Snapshot A 55-year-old male with congestive heart failure, coronary artery disease, and hypertension presents to your urgent care with shortness of breath. He is on vacation and lost his medications during his travel. He reports that his shortness of breath has been getting worse over the past few days, especially when he is walking. His exam is notable for decreased lung sounds bilaterally with overlying dullness to percussion and bilateral 1+ pitting edema to the knees. A chest radiograph was performed, which showed blunting of the costophrenic angles. Introduction Clinical definition login to view 1 more bullet Epidemiology login to view 5 more bullets Etiology login to view 1 more bullet Pathogenesis login to view 5 more bullets Prognosis login to view 1 more bullet Presentation Symptoms login to view 3 more bullets Physical examination login to view 3 more bullets Special presentation login to view 2 more bullets Imaging Chest radiography login to view 2 more bullets Studies Thoracentesis login to view 2 more bullets Fluid studies login to view 4 more bullets Light Criteria for Pleural Fluid Analysis Transudative Exudative Fluid LDH ≤ 2/3 upper limit of normal serum > 2/3 upper limit of normal serum Fluid LDH/Serum LDH ≤ 0.6 > 0.6 Fluid total protein/serum total protein ≤ 0.5 > 0.5 Diagnosis Must meet all criteria to diagnose a transudate Meet any single criterion to diagnose exudate Differential Diagnosis Pyothorax Hemothorax Chylothorax Treatment Management approach login to view 3 more bullets Interventional login to view 7 more bullets Complications Empyema Loculation Pneumothorax from thoracentesis