Pleural fluid cholesterol level is an important parameter in differentiating exudative from transudative pleural effusions

Chakradhar Majhi, Butungeshwar Pradhan, Bikash C. Nanda, Sagnika Tripathy


Background: The first important step is to decide whether the pleural effusion is transudate or exudates by Light’s criteria. Light’s criteria can misclassify 25% of pleural transudates as exudates. Pleural fluid cholesterol level can differentiate transudates from exudates as a single parameter instead of multiple parameters used in Light’s criteria. Measurement of pleural fluid cholesterol levels to differentiate transudative effusions from exudative effusions.

Methods: Consecutive 60 cases of pleural effusion were taken in the study. Pleural fluid analysis was done for parameters of Light’s criteria along with pleural fluid cholesterol levels. First exudative and transudative effusion was classified by Light’s criteria. Other  clinical and relevant  biochemical tests were done to arrive in  the final etiological diagnosis  and data were collected and analysed .Pleural fluid cholesterol levels was  correlated to Light’s criteria.

Results: Total 60 cases of pleural effusion were there in the study. There were 43 exudative and 17 transudative effusions. Mean cholesterol level was 64.2± 7.5mg/dl in exudative effusions and 26.05±8.01 mg/dl in transudates. Pleural fluid cholesterol was ≥55mg /dl in 43 cases of exudates and <55mg/dl in 17 cases of transudates.

Conclusions: Pleural fluid cholesterol level of ≥ 55mg/dl had similar sensitivity and specificity to Light’s criteria and as a single important parameter to differentiate exudative from transudative pleural effusion


Exudates, Cholesterol level, Differentiation, Pleural fluid, Transudates

Full Text:



Jay SJ. Diagnostic procedure for pleural disease. Symposium on pleural disease. Clin Chest Md. 1985;6(1):33-48.

Moon Jan Na. Diagnostic tools of pleural effusion. Tubre Respir Dis. 2014;76 (5):199-210.

Steven A, Sahn MD Denver. The differential diagnosis of pleural effusion. Western Journal of Med. 1982;137(2):99-108.

Light RW, MacGregor MI, Luchisinger PC, Ball WC. Pleural effusions: The diagnosis separation of transudates and exudates. Ann Intern Med. 1972;77:507-13.

Porcel JM. Identifying transudates misclassified by Light’s criteris. Curr Opin Pulm Med. 2013;19(4):362-7.

Stead WW, Eichenholz A, Stass HK. Operative and pathologic finding in twenty four patients with syndrome of idiopathic pleurisy with effusion, presumably Tuberculosis. Am Rev Tubrcl. 1955;71(4):473.

Porcel-Perez JM, Vivess soto M, Esquerda Serrane A, Jover Saenz A. Cut off value of biochemical tests on pleural fluid. Their usefulness in differential diagnosis of 1040 patients with pleural effusion. .An Med Interna. 2004 Mar;21(3):113-7.

Hamm H, Brohan U, Bohmer R, Missmahl HP. Cholesterol in pleural effusions: a diagnostic aid. Chest. 1987 Aug 1;92(2):296-302.

Spady DK, Dietschy JM. Sterol synthesis in vivo in 18 tissues of the squirrel monkey, guinea pig, rabbit, hamster, and rat. J Lipid Res. 1983 Mar 1;24(3):303-15.

Brown MS, Goldstein JL. Receptor-mediated control of cholesterol metabolism. Science. 1976 Jan 16;191(4223):150-4.

JE Heffner, LK Brown, CA Barberi. Diagnostic value of tests that discriminate between exudative and transudative pleural effusions. Chest. 1997;111(4):970-80.

Hamal AB, Yogi KN, Bam N, Das SK, Karn R. Pleural fluid cholesterol in differentiating exudative and transudative pleural effusion. Pulm Med. 2013;2013.

Hamm H, Brohan V, Bohmar R, Missmahl HP. Cholesterol in pleural effusion: a diagnostic aid. Chest. 1987 Aug; 92(2):298-302.

Carr DT, Power MH. Clinical value of measurement of concentration of proteins in pleural fluid. NEJM. 1958;259:926-17.

Burgess LJ, Maritz FJ, Tsljaard FFJ. Comparative analysis of the biochemical parameters used to distinguish between pleural transudates and exudates. Chest. 1995;107:1604-9.

Costa M, Quiroga T, Craz E. Measurement of pleural fluid cholesterol and Lactase dehydrogenase: Measurement of pleural fluid cholesterol and Lactase dehydrogenase: a simple and accurate set of indicators for separating exudates from transudates. Chest. 1995;108:1260-3.

Gil SV, Moragon ME, Cages Viedenma E, Perpina Tordera M, Leon Fabreges M, Sachis Aldaj J. Pleural cholesterol in differentiating transudates and exudates. Respiration. 1995;62:57-63.

Valdes A, Pose A, Suarez J, Gonzalez-Juanaty JR, Sarandesses A,San Jose E. Cholesterol: a useful parameter for distinguishing between pleural exudates and transudates. Chest. 1991;99:1097-02.