Clinics in chest medicine
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When a patient with a parapneumonic pleural effusion is first evaluated, a therapeutic thoracentesis should be performed if more than a minimal amount of pleural fluid is present. Fluid obtained at the therapeutic thoracentesis should be gram-stained and cultured and analyzed for glucose, pH, LDH, white blood cells, and differential cell count. If the fluid cannot be drained because of loculations, a chest tube should be inserted and thrombolytic agents administered. ⋯ Patients with loculated-parapneumonic effusions should be treated with tube thoracostomy and thrombolytic agents. If drainage is incomplete, thoracoscopy, with breakdown of adhesions and debridement of the pleural space, is indicated. If thoracoscopy is unsuccessful, then thoracotomy, with decortication, is indicated unless the patient is too debilitated.
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Clinics in chest medicine · Jun 1998
ReviewEvaluating diagnostic tests in the pleural space. Differentiating transudates from exudates as a model.
Physicians have a staggering variety of diagnostic tests available for directing their diagnostic and therapeutic decisions. Technologic advances in laboratory science have increased the sophistication of new tests and accelerated their rate of adoption into clinical practice. Unfortunately, studies that report the value of new diagnostic tests often fail to follow accepted methodologic standards for unbiased test assessment or provide clinicians with sufficient information for the intelligent evaluation of a test's performance and applicability. The following review of pleural fluid tests that discriminate between exudative and transudative effusions serves to highlight important methodologic considerations in the assessment of diagnostic tests.