Exudates

• Exudates by lung parenchymal infection (25%)
• Malignancy (15%):
  • primary lung cancer most common,
  • metastases (esp. breast,
  • lymphoma,
  • etc.),
  • mesothelioma (✓ serum osteopontin levels; NEJM 2005;353:15)
• Pulmonary embolism (10%):
  • effusions in ~40% of PEs;
  • exudate (75%) >transudate (25%);
  • hemorrhagic—must have high suspicion b/c presentation highly variable
• Collagen vascular disease:
  • RA (large)
  • SLE (small)
  • GPA
  • EGPA
• Abdominal diseases:
  • pancreatitis
  • cholecystitis
  • esophageal rupture
  • abdominal abscess
• Hemothorax (Hcteff/Hctblood >50%):
  • trauma
  • PE
  • malignancy
  • coagulopathy,
  • leaking aortic aneurysm,
  • aortic dissection
  • pulmonary vascular malformation
• Chylothorax (triglycerides >110): thoracic duct damage due to trauma, malignancy, LAM
• Other:
  • Post-CABG: left-sided; initially bloody, clears after several wks
  • Dressler’s syndrome (pericarditis & pleuritis post-MI), uremia, post-radiation therapy
  • Asbestos exposure: benign; ⊕ eosinophils
  • Drug-induced (eg, nitrofurantoin, methysergide, bromocriptine, amiodarone): ⊕ eos
  • Uremia; post-XRT; sarcoidosis
  • Meigs syndrome: benign ovarian tumor → ascites & pleural effusion
  • Yellow-nail syndrome: