Glad you liked it :):):)

Corollary - I’m allowed to respond to emergencies wearing whatever I like.

Agreed it’s just a question of when. Do it too early and you and I will be back in 3-4 days for the same reason.

I think we agree, but you also highlight the many questions and counterpoints I see in transudative pleural effusions. Always good to discuss.

Also, patients without pulmonary edema present with unilateral opacification of the hemithorax without significant hypoxemia all the time (empyema, malignant pleural effusion). These patients often aren’t hypoxemic, more dyspneic, arguing the hypoxemia is a parenchymal driver.

Both of these points are relevant but diuresis is still king in both situations. Pleural intervention without diuresis will result in more pleural accumulation. A better tact is to diurese first, then consider pleural drainage later. Limits repeat interventions.

Hard to argue removing fluid outside of the lungs will improve the hypoxemia. Mechanics yes, diffusion defect no.

Yep, seeing a lot of empyema and necrotizing pneumonia.

Ah, the latter was the context I needed. Thank you.

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