What is the significance of coagulum in pleural fluid?

From the Guidelines

The presence of a coagulum in pleural fluid is a significant finding that suggests an exudative pleural effusion, which is often associated with inflammatory or malignant processes, and requires further diagnostic testing to determine the underlying cause. When pleural fluid is collected during thoracentesis, the formation of a coagulum indicates that the fluid contains high protein content, particularly fibrinogen, which allows it to clot spontaneously. This finding is typically associated with exudative pleural effusions rather than transudative effusions. Common causes include parapneumonic effusions, empyema, malignancy, tuberculosis, or other inflammatory conditions 1. The coagulum forms because the fluid contains clotting factors similar to those in blood. This finding helps clinicians distinguish between exudates and transudates, which is crucial for determining the underlying cause of the effusion and guiding appropriate treatment. Some key points to consider when evaluating a patient with a coagulum in their pleural fluid include:

• The need for further diagnostic tests, such as cell count, culture, cytology, and biochemical analysis, to identify the specific etiology of the exudative effusion 1
• The importance of distinguishing between exudates and transudates, as this can significantly impact treatment and management decisions 1
• The potential for malignant or inflammatory processes to be present, and the need for prompt and thorough evaluation to determine the underlying cause of the effusion 1
• The use of ultrasound-guided thoracentesis to improve the rate of successful pleural aspiration and reduce the incidence of iatrogenic pneumothorax 1 In terms of management, the British Thoracic Society guideline for pleural disease recommends that patients with suspected pleural infection should undergo further radiological imaging and pleural fluid sampling for diagnostic purposes within 24 hours 1. Additionally, the guideline suggests that all patients treated for pleural infection should receive appropriate antibiotic treatment, and that chest drainage should be considered unless there is a clear contraindication 1. Overall, the presence of a coagulum in pleural fluid is a significant finding that requires prompt and thorough evaluation to determine the underlying cause of the effusion, and to guide appropriate treatment and management decisions.

From the Research

Pleural Fluid Presence of Coagulum Meaning

The presence of coagulum in pleural fluid can be an indicator of the underlying etiology of the pleural effusion.

• Coagulum is a clot or a gel-like substance that can form in the pleural fluid, and its presence can be related to the coagulation system's role in the development of pleural effusions 2.
• The coagulation system plays a crucial role in the inflammatory process responsible for pleural effusions, and its activation can lead to the formation of coagulum in the pleural fluid 2.
• The evaluation of coagulation factors, including the presence of coagulum, can contribute to the etiological diagnosis of pleural effusions, although it may not be sufficient to differentiate between different subgroups of exudates 2.
• The presence of coagulum in pleural fluid can be associated with inflammatory effusions (exudates), where there is activation of coagulation and increased levels of fragment 1+2 and thrombin-antithrombin complex 2.
• However, the presence of coagulum is not a specific marker for any particular disease, and its interpretation should be considered in the context of the overall clinical and laboratory evaluation of the patient 3, 4, 5.