71-year-old male presents to the emergency department with the complaint of progressive shortness of breath and peripheral edema for one weeks' duration...

[shaktalks]

A 71-year-old male presents to the emergency department with the complaint of progressive shortness of breath and peripheral edema for one weeks' duration. He is admitted to the hospital and an echocardiogram shows a low ejection fraction. A computerized tomographic scan is obtained and reveals bilateral pleural effusions. The pleural effusion can be best described as

1. being caused by inflammation
2. fluid with a high protein level and high specific gravity
3. fluid with a low protein level and low specific gravity
4. having a pleural: serum LDH ratio >0.6
5. having a pleural: serum protein ratio >0.5

Comments

[robertsekhose]

This is really sad to know about his condition. I hope he get well soon.

[shaktalks]

hey! these are sample cases for medical boards but this situation is very common to see nowadays.

[shaktalks]

fluid with a low protein level and low specific gravity

Pleural effusions are classified as either exudative or transudative.

A pleural effusion qualifies as an exudate with the one or more of the following criteria:

• pleural to serum LDH ratio of >0.6,
• pleural: serum protein ratio >0.5,
• total protein >3 g/dL, or
• pleural fluid LDH >2/3 the normal upper limit of serum LDH (200 - 300).
  • normal serum LDH? 140 units per liter (U/L) - 280 U/L

Transudative effusions usually are due to a change in hydrostatic or oncotic pressure, as in conditions such as:

• congestive heart failure
• liver cirrhosis, and
• nephrotic syndrome.

The patient in the above scenario has pleural effusions secondary to congestive heart failure, which makes transudative fluid the correct statement.