Pleural Tap

by Jeremy Brown, PhD

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    00:00 So the pleural tap is a very important and key test for patients presenting with pleural effusions. It’s done by an operator in the outpatient department. It’s very easy. It’s very quick. It requires a little bit of local anaesthetic between the ribs and then insertion of needle into the fluid and withdrawing 20, 30, 40, 50 ml of pleural fluid to be sent to the laboratory for investigation.

    00:27 It’s best done under ultrasound control to avoid damaging any of the local structures with the needle insertion. If you drew out the blood at the effusion and it looks like there’s blood present, then actually, that’s quite suggestive that there may be malignancy or pulmonary embolus. If you drew out the fluid and it’s visibly turbid i.e. it’s white and opaque you can’t see through it, then that would actually suggest potential empyema. So after pleural tap, the pleural fluid is sent off for multitude of tests. The most important, perhaps being albumin content because that dictates whether the patient has a transudate or an exudate. Less than 30 grams per litre equals a transudate. Greater than 30 grams per litre means they have an exudate. In addition to lactate dehydrogenase, enzyme levels are measured as these are raised in patients with exudates. The glucose level may be measured and that’s matched with the blood glucose because low glucose suggests infection of the pleural space.

    01:28 The fluid is sent off for culture and microscopy including for acid-fast bacilli mycobacteria to identify the presence of pleural infection, although unfortunately, these tests aren’t particularly sensitive. In fact, for tuberculosis, it’s actually quite rare to identify the organism in patients with pleural tuberculosis. The pH is measured because if that is less than 7, that is highly suggestive of bacterial infection. In addition, the fluid is sent to the histopathologist for cytological examination, and this is basically to identify cancer cells.

    02:02 It has a sensitivity which is reasonably good 65% sensitivity for the first pleural tap, maybe increasing to 75% sensitivity if repeated with the second pleural tap.

    02:14 In addition, the cytology identifies the type of inflammatory cell present. For example, lots of neutrophils would suggest there’s pleural infection with bacteria such an empyema.

    02:23 Lots of lymphocytes might suggest that the patient has tuberculosis.

    About the Lecture

    The lecture Pleural Tap by Jeremy Brown, PhD is from the course Pleural Disease.

    Included Quiz Questions

    1. < 30gm/L of albumin content in pleural fluid.
    2. LDH level is increased in pleural fluid.
    3. pH is less than 7.2 in pleural fluid.
    4. Glucose level is decreased in pleural fluid.
    5. Culture and sensitivity in pleural fluid show bacteria.
    1. Malignancy
    2. Tuberculosis.
    3. Viral infection.
    4. Fungal infection.
    5. Heart failure.

    Author of lecture Pleural Tap

     Jeremy Brown, PhD

    Jeremy Brown, PhD

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