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An accurate diagnosis of the cause of the effusion, transudate versus exudate, relies on a comparison of the chemistries in the pleural fluid to those in the blood, using Light's criteria. According to Light's criteria (Light, et al. 1972), a pleural effusion is likely exudative if at least one of the following exists: [31]
Transudate is extravascular fluid with low protein content and a low specific gravity (< 1.012). It has low nucleated cell counts (less than 500 to 1000 per microliter) and the primary cell types are mononuclear cells: macrophages, lymphocytes and mesothelial cells. For instance, an ultrafiltrate of blood plasma is transudate.
On the surface of this solution, 1 drop of the effusion fluid is carefully layered. If the drop disappears and the solution remains clear, the Rivalta's test is defined as negative. If the drop retains its shape, stays attached to the surface or slowly floats down to the bottom of the tube (drop- or jelly-fish-like), the Rivalta's test is ...
(See below for difference between transudate and exudate) Malignant (or cancerous) pleural effusion is effusion where cancer cells are present. [11] It is usually classified as exudate. Types of exudates: serous, serosanguineous, sanguineous, hemorrhaging and purulent drainage. Serous: Clear straw colored liquid that drains from the wound.
Transudate: Exudate: Main causes ↑ hydrostatic pressure, ↓ colloid osmotic pressure: Inflammation-Increased vascular permeability: Appearance: Clear [1] Cloudy [1] Specific gravity < 1.012 > 1.020 Protein content < 2.5 g/dL > 2.9 g/dL [2] fluid protein/ serum protein < 0.5 > 0.5 [3] SAAG = Serum [albumin] - Effusion [albumin] > 1.2 g/dL < 1 ...
Because the transdiaphragmatic lymphatic channels are larger in diameter on the right, the pleural effusion is classically on the right side. The causes of the ascites and pleural effusion are poorly understood. [1] Atypical Meigs syndrome, characterized by a benign pelvic mass with right-sided pleural effusion but without ascites, can also occur.
The serum-ascites albumin gradient (SAAG) is probably a better discriminant than older measures (transudate versus exudate) for the causes of ascites. [12] A high gradient (> 1.1 g/dL) indicates the ascites is due to portal hypertension. A low gradient (< 1.1 g/dL) indicates ascites of non-portal hypertensive as a cause. [13]
Hydrothorax is the synonym of pleural effusion in which fluid accumulates in the pleural cavity. This condition is most likely to develop secondary to congestive heart failure, following an increase in hydrostatic pressure within the lungs. More rarely, hydrothorax can develop in 10% of patients with ascites which is called hepatic hydrothorax ...