Send fluid for specific gravity, pH, glucose, cell count, differential diagnosis, amylase, total protein, LDH, culture for aerobes, anaerobes and mycobacteria, Gram stain, AFB stain, cytologic analysis, CEA as indicated. Under 1.016 is suggestive of a transudate. Consider abdominal CT if suspect lymphoma. Treat underlying disease. An empyema or effusion should be drained by repeated needle aspirations or a chest tube.
Intrapleural urokinase can be helpful in treating loculated fluid if used early.
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