Light separates parapneumonic effusions into classes based on radiographic and laboratory findings. The class of an effusion affects the optimum management strategy. The author is from the University of California at Irvine.
|
Imaging Studies |
Smear and/or Culture |
Type |
Class |
|
small; less than 10 mm thick on decubitus X-ray |
Gram stain and culture negative |
nonsignificant pleural effusion |
1 |
|
>= 10 mm thick on lateral decubitus X-ray |
Gram stain and culture negative |
typical parapneumonic pleural effusion |
2 |
|
|
Gram stain and culture negative |
borderline complicated pleural effusion |
3 |
|
not loculated |
Gram stain or culture positive; no frank pus |
simple complicated pleural effusion |
4 |
|
multiloculated |
Gram stain or culture positive; no frank pus |
complex complicated pleural effusion |
5 |
|
single locule or free-flowing |
frank pus present |
simple empyema |
6 |
|
multiple locules |
frank pus present |
complex empyema |
7 |
|
pH |
Glucose |
LDH |
Type |
Class |
|
|
|
|
nonsignificant pleural effusion |
1 |
|
pH > 7.20 |
> 40 mg/dL |
|
typical parapneumonic pleural effusion |
2 |
|
pH < 7.20 and > 7.00 |
> 40 mg/dL |
LDH > 1,000 IU/L |
borderline complicated pleural effusion |
3 |
|
pH < 7.00 |
< 40 mg/dL |
|
simple complicated pleural effusion |
4 |
|
pH < 7.00 |
< 40 mg/dL |
|
complex complicated pleural effusion |
5 |
|
|
|
|
simple empyema |
6 |
|
|
|
|
complex empyema |
7 |
|
Class |
Management |
|
1 |
no thoracentesis indicated |
|
2 |
antibiotics alone |
|
3 |
antibiotics plus serial thoracentesis |
|
4 |
tube thoracostomy plus antibiotics |
|
5 |
tube thoracostomy plus thrombolytics; rarely requires thoracoscopy or decortication |
|
6 |
tube thoracostomy with/without decortication |
|
7 |
tube thoracostomy with thrombolytics; often requires thoracoscopy or decortication |
Specialty: Pulmonology
