Discriminating Between Transudates and Exudates

The dichotomous classification of pleural fluid as a transudate or an exudate simplifies diagnostic efforts in determining the cause of pleural effusions. Multiple pleural fluid tests are available to discriminate between these two classes of effusions. Tests commonly used in clinical practice depend on the detection in pleural fluid of large-molecular-weight chemicals that enter the pleural space to greater degrees in conditions associated with exudative compared with transudative effusions. Considerable misclassifications can occur with all available testing strategies, so clinicians benefit from adopting a nondichotomous, bayesian approach for interpreting test results.