A cloudy yellow pleural fluid was obtained on a 60 year old

A cloudy, yellow pleural fluid was obtained on a 60 year old male, the microscopic evaluation reveals many WBC’s, few mesothelial cells, and moderate RBC’s and bacteria. Would you suspect this is a transudate or exudate? Could you propose a preliminary diagnosis based on the findings?

Solution

Here the WBC differential count makes us suspect that patient has an exudative pleural fluid. This might have been caused due to TB, pneumonia or mainly due to malignant tumor/cancer.

Here microscopic evaluation indicates the presence of bacteria so if we suspect TB pleurisy then we can go for a BACTEC system with bedside inoculation which provides higher yields and faster results for diagnosis.

Pleural biopsy (bronchoscopy/thoracoscopy can also be performed for the diagnosis of TB or presence of malignancy.