When are specialized lab tests considered 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

Additional specialized tests are warranted when specific etiologies are suspected. Measure pleural fluid amylase levels if a pancreatic origin or ruptured esophagus is suspected or if a unilateral, left-sided pleural effusion remains undiagnosed after initial testing. Of note, increased pleural fluid amylase can also be seen with malignancy. An additional assay of amylase isoenzymes can help distinguish a pancreatic source (diagnosed by elevated pleural fluid pancreatic isoenzymes) from other etiologies.

Measure triglyceride and cholesterol levels in milky pleural fluids when chylothorax or pseudochylothorax is suspected.

Consider immunologic studies, including pleural fluid antinuclear antibody and rheumatoid factor, when collagen-vascular diseases are suspected.


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