Approach to the Diagnosis of Pleural Effusions - Flowchart
Approach to the Diagnosis of Pleural Effusions - Flowchart
«Flowchart»

DIAGNOSTIC ALGORITHM OF PLEURAL EFFUSION

Pleural effusion

DIAGNOSTIC ALGORITHM OF PLEURAL EFFUSION

Pleural effusion

DIAGNOSTIC ALGORITHM OF PLEURAL EFFUSION

DIAGNOSTIC ALGORITHM OF PLEURAL EFFUSION

Pleural effusion

Pleural effusion

Perform diagnostic thoracentesis
Measure pleural fluid protein and LDH

Perform diagnostic thoracentesis
Measure pleural fluid protein and LDH

Perform diagnostic thoracentesis
Measure pleural fluid protein and LDH


Transudate
Treat CHF, cirrhosis, nephrosis

Transudate
Treat CHF, cirrhosis, nephrosis

Transudate
Treat CHF, cirrhosis, nephrosis

Transudate

Exudate
Further diagnostic procedures

Exudate
Further diagnostic procedures

Exudate
Further diagnostic procedures

Exudate

Treat for PE

Treat for PE

Treat for PE

Treat for TB

Treat for TB

Treat for TB

Observe

Observe

Observe

Consider thoracoscopy or open pleural biopsy

Consider thoracoscopy or open pleural biopsy

Consider thoracoscopy or open pleural biopsy

End

End

End

Consider pulmonary embolus (spiral CT or lung scan)

Consider pulmonary embolus (spiral CT or lung scan)

Consider pulmonary embolus (spiral CT or lung scan)

Yes

Yes

Yes

No

No

No

PF marker for TB

PF marker for TB

PF marker for TB

Yes

Yes

Yes

No

No

No

SYMPTOMS IMPROVING

SYMPTOMS IMPROVING

SYMPTOMS IMPROVING

SYMPTOMS IMPROVING

Yes

Yes

Yes

No

No

No

CHF, congestive heart failure; CT, computed tomography; LDH, lactate dehydrogenase; PE, pulmonary embolism; PF, pleural fluid; TB, tuberculosis.

CHF, congestive heart failure; CT, computed tomography; LDH, lactate dehydrogenase; PE, pulmonary embolism; PF, pleural fluid; TB, tuberculosis.

CHF, congestive heart failure; CT, computed tomography; LDH, lactate dehydrogenase; PE, pulmonary embolism; PF, pleural fluid; TB, tuberculosis.

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

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

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





No diagnosis

No diagnosis

No diagnosis

Glucose <60 mg/dL

Consider:


Malignancy
Bacterial infections
Rheumatoid pleuritis

Glucose <60 mg/dL

Glucose <60 mg/dL

Consider:


Malignancy
Bacterial infections
Rheumatoid pleuritis


Malignancy
Bacterial infections
Rheumatoid pleuritis Glucose

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

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

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




Yes

Yes

Yes

No

No

No