In states of excess accumulation, pleural fluid can be sampled and evaluated to determine what disease state may be causing it. The evaluation consists of
Gram stain and culture - identifies bacterial infections
cell count and differential - differentiates exudative from transudative effusions
cytology - identifies cancer cells, may also identify some infective organisms
Pleuralfluid analysis is important in the diagnosis and staging of a suspected or known malignancy.
When the anesthetizing needle enters the parietal pleura and pleuralfluid is aspirated, the depth of the needle should be marked by applying a clamp to the needle at skin level.
Fluid should never be forcibly aspirated from the pleural space, so as to avoid damaging the lung with the needle or catheter.
Complicated parapneumonic effusions include empyema (the finding of gross pus in the pleural space), those with positive pleuralfluid cultures or Gram stains, and those in which the microbiology is negative but the patient continues to show signs of infection with fever, severe pleuritic pain and leukocytosis.
By contrast, rapid accumulation of pleuralfluid in a patient with pneumonia is an indication for immediate thoracentesis.
With a trapped lung (one that cannot fully expand secondary to a visceral pleural peel), exudative pleuralfluid fills the pleural space and the characteristics of the fluid depend on the etiology (e.g., malignancy, post-parapneumonic, trauma).
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