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Use of Pleural Fluid N-Terminal-Pro-Brain Natriuretic Peptide and Brain Natriuretic Peptide in Diagnosing Pleural Effusion Due to Congestive Heart Failure

Richard W. Light, MD, FCCP
Author and Funding Information

Correspondence to: Richard W. Light, MD, FCCP, Vanderbilt University, 2201 West End Ave, Nashville, TN 37235; e-mail: rlight98@yahoo.com

Dr. Light is affiliated with the Division of Allergy, Critical Care, Pulmonary Disease, and Critical Care Medicine, Vanderbilt University.


The author has reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(3):656-658. doi:10.1378/chest.09-0924
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Extract

Pleural effusions have classically been divided into transudates and exudates. Most transudative pleural effusions are due to heart failure. The criteria of Light et al1 have been used to make this differentiation for the past 25 years. The main problem with those criteria is that although they identify nearly all exudates correctly, they misidentify about 20 to 25% of transudates as exudates.2 Almost all of the patients with misclassified transudates have heart failure and are receiving therapy with diuretics. Although modifications to the criteria of Light et al1 and alternative measures such as the pleural fluid cholesterol level have been assessed as alternative measures to separate transudates from exudates, none are superior to the criteria of Light et al.3

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