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May 9, 1977

Pleural Effusion: A Diagnostic Dilemma-Reply

JAMA. 1977;237(19):2035. doi:10.1001/jama.1977.03270460021003

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In Reply.—  The cost-effective philosophy is really the central issue in our article, and we do not feel that this approach to the management of pleural effusions is detrimental to patient care. Our data suggest that a physician is not being fooled very often. For instance, our culture results suggest a low rate of positive findings; yet most physicians might think it irresponsible not to order cultures on every pleural fluid specimen. If the physician feels compelled never to be fooled, then he will have to order every known test available on a pleural fluid specimen. We know this would greatly increase cost, but suspect that it would not improve the diagnositc yield.Concerning pleural fluid pH, we did not mention this in our article because we have no great experience with the technique as yet. Again, we believe this test is indicated in specific situations (ie, parapneumonic effusions) and