Revision as of 20:59, 13 May 2015 by Rossdonaldson1 (talk | contribs) (Background)


  • Pleural space infections with positive Gram stain or culture OR parapneumonic effusions without pleural fluid sampling
  • Stages
    1. Exudative
      • Free-flowing pleural effusion amenable to chest tube drainage; may only last <48hr
    2. Fibrinopurulent
      • Loculations develop making resolution w/ single chest tube drainage unlikely
    3. Organizational
      • Takes several weeks to develop; "pleural peel" restricts lung expansion


Clinical Features

  • Usually preceded by PNA
    • Suspect if symptoms of PNA do not resolve

Differential Diagnosis


  • Aspiration of purulent material on thoracentesis and at least 1 of the following:
    1. Positive Gram stain or culture
    2. Pleural fluid glucose <40
    3. pH <7.1
    4. LDH >1000


Adult Chest Tube Sizes

Chest Tube Size Type of Patient Underlying Causes
Small (8-14 Fr)
  • Alveolar-pleural fistulae (small air leak)
  • Iatrogenic air
Medium (20-28 Fr)
  • Trauma/bleeding (hemothorax/hemopneumothorax)
  • Bronchial-pleural fistulae (large air leak)
  • Malignant fluid
Large (36-40 Fr)
  • Thick pus

See Also


  • Tintinalli
  • Inaba Et. al J Trauma Acute Care Surg. 2012 Feb;72(2):422-7.
  • Advanced Trauma Life Support® Update 2019: Management and Applications for Adults and Special Populations.