A 61-year-old male is admitted to the hospital with worsening shortness of breath and fatigue. Physical examination reveals dullness to percussion and decreased breath sounds in the right lung. A ches

Question

Options

• Abacterial pleuritis
• Bcirrhosis of the liver
• Ccongestive heart failure
• Dnephrotic syndrome
• Eprotein losing enteropathy

• A
  82% (46)
• B
  2% (1)
• C
  2% (1)
• D
  9% (5)
• E
  5% (3)

Explanation

Exudative effusions are characterized by one or more of the following: pleural fluid protein/serum protein ratio > 0.5, pleural fluid LDH/serum LDH ratio > 0.6, or pleural fluid LDH more than two- thirds the normal upper limit for serum (Light's criteria). An exudate results from leakage of protein-rich fluid from the plasma into the interstitium. It is usually the result of increased vascular permeability caused by inflammation. Exudates also contain numerous acute or chronic inflammatory cells, depending on the inciting event. When the pleural effusion is unilateral, always consider a bacterial cause. Of the listed options, only bacterial pleuritis would produce an exudate. If pleuritis is caused by pyogenic organisms, the exudate is purulent (neutrophil-rich). If pleural inflammation is due to mycobacterial infection or neoplastic infiltration, the resulting exudate will contain chronic inflammatory cells such as lymphocytes, macrophages.

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