med 610 clinical respiratory diseases & critcare med

Pleural Effusions

Case 2

A 45 year-old man with cirrhosis secondary to chronic alcohol abuse and Hepatitis C presents to clinic complaining of increasing dyspnea. He has had ascites for several months but his abdominal girth has not changed since his last clinic visit. A chest x-ray is obtained and shows a new right pleural effusion. Thoracentesis is performed and reveals LDH 95 (serum value 290, upper limit of normal for serum 180), total protein 2.2 (serum value 5.8). The gram’s stain is negative and there are no white blood cells in the fluid.

How would you interpret the results of the pleural fluid studies?


How do you explain the presence of the pleural effusion?


How can you confirm the diagnosis?


What can you do to manage this pleural effusion? Is there a role for placing a drain in his right chest to limit the accumulation of fluid in the pleural space?


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