Moffitt Pearls 1.12.18 – Pleural Effusions s/p CABG

Thank you Kapil for presenting the case of an elderly man born in China presenting w/ cough found to have a unilateral exudative pleural effusion. After inpatient work-up w/ ddx initially including TB and malignancy, it was felt that this effusion is likely a result of his recent CABG (the date was signed out to the team was years prior when in fact it was weeks prior).

Key Pearls

  1. Always verify history, labs, medications and imaging for holdover patients as this can dramatically influence your approach and work-up. Trust, but verify!
  2. Light’s criteria (below) is positive when ONLY 1 out of the 3 criteria (below) are met. This test is extremely sensitive (98%) so as not to miss exudative effusions (see below).
  3. Pleural effusions are common after CABG with a reported prevalence of 40-75% 1 week after surgery. Most of these are asymptomatic, exudative, small, left-sided and resolve over several weeks.
  4. The cause of 15-20% of all plural effusions will remain unknown. See this article from Chest looking at non-malignant effusions. They found that bilateral, transudative effusions were associated with a one year mortality of 50%!

More on Effusions after CABG

  • Bloody, exudative, effusions tend to occur to earlier ( < 4 weeks after surgery). These are usually easy to control with one to three therapeutic thoracenteses.
  • Non-bloody effusions tend to occur later (> 4 weeks after surgery) and have a relatively low LDH and high percentage of lymphocytes. These effusions tend to be more difficult to control.

See this article for a review of pleural effusions and these figures!

light's criteriapleural effusions



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