Question N0-01

A pleural aspiration on the 50 year-old women whose chest x-ray is shown below.

PLEURAL ASPIRATION ANALYSIS

*Total Protein = 2.35 G/L
*Lactic Dehydrogenase (LDH) = 156 IU/L
*pH = 7.36
*Microbiology (Gram stain and culture) = Nil Growth

#Question
What is the most likely cause of the effusion from your interpretation?

(a) Bronchial carcinoma
(b) Hypothyroidism
(c) Pneumonia
(d) Rheumatoid disease
(e) Pulmonary embolus


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Answer - Hypothyroidism

Pleural effusions are divided into exudates and transudates. This is based on the total protein content of pleural fluid.

Exudate = greater than 30 g/l of protein

Transudate = less than 30 g/l of protein

Exudates tend to be unilateral and trasudates bilateral due to the nature of the causative factors.

The X-Ray shows bilateral pleural effusions – albeit larger on the left. The aspirate analysis also shows a transudate. The only option within the list which causes a transudate is hypothyroidism.