Etiologic diagnostic investigation of pleural fluid eosinophilia

This figure summarizes our suggested approach to diagnose an underlying etiology for patients with PFE. The differential diagnosis is wide. We use clinical, laboratory, and PFA to obtain a diagnosis. Only a proportion will need a pleural biopsy. This algorithm is intended for use in conjunction with additional UpToDate content on PFE.

CBC: complete blood count; CT: computed tomography; IgG4-RD: immunoglobulin G4-related disease; ILD: interstitial lung disease; O+P: ova and parasites; PE: pulmonary embolism; PFA: pleural fluid analysis; PFE: pleural fluid eosinophilia; RA: rheumatoid arthritis.

* Most etiologies of PFE are exudates, but in rare circumstances, PFE is associated with cirrhosis or heart failure, which are classically transudative.

¶ Several drugs have been implicated in PFE. A trial of drug withdrawal may be needed to confidently make a diagnosis of drug-induced PFE.

Δ Observation periods vary depending on the etiology and should be individualized accordingly. Expected timelines are poorly defined. Refer to UpToDate content.

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Etiologic diagnostic investigation of pleural fluid eosinophilia