What are the criteria used to classify pleural effusions as transudative or exudative?
Light's criteria.
If initial intra-pleural enzyme therapy is ineffective, which procedures can be considered to achieve adequate pleural drainage?
Additional chest tube insertion, or a surgical approach - such as video-assisted thoracic surgery (VATS), which is preferred over open thoracotomy. Use of VATS over open thoracotomy is associated with reduced morbidity and length of stay, whilst achieving similar outcomes.
PA and lateral X-ray films following removal of pleural drain. No pneumothorax identified. Mild pleural effusion seen on the right, with thickened appearance of the horizontal fissure likely due to movement of fluid into the inter-fissural space following intra-pleural enzyme therapy. Note improved appearances of encysted pleural fluid in the right upper zone.
Following pleural drainage and improvement in the patient's fevers, dyspnoea, and chest pain, the patient was later discharged home to complete a course of step-down oral antibiotic therapy.