Page 43 - Radiology Book

Fluid
Suggested Diagnosis
Ammonia odor
Urinothorax
Black
Aspergillus involvement in the pleura
Bloody
Trauma, traumatic thoracentesis, pulmonary embolism, malignacy
Brown
Rupture of an amebic liver abscess into the pleural space
Food particles
Rupture of the esophagus into the pleural space
Putrid odor
Anaerobic infection of the pleura or emphyema
Viscous
Malignant mesothelioma due to increased levels of hyaluronic acid
White
Chylothorax cholesterol in the uid or empyema
Yellow-green
Rheumatoid pleuritis
tHoracentesis continued
3. Light’s Criteria: one or more of the following:
· Pleural uid/serum LDH >0.6
· Pleural uid LDH >2⁄3 the normal upper limit for
serum (Light RW, et al. Ann Intern Med. 1972;77:507-513.) diagnoses suggested by Pleural fluid
eXamination findings
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· Nearly 100% sensitive at identifying exudates, but about 20% of patients with effusions caused by heart failure may ful ll exudate criteria after receiving diuretics.
· Pleural uid/serum protein >0.5
Adapted from Sahn SA. Am Rev Respir Dis. 1988;138:184-234.
lumbar Puncture
Prep Work
Supplies
· Lumbar puncture kit, sterile and nonsterile gloves.
· Betadine or chlorhexidine for skin prep.
· 5” × 5” gauze, 2 drapes/towels (Chux).
Procedure
1. Position
· Lateral decubitus position with patient in the fetal position, curled up, or seated leaning over the table (both will open
the interspinous space). Position is key!
Procedures