Pleural effusion. A diagnostic dilemma

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Abstract
The cause of pleural effusion in 108 of 133 patients was determined by laboratory tests and clinical examination; it was indeterminate in 25, even after complete diagnostic evaluation. In 164 diagnostic thoracenteses, 136 cytologic examinations were done; the results were positive for cancer in 20 (15%). Five of 19 patients (26%) with bronchogenic cancer, 13 of 25 (52%) with metastatic cancer of the lung, and 2 of 20 (10%) with lymphoma had positive results on cytologic examination. Of 143 routine bacterial cultures, only 5 were positive (3%). Of 103 mycobacterial and 76 fungal cultures, only 1 was positive in each instance. Despite the high incidence of indeterminate diagnoses, it was recommended that only measurement of protein content and cytologic examination be ordered routinely. The algorithm provides a logical, cost-effective approach to the diagnostic problem of pleural effusion.