MRPearls What are some common causes of transudative pleural effusions? (14/18)

#MRPearls The @CPsolvers has put together this awesome diagnostic schema for transudative pleural effusions. (15/18)

#MRPearls Can you think of any other causes of exudative pleural effusions other than malignancy and infectious etiologies? (16/18)

#MRPearls Check out this @CPsolvers schema for exudative pleural effusions? (17/18)

#MRPearls For more information, check out @atscommunity and @NEJM. (18/18)
nejm.org/doi/10.1056/NE…
thoracic.org/professionals/…