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Which patients with a parapneumonic effusion need a chest tube?

Scott A. Helgeson, MD, Brett T. Hiroto, MD, Scott J. Billings, MD, Courtney L. Scott, DO and Michele D. Lewis, MD
Cleveland Clinic Journal of Medicine August 2018, 85 (8) 609-611; DOI: https://doi.org/10.3949/ccjm.85a.17036

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Tables

  • TABLE 1

    Parapneumonic effusion: Categories, management, and prognosis

    CategoryRadiographic appearancePleural fluid analysisManagementPrognosis
    Category 1< 10-mm effusionNo fluid analysisNo drainage neededVery good
    Category 2> 10-mm effusion and < 50% of the hemithoraxNegative Gram stain and culture
    pH ≥ 7.2    		No drainage neededGood
    Category 3≥ 50% of the hemithorax, or loculations, or thickened parietal pleuraPositive Gram stain and culture
    pH < 7.2
    Glucose < 60 mg/dL    		Complete drainage necessaryPoor
    Category 4≥ 50% of the hemithorax, or loculations, or thickened parietal pleuraFrank pusComplete drainage necessaryVery poor

    • Based on information in reference 5.

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