Chest
Volume 124, Issue 1, July 2003, Pages 167-176
Journal home page for Chest

Clinical Investigations
Pleural
Patient With Bilateral Pleural Effusion: Are the Findings the Same in Each Fluid?

https://doi.org/10.1378/chest.124.1.167Get rights and content

Study objectives

To determine whether, in patients with bilateral pleural effusions, the main cellular and biochemical features of the pleural fluid on the right side differ from or correlate with those on the left side. We examined lactate dehydrogenase (LDH), glucose, and total protein (TP) levels, RBC count, nucleated cell count (NCC), and differential cell count.

Patients and methods

Twenty-seven patients with bilateral pleural effusions, including 13 patients with effusions after coronary artery bypass graft surgery, 12 patients with congestive heart failure, 1 patient with malignant pericarditis, and 1 patient with renal failure, were studied retrospectively.

Results

The right-sided and the left-sided pleural effusions did not differ in the mean TP (p = 0.38), glucose (p = 0.31), and LDH (p = 0.39) levels, RBC count (p = 0.31), NCC (p = 0.96), and the percentage of neutrophils (p = 0.22), lymphocytes (p = 0.73), mononuclear cells (MNCs) [p = 0.49], and eosinophils (p = 0.65). The bias ± precision was 0.1 ± 0.64 g/dL for TP, − 2.7 ± 23 mg/dL for glucose, 41 ± 362 IU/L for LDH, 6,100 ± 62,900 cells/μL for RBC count, − 36 ± 1,043 cells/μL for NCC, − 2.9 ± 11.6% for the percentage of neutrophils, 1.15 ± 17% for the percentage of lymphocytes, 2.3 ± 17% for the percentage of the MNCs, and − 0.15 ± 5.4% for the percentage of eosinophils. Moreover, there was a close correlation between the right-sided and the left-sided pleural effusions concerning TP level (r = 0.85, p < 0.001), glucose level (r = 0.78, p < 0.001), LDH level (r = 0.71, p < 0.001), RBC count (r = 0.66, p < 0.001), NCC (r = 0.60, p = 0.001), and the percentage of neutrophils (r = 0.77, p < 0.001), lymphocytes (r = 0.77, p < 0.001), MNCs (r = 0.74, p < 0.001), and eosinophils (r = 0.84, p < 0.001).

Conclusion

Since the pleural fluid findings tend to be similar in both sides of patients with bilateral pleural effusion, we suggest that diagnostic thoracentesis may not need to be performed on both sides, unless there is a specific clinical indication.

Section snippets

Materials and Methods

Saint Thomas Hospital is a tertiary-care medical center. Since September 1, 1997, we have maintained a database on all patients who undergo ultrasonically guided thoracentesis and who signed an informed consent approved by the Institutional Review Board. Every patient (both outpatients and inpatients) who undergoes ultrasound-assisted thoracentesis in Saint Thomas Hospital and signs the consent form is prospectively entered. We conducted a retrospective pilot study to examine whether, in

Results

Thirty-three patients were identified from the database who underwent bilateral thoracentesis on the same day. Twenty-seven patients with definitive diagnosis and available laboratory data were included in the study. Four patients were excluded because pleural fluid data were missing from one or both sides, and two patients were excluded because of no definite diagnosis.

The most common diagnoses were pleural effusion after CABG (13 cases) and congestive heart failure (12 cases). One patient had

Discussion

In the present study, we examined whether, in patients with bilateral pleural effusion, the pleural fluid characteristics differ from one side to the other. We studied the TP, glucose, and LDH levels, RBC counts, NCCs, and differentials. Our results indicate the following: (1) there is no significant difference in the mean values of the measurements between the right side and the left side, (2) the bias for every pleural fluid characteristic is not clinically significant, and (3) there are

ACKNOWLEDGMENT

The authors thank Miss Emily Melton for secretarial assistance.

References (23)

  • G Hillerdal et al.

    Benign asbestos pleural effusion: 73 exudates in 60 patients

    Eur J Respir Dis

    (1987)
  • Cited by (18)

    • Etiologies of bilateral pleural effusions

      2013, Respiratory Medicine
      Citation Excerpt :

      That study also showed that, on average, characteristics of the fluid were similar between the left and right sides, including levels of protein, LDH, glucose, and cell counts. Those authors concluded that bilateral fluid analysis need not be performed on both sides unless there is a specific clinical indication.2 There is limited data regarding pleural fluid etiologies or safety of removing fluid from both hemithoraces at the same time in patients with bilateral pleural effusions.

    • Medical thoracoscopy - Diagnostic indications

      2020, Atemwegs- und Lungenkrankheiten
    View all citing articles on Scopus

    Support was provided by the Saint Thomas Foundation.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (e-mail: [email protected]).

    View full text