Cardoso, "Determination of total proteins and lactate dehydrogenase for the diagnosis of pleural transudates
and exudates: redefining the classical criterion with a new statistical approach," Jornal Brasileiro de Pneumologia, vol.
Causes of bilateral/variable, left-sided and right-sided pleural effusion Bilateral / Variable Left (*) Right (*) Transudate
Left sided heart Constrictive Cirrhotic liver disease failure pericarditis Right sided heart Hypoalbuminemia failure Peritoneal dialysis Meigs' syndrome Nephrotic syndrome Superior vena cava Pulmonary embolism obstruction Hypothyroidism Ovarian hyperstimulation Chylothorax Urinothorax Exudate Parapneumonic Following Hepatic abscess effusion cardiac Chylothorax Malignant neoplasm surgery Pulmonary embolism Splenic Rheumatoid abscess arthritis Benign Post-MI effusion secondary syndrome to asbestosis Acute Other autoimmune pancreatitis diseases Pancreati- Subphrenic abscess copleural Uremia fistula Drug induced Radiotherapy Esophageal rupture Table 5.
The serum-ascites albumin gradient (SAAG) is a reasonably reliable way to differentiate between transudate
and exudate fluids (serum albumin minus the ascitic albumen level).
Table 1 shows the distribution of the causes of exudates (in 85 patients) and transudates
(in 16 patients) in the cases under study.
The causes of pleural effusions can be classified as either a transudate
(Table 1) or an exudate (Table 2).
The classic work of Light and colleagues demonstrated that 99% of pleural effusions could be classified into two general categories: transudative or exudative .A basic difference is that transudates
, in general, reflect a systemic perturbation, whereas exudates usually signify underlying local (pleuropulmonary) disease.
Some specific conditions associated with transudates
are: Congestive heart failure--Fluid usually straw colored, with low white blood cell counts (< 500 cells/mm3) and a mononuclear cell predominance.
(7,32) Rheumatoid pleural effusions may be transudates
with low cell counts, predominantly lymphocytes, or exudates with greater cell counts and high lactate dehydrogenase and protein concentrations.
* Understand approaches for distinguishing transudates
vs exudates in fluids.
Mostly 36 (55.38%) fluids were transudates
and rest 29 (44.62%) were exudates.
Ball Jr, "Pleural effusions: the diagnostic separation of transudates
and exudates," Annals of Internal Medicine, vol.
Cholesterol levels were more than 60 mg/dl in cases of exudates whereas transudates
have a cholesterol levels below 60 mg/dl.