Today Dr. Hobbs presented an interesting case of post-obstructive pneumonia presumably from external compression from calcified lymphadenopathy from prior granulomatous disease. There were several take away points:
Transudate vs. Exudate: remember Light's Criteria
- Pleural Protein/Serum Protein >0.5
- Pleural LDH/Serum LDH >0.6
- Pleural LDH >2/3 the upper limit of normal
Chest Tube Placement: indications according to ATS guidelines
Broncholiths: calcified material within the lumen of a bronchus. Can be a result of histoplasmosis, TB or a calcified endobronchial tumor. Recently discussed in NEJM (Williams K, Swanson K. N Engl J Med 2017;377:e4)
Tuberculosis In Oregon: TB cases from Micronesia continue to be diagnosed in Oregon. This includes Guam, the Marshall Islands, the Federated States of Micronesia and the Mariana Islands. 4 cases have been reported in 2017 thus far. And, they are typically very ill at diagnosis. Remember to consider TB on the differential!
- Remember if diagnosing TB from a pleural effusion, the sensitivity and specificiy of of pleural fluid stain and culture is dismal (staining less than 5% and culture + 20-30%). The test of choice would be pleural fluid adenosine deaminase (ADA) measurement which is >60U/L is 95% sensitive and 96% specific for TB.