CC: 3 days of shortness of breath
ID: 82 yo Hispanic male with HTN, DLD, DM, COPD, HFpEF with >50 pack-year smoking history presents with 3 days of shortness of breath. He was found to have a white out of his R lung and thoracentesis of the pleural effusion was markedly bloody. Initial pleural fluid studies revealed an exudate with ADA of 21, negative cytology (x3), and subsequently, a normal pleural biopsy. On further imaging, he was found to have bulky lymphadenopathy and is pending a lymph node biopsy.
Pearls from morning report:
- When you have a bloody pleural effusion, make sure to check the pleural fluid hematocrit! A frank hemothorax is when pleural fluid hematocrit > 50% of peripheral hematocrit. Otherwise, grossly bloody effusions are associated with trauma, malignancy, or TB.
- When you have an undiagnosed exudative effusion when TB or malignancy is suspected, get a thoracoscopic pleural biopsy! The combination of histology and culture of pleural biopsy tissue will establish the diagnosis of TB in up to 90% of patients.
- > 5% mesothelial cells in pleural fluid makes TB very unlikely
Dr. Light is still a practicing physician at Vanderbilt! In his words, here’s how he devised Light’s Criteria.
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