Meig’s syndrome – ovarian tumor (fibroma) plus right-sided pleural effution
Pleural effusion due to rheumatoid pleuritis
Fibrinous exudate, some neutrophils and neutrophil debris
Rheumatoid nodules: nodular aggregates of palisaded histiocytes and fibroblasts that surround central areas of fibrinoid necrosis – CHARACTERISTIC
Most common thoracic manifestation of rheumatoid disease
Typically unilateral: .
Exudative with a high protein level and it usually shows low glucose levels: <50mg/dL and very high LDH
Male predominance, within 5 years of Rheumatoid arthritis Dx; subcutaneous nodules present: .
Parapneumonic effusion – loculated effusion
Empyema: pus in the pleural space; purulent, complicated parapeumonic effusion in a patient with bacterial pneumonia
Malignant pleural effusions
Primary but more commonly metastatic
Dx: microscopid identification of malignant cells in pleural fluid samples or in pleural tissue biopsies
Lung carcinoma (30%), breast carcinoma (25%) and lymphomas 20%: .
First step in developing a DDx of a pleural effusion
Is to establish whether the effusion is a transudate or an exudate by Dx thoracentesis
Then cell counts, cytology, culture for microorganisms, other tests – glucose, pH, amylase, serologic tests
Cell counts on fluid samples
Lymphocyte predominance: TB
PMN predominance: parapneumonic effusions
Primary spontaneous pneumothorax: most often in tall, thin, young men when an apical subpleural bleb ruptures, smokers; sudden chest pain and dyspnea; most resolve spontaneously
Secondary spontaneous pneumothorax: removal of air from the pleural space with a chest tube is required and thorascopic surgery to repair the air leak[can be from: COPD (emphysema), PCJ infection in patients with AIDS, eosinophilic granuloma of the lung, necrotizing pneumonias, TB and lymphangiomyomatosis