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Updated: Aug 09, 2018

Author: James J Lamberg, DO; Chief Editor: Meda Raghavendra (Raghu), MD

Light's Criteria
Determination of transudate versus exudate source of pleural effusion

Fluid is exudate if one of the following Light’s criteria is present:[1, 2, 3, 4]

Effusion protein/serum protein ratio greater than 0.5

Effusion lactate dehydrogenase (LDH)/serum LDH ratio greater than 0.6

Effusion LDH level greater than two-thirds the upper limit of the laboratory's reference range of serum LDH

Exudative effusions

See the list below:

Abdominal fluid: Abscess in tissues near lung, ascites, Meigs syndrome, pancreatitis

Connective-tissue disease: Churg-Strauss disease, lupus, rheumatoid arthritis, Wegener granulomatosis

Endocrine: Hypothyroidism, ovarian hyperstimulation

Iatrogenic: Drug-induced, esophageal perforation, feeding tube in lung

Infectious: Abscess in tissues near lung, bacterial pneumonia, fungal disease, parasites, tuberculosis

Inflammatory: Acute respiratory distress syndrome (ARDS), asbestosis, pancreatitis, radiation, sarcoidosis, uremia

Lymphatic abnormalities: Chylothorax, malignancy, lymphangiectasia

Malignancy: Carcinoma, lymphoma, leukemia, mesothelioma, paraproteinemia

Transudative effusions

See the list below:

Atelectasis: Due to increased negative intrapleural pressure

Cerebrospinal fluid (CSF) leak into pleural space: Thoracic spine injury, ventriculoperitoneal (VP) shunt dysfunction

Heart failure

Hepatic hydrothorax

Hypoalbuminemia

Iatrogenic: Misplaced catheter into lung

Nephrotic syndrome

Peritoneal dialysis

Urinothorax: Due to obstructive uropathy

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Exceptions

These are processes that typically cause exudative effusions, but may cause transudative effusions.

Amyloidosis

Chylothorax

Constrictive pericarditis

Hypothyroid pleural effusion

Malignancy

Pulmonary embolism

Sarcoidosis

Superior vena cava obstruction

Trapped lung

Leading causes of pleural effusion

See the list below:

Congestive heart failure (transudate), incidence 500,000/year

Pneumonia (exudate), incidence 300,000/year

Cancer (exudate), incidence 200,000/year

Pulmonary embolus (transudate or exudate), incidence 150,000/year

Viral disease (exudate), incidence 100,000/year

Coronary-artery bypass surgery (exudate), incidence 60,000/year

Cirrhosis with ascites (transudate), incidence 50,000/year

Test sensitivity and specificity for exudate

Table 1. Test Sensitivity and Specificity for Exudate (Open Table in a new window)

Sensitivity, % Specificity, %

Light’s criteria 98 83

Protein/serum protein ratio >0.5 85 84

LDH/serum LDH ratio >0.6 90 82

LDH >2/3 upper limits of serum normal 82 89

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Pleural-fluid cholesterol level >60 mg/dL 54 92

Pleural-fluid cholesterol level >43 mg/dL 75 80

Pleural-fluid/serum cholesterol ratio >0.3 89 81

Serum/pleural-fluid albumin level ≤1.2 g/dL 87 92

Questions & Answers

Overview

What is sensitivity and specificity for exudate of Light's criteria compared to other tests?

What are the Light's criteria to determine if fluid in pleural effusion is exudate?

What are the Light's criteria for exudative pleural effusions?

What are the Light's criteria for transudative pleural effusions?

What are the exceptions in Light's criteria for pleural effusions?

What are the leading causes of pleural effusion?

Contributor Information and Disclosures

Author

James J Lamberg, DO Physician Anesthesiologist, Lancaster General Health, Penn Medicine

James J Lamberg, DO is a member of the following medical societies: American Medical Association, American Osteopathic
Association, American Society of Anesthesiologists, International Anesthesia Research Society, Pennsylvania Society of
Anesthesiologists, Pennsylvania Society of Anesthesiologists, Society for Technology in Anesthesia, Society of Critical Care
Anesthesiologists, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Chief Editor

Meda Raghavendra (Raghu), MD Associate Professor, Interventional Pain Management, Department of Anesthesiology,
Chicago Stritch School of Medicine, Loyola University Medical Center

Meda Raghavendra (Raghu), MD is a member of the following medical societies: American Society of Anesthesiologists,
American Society of Regional Anesthesia and Pain Medicine, American Association of Physicians of Indian Origin

Disclosure: Nothing to disclose.

References

1. Light RW, Macgregor MI, Luchsinger PC, Ball WC Jr. Pleural effusions: the diagnostic separation of transudates and exudates.
Ann Intern Med. 1972 Oct. 77(4):507-13. [Medline].

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2. Light RW, Erozan YS, Ball WC Jr. Cells in pleural fluid. Their value in differential diagnosis. Arch Intern Med. 1973 Dec.
132(6):854-60. [Medline].

3. Ali HA, Lippmann M, Mundathaje U, Khaleeq G. Spontaneous hemothorax: a comprehensive review. Chest. 2008 Nov.
134(5):1056-65. [Medline].

4. Light RW. Clinical practice. Pleural effusion. N Engl J Med. 2002 Jun 20. 346(25):1971-7. [Medline].

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