1/ Here is the story - hopefully instructive. Patient (ESRD w/ dialysis) admitted 3 weeks previously for dyspnea. Portable CXR shows small pleural effusion & some haziness - pneumonia or atelectasis. No fever, no increased WBC, no productive cough. Discussed now w/ radiology
https://twitter.com/medrants/status/1493005774691389441
2/ Radiologist teaches our team - pneumonia is a CLINICAL DIAGNOSIS - cannot make the diagnosis by CXR/CT scan.
Patient discharged - readmitted for more dyspnea - now with moderate pericardial effusion and large left pleural effusion. Receive furosemide & then thoracentesis
Patient discharged - readmitted for more dyspnea - now with moderate pericardial effusion and large left pleural effusion. Receive furosemide & then thoracentesis
3/
fluid LDH - 136
fluid TP. - 3.8
serum LDH - 212
serum TP - 5.6
Fluid very clear - pH 7.43 - no WBCs
Light's criteria - exudative effusion
All appropriate pleural fluid studies negative
fluid LDH - 136
fluid TP. - 3.8
serum LDH - 212
serum TP - 5.6
Fluid very clear - pH 7.43 - no WBCs
Light's criteria - exudative effusion
All appropriate pleural fluid studies negative
4/ "The criteria from Light et al and these alternative criteria identify nearly all exudates correctly, but they misclassify approximately 20-25% of transudates as exudates, ...
5/ usually in patients on long-term diuretic therapy for congestive heart failure (because of the concentrating effect of diuresis on protein and LDH levels within the pleural space). medscape.com/answers/299959…
6/ Heart failure treated with diuretics can lead to false positive Light's criteria
@DxRxEdu @rabihmgeha @CPSolvers @uabimres @BradSpellberg #MedTwitter
@DxRxEdu @rabihmgeha @CPSolvers @uabimres @BradSpellberg #MedTwitter
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