Workup for effusion

• r/o infxn: usually apparent from Hx & CXR; ? value of ✓ acute and convalescent serologies

• r/o noninfectious etiologies: BUN, Cr, ANA, RF, HIV, screen for common malignancies

• Pericardiocentesis if suspect infxn or malignancy or large effusion (>2 cm) or recurrent ✓ cell counts, TP, LDH, glc, Gram stain & Cx, AFB, cytology ADA, PCR for MTb, and specific tumor markers as indicated by clinical suspicion “exudate”: TP >3 g/dL, TPeff/TPserum >0.5, LDHeff/LDHserum >0.6 or glc <60 mg/dL; high Se (~90%) but very low Sp (~20%); overall low utility (Chest 1997;111:1213)

• Pericardial bx if suspicion for malignancy or TB; perform during every surgical drainage