Pleural fluid eosinophilia
- John T Huggins, MD
John T Huggins, MD
- Associate Professor of Medicine
- Medical University of South Carolina
- Section Editors
- Bruce S Bochner, MD
Bruce S Bochner, MD
- Editor-in-Chief — Allergy and Immunology
- Section Editor — Adult Allergy; Asthma
- Samuel M Feinberg Professor of Medicine
- Northwestern University Feinberg School of Medicine
- V Courtney Broaddus, MD
V Courtney Broaddus, MD
- Section Editor — Pleural Disease
- Professor of Medicine
- University of California San Francisco
Pleural fluid eosinophilia (PFE, also called eosinophilic pleural effusion) is defined as pleural fluid with a nucleated cell count containing more than 10 percent eosinophils [1-4]. It is estimated that approximately 10 percent of exudative pleural effusions are eosinophilic [2,3,5].
The presence of PFE narrows the differential diagnosis of a pleural effusion. Establishing the cause is dependent upon careful analysis of the clinical presentation and the pleural fluid. The most common cause is air or blood in the pleural space.
The pathogenesis, etiology, and evaluation of eosinophilic pleural effusions will be reviewed here. The general analysis of pleural fluid and evaluation of systemic eosinophilia and pulmonary parenchymal eosinophilia are discussed separately. (See "Diagnostic evaluation of a pleural effusion in adults: Initial testing" and "Approach to the patient with unexplained eosinophilia" and "Causes of pulmonary eosinophilia".)
The development of pleural fluid eosinophilia (PFE) requires the recruitment of bone marrow-derived eosinophils, since eosinophils are not part of the normal cellular milieu of lung and pleural tissue . The mechanisms that lead to the recruitment of eosinophils to the pleural space have not been clearly elucidated.
The time course of the development of pleural fluid and peripheral blood eosinophilia in response to air or blood in the pleural space suggests that the specific mechanisms that trigger eosinophil accumulation may vary . PFE develops within hours after a spontaneous pneumothorax compared to within 10 to 14 days after the onset of a traumatic or hemorrhagic pleural effusion . In addition, pleural trauma and hemothorax, but not pneumothorax, are often associated with peripheral blood eosinophilia that develops days after PFE.
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- Pleural trauma
- - Air in the pleural space
- - Blood in the pleural space
- - Repeated thoracentesis
- Pulmonary embolism
- Rare causes
- Physical examination
- Laboratory analysis
- Pleural fluid analysis
- Undetermined etiology
- TREATMENT AND MONITORING
- SUMMARY AND RECOMMENDATIONS