A 34 year old female presents to your ED with right sided chest pain and increasing shortness of breath. She has a history of chronic alcohol abuse and recurrent pancreatitis. A CXR performed shows a large right sided pleural effusion. Aspiration of the effusion was performed.

Pleural Fluid:

LDH 894

Total Protein 3.6

WCC 4000, with 90% Eosinophils

Gram stain -ve

Serum:

LDH 175

Total Protein  5.3

Questions:

1. What are the possible findings on Chest examination?

2. Describe the results

3. Give 5 differential diagnosis, with the most likely diagnosis in this patient

4. In general, what are the indications for urgent drainage of a pleural effusion?