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Previous Volume 346:1971-1977 June 20, 2002 Number 25 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations.

A 70-year-old man with an 80-pack-year history of smoking and a history of congestive heart failure presents with increasing shortness of breath. He also has aching chest pain on the right side that worsens with deep inspiration. He is afebrile. The chest radiograph reveals bilateral pleural effusions, with more pleural fluid on the right than on the left. How should this patient . . . [Full Text of this Article]

The Clinical Problem

Strategies and Evidence

Initial Evaluation

Indications for Thoracentesis

Appearance of the Pleural Fluid

Differentiation of Exudates from Transudates

Evaluation of an Exudative Effusion

            Total and Differential Cell Counts

            Smears and Cultures

            Pleural-Fluid Glucose Level

            Pleural-Fluid Lactate Dehydrogenase Level

            Pleural-Fluid Tests for Cancer

            Pleural-Fluid Markers of Tuberculosis

            Other Tests on the Pleural Fluid

            Evaluation for Pulmonary Embolism

Pleural Effusion of Unknown Cause

Areas of Uncertainty

Guidelines

Conclusions and Recommendations

Source Information

From the Pulmonary Disease Program, St. Thomas Hospital, and the Department of Medicine, Vanderbilt University School of Medicine — both in Nashville.

Address reprint requests to Dr. Light at the Pulmonary Disease Program, St. Thomas Hospital, 4220 Harding Rd., Nashville, TN 37205, or at rlight98@yahoo.com.

References

Related Letters:

Pleural Effusion
Fridlender Z. G., Gotsman I., Light R. W.
Extract | Full Text | PDF  
N Engl J Med 2002; 347:1286-1287, Oct 17, 2002. Correspondence

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