What is the role of pleural fluid eosinophilia in the workup for pleural effusion (fluid on the lungs)?

Updated: Dec 28, 2018
  • Author: Kamran Boka, MD, MS; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Answer

Pleural fluid eosinophilia (PFE), with eosinophil values greater than 10% of nucleated cells, is seen in approximately 10% of pleural effusions and is not correlated with peripheral blood eosinophilia. PFE is most often caused by air or blood in the pleural space. Blood in the pleural space causing PFE may be the result of pulmonary embolism with infarction or benign asbestos pleural effusion. PFE may be associated with other nonmalignant diseases, including parasitic disease (especially paragonimiasis), fungal infection (coccidioidomycosis, cryptococcosis, histoplasmosis), and a variety of medications.

The presence of PFE does not exclude a malignant effusion, especially in patient populations with a high prevalence of malignancy. The presence of PFE makes tuberculous pleurisy unlikely and also makes the progression of a parapneumonic effusion to an empyema unlikely.


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