

#182 Pleural Effusions: 5 Pearls Segment
110 snips Jul 9, 2025
Chris Kapp, an interventional pulmonologist at Northwestern, shares his expertise on pleural effusions. He explains the nuances of thoracentesis and sheds light on Light’s Criteria for differentiating pleural fluid types. Listeners learn about the diagnostic importance of pleural fluid studies, including pH levels and cell differentials. Kapp also discusses the challenges in managing parapneumonic and malignant pleural effusions, emphasizing tailored treatment strategies and the role of patient preferences in effective care.
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When to Use Thoracentesis
- Always consider thoracentesis for new unilateral pleural effusions or red-flag symptoms like fever and weight loss.
- Avoid anchoring; up to 30% of effusions have multiple causes like heart failure plus malignancy.
Limitations of Light's Criteria
- Light's criteria reliably identify transudates but can overcall exudates, yielding pseudo-exudates especially in patients on diuretics.
- Use serum-pleural albumin and protein gradients or NT-proBNP to clarify pseudo-exudates.
Physiology Behind Effusion Types
- Transudative effusions result from hydrostatic and oncotic pressure changes, keeping large proteins in serum.
- Exudative effusions stem from capillary injury allowing proteins like LDH and cholesterol to leak into pleural space.