Pleural effusion

Perform diagnostic thoracentesis
Measure pleural fluid protein and LDH

Any of following met?
PF/serum protein >0.5
PF/serum LDH >0.6
PF LDH >2/3 upper normal serum limit

Transudate
Treat CHF, cirrhosis, nephrosis

Exudate
Further diagnostic procedures

Measure PF glucose, amylase
Obtain PF cytology
Obtain differential cell count
Culture, stain PF
PF marker for TB

Treat for PE

Treat for TB

Observe

Consider thoracoscopy or open pleural biopsy

End

Yes

No

Amylase elevated

Consider:

Esophageal rupture
Pancreatic pleural effusion
Malignancy

No diagnosis

Glucose <60 mg/dL

Consider:

Malignancy
Bacterial infections
Rheumatoid pleuritis

Consider pulmonary embolus (spiral CT or lung scan)

Yes

No

PF marker for TB

Yes

No

SYMPTOMS IMPROVING

Yes

No