A 35-year-old male was seen for 2 weeks history of fever, cough and increasing dyspnea. On examination he is not in respiratory distress. He has temperature of 38.5 PR of 120. There is evidence of right pleural effusion. WBC of 9000. CXR showed moderate right pleural effusion. Thoracentesis yields minimally turbid yellow fluid with the following results: pleural fluid nucleated cell count of 3000 with 85% lymphocytes pleural fluid protein 5.2 g/dl pleural fluid LDH 230 U/l Pleural fluid glucose 80 mg/dl PH 7.36 Pleural fluid Gram stain is negative, Pleural fluid cytology is negative What is the most likely diagnosis?
سؤال مجاني 1 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: A. Tuberculous pleurisy
Pleural protein 5.2 g/dl = exudate with 85% lymphocytes, a negative Gram stain and negative cytology in a febrile young man, so the answer is tuberculous pleurisy (send ADA, AFB culture, pleural biopsy). A parapneumonic effusion is neutrophil-predominant. Malignant effusions can be lymphocytic, but the age, fever and negative cytology favour TB. PE effusions contain RBCs and eosinophils.
ليش كل خيار صح أو غلط
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A
ليش صح
Tuberculous pleurisy gives an exudate with lymphocyte predominance (a chronic illness), which fits this fluid with 85% lymphocytes.
✓ Pleural effusion.pdf · p. 7 -
B
ليش غلط
A parapneumonic effusion comes with an acute illness, which gives a neutrophil-predominant fluid; this fluid is 85% lymphocytes, as in chronic illnesses such as TB.
✓ Plerual effusions.pdf · p. 18 -
C
ليش غلط
A malignant effusion is described with abnormal cytology and low pH and glucose; here cytology is negative, and pH 7.36 and glucose 80 are normal.
✓ Pleural effusion.pdf · p. 8 -
D
ليش غلط
Effusions from pulmonary infarction are serous or blood-stained with red blood cells and eosinophils, not lymphocyte-predominant.
✓ Pleural effusion.pdf · p. 9 -
E
ليش غلط
Asbestos exposure is tied to mesothelioma, whose fluid is a bloody exudate; this fluid is yellow and minimally turbid in a febrile patient.
✓ Pleural effusion.pdf · p. 8
- المصدر
- Pleural effusion.pdf · p. 7
Plerual effusions.pdf · p. 18 - المحاضرة
- Tuberculosis · Pulmonology · Module B
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