A practical approach to pseudoexudative pleural effusions.

Autor: Mohan G; Department of Internal Medicine, Rutgers-Monmouth Medical Center, Long Branch, NJ, USA. Electronic address: gm718@scarletmail.rutgers.edu., Bhide P; Department of Internal Medicine, Rutgers-Monmouth Medical Center, Long Branch, NJ, USA., Agrawal A; Division of Pulmonary, Critical Care & Sleep Medicine, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA., Kaul V; Crouse Health/SUNY Upstate Medical University, Syracuse, NY, USA., Chaddha U; Division of Pulmonary, Critical Care & Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Jazyk: angličtina
Zdroj: Respiratory medicine [Respir Med] 2023 Aug; Vol. 214, pp. 107279. Date of Electronic Publication: 2023 May 10.
DOI: 10.1016/j.rmed.2023.107279
Abstrakt: Light's criteria falsely label a significant number of effusions as exudates. Such exudative effusions with transudative etiologies are referred to as "pseduoexudates". In this review, we discuss a practical approach to correctly classify an effusion that may be a pseudoexudate. A PubMed search yielded 1996 manuscripts between 1990 and 2022. Abstracts were screened and 29 relevant studies were included in this review article. Common etiologies for pseudoexudates include diuretic therapy, traumatic pleural taps, and coronary artery bypass grafting. Here, we explore alternative diagnostic criteria. Concordant exudates (CE), defined as effusions where proteins in pleural fluid/serum (PF/SPr) > 0.5 and pleural fluid LDH level of >160 IU/L (>2/3 upper limit of normal) confer higher predictive value to the Light's criteria. Serum-pleural effusion albumin gradient (SPAG) > 1.2 g/dL and serum-pleural effusion protein gradient (SPPG) > 3.1 g/dL together yielded a sensitivity of 100% in heart failure and a sensitivity of 99% in hepatic hydrothorax whe n identifying pseudoexudates (Bielsa et al., 2012) [5]. Pleural fluid N-Terminal Pro Brain Natriuretic Peptide (NTPBNP) offered a specificity and sensitivity of 99% in identifying pseudoexudates when using a cut-off of >1714 pg/mL (Han et al., 2008) [24]. However, its utility remains questionable. Additionally, we also looked at pleural fluid cholesterol and imaging modalities such as ultrasound and CT scan to measure pleural thickness and nodularity. Finally, the diagnostic algorithm we suggest involves using SPAG >1.2 g/dL and SPPG >3.1 g/dL in effusions classified as exudates when there is a strong clinical suspicion for pseudoexudates.
Competing Interests: Declaration of competing interest All authors declare that they have no conflicts of interest.
(Copyright © 2023 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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