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We greatly appreciate the comments of Drs Winckler and Yam. Their observations on cytopathologic changes in pleural fluid of patients with pulmonary embolism are of considerable interest to us, and, we think, complement our own findings.Serial changes in the cellular constituents of pleural fluid, as they have described, are important in the study of pathophysiologic mechanisms and may offer considerable insight into the basis for, and the outcome of, pleural effusions in pulmonary embolism. They are not so helpful, however, in the initial diagnostic decisions that concern the clinician within a few hours or days of the patient's presentation, which was the main focus of our paper. For example, these authors state that the changes in cell types and the morphology of macrophages and mesothelial cells are "best seen two to three weeks after the acute insult," a time when diagnostic measures such as thoracentesis are rarely
Bynum LJ, Wilson JE. Cytologic Changes of Pleural Effusion in Pulmonary Embolism-Reply. Arch Intern Med. 1976;136(10):1196–1197. doi:10.1001/archinte.1976.03630100103030
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