Pulmonary Disease

Answer 1 PE. The patient’s clinical history strongly suggests PE with an associated left leg deep venous thrombosis (DVT). This patient also has a transudative pleural effusion (fluid protein:serum protein, 0.24; fluid LDH:serum LDH, 0.27). PE may present with pleural effusions in one third to one half of patients, depending on whether chest radiography or computed tomography is performed.1 Although PE-associated pleural effusions are typically small and exudative, many may be transudative and approximately 10% may be large or massive.2 PE should be investigated when evaluating patients with pleural effusions of unknown etiology, whether exudative or transudative. Although congestive heart failure and hepatic insufficiency are causes of transudative pleural effusion, these conditions are not supported by the patient’s clinical history. Malignant pleural effusion and pneumonia would result in exudative effusions. REFERENCE 1. Porcel JM, Madronero AB, Pardina M, et al. Analysis of pleural effusions in acute pulmonary embolism: radiological and pleural fluid data from 230 patients. Respirology 2007;12:234-9. 2.  Light RW. Clinical practice. Pleural effusion. N Engl J Med 2002;346:1971-7. Click here to return to the questions

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