Volume and Cellular Content of Normal Pleural Fluid in
Humans Examined by Pleural Lavage
MARC NOPPEN, MARC DE WAELE, RONG LI, KRISTIEN VANDER GUCHT, JAN D’HAESE, ERIK GERLO,
and WALTER VINCKEN
Respiratory Division and Departments of Hematology, Clinical Chemistry, and Anaesthesiology, Academic Hospital Academisch Ziekenhuis Vrÿe
Universiteit Brussel, Brussels, Belgium
Currently, no reliable data are available on the volume or on the
cellular content of pleural fluid in normal humans. In analogy with
bronchoalveolar lavage (a technique enabling retrieval of small
volumes of epithelial lining fluid from the lung), we developed a
pleural lavage (PL) technique consisting of injection and retrieval
of 150 ml of saline into the right pleural space, performed during
a thoracoscopic sympathicolysis procedure in otherwise healthy
subjects suffering from essential hyperhidrosis. With urea used as
an endogenous marker of dilution, measured mean right-sided
pleural fluid volume was 8.4 ⫾ 4.3 ml. In a subgroup of subjects,
we confirmed that right- and left-sided pleural fluid volumes were
similar. Expressed per kilogram of body mass, total pleural fluid
volume in normal, nonsmoking humans is 0.26 ⫾ 0.1 ml/kg. Total
cell count in the PL fluid of nonsmoking normal subjects yielded a
median of 91 ⫻ 103 white blood cells (WBC) per milliliter of lavage
fluid (interquartile range [IR] ⫽ 124 ⫻ 103 cells/ml). Taking into
account a measured dilution factor of 18.86, the total WBC count
in the original pleural fluid was 1,716 ⫻ 103 cells/ml. Differential
cell counts yielded a predominance of macrophages (median: 75%;
IR: 16%) and lymphocytes (median: 23%; IR: 18%). Mesothelial
cells (median: 1%; IR: 2%), neutrophils (median: 0%; IR: 1%), and
eosinophils (median: 0%; IR: 0%) were only marginally present.
There were no significant differences between males and females
or between right- and left-sided pleural fluid in total and differen-
tial cell counts. In contrast, in smokers a small but statistically sig-
nificant increase in pleural fluid neutrophils (median: 1%; IR: 2%;
p ⬍ 0.015) was observed. In conclusion, PL performed during tho-
racoscopy for sympathicolysis allowed for the first time determina-
tion of the volume and of the total and differential cell contents of
the pleural fluid present in normal human pleura.
In normal humans, a small amount of pleural fluid is present
(1, 2). The exact volume of this fluid is unknown. Careful mea-
surements in rabbits and dogs have yielded volumes of pleural
fluid of 0.1 to 0.3 ml/kg (2–4), and a similar volume is thought
to be present in normal humans (1).
Normal pleural fluid, at least in laboratory animals such as
rabbits and dogs (3, 4), contains a significant number of cells.
Total cell counts vary from 1,500 to 2,450/␮l, with a high vari-
ance observed in differential cell counts of 9% to 70% me-
sothelial cells, 28% to 70% macrophages, 2% to 11% lympho-
cytes, and 0% to 2% polymorphonuclear leukocytes (3, 4).
No reliable data are available on the cellular content of
pleural fluid in normal humans. The only study addressing this
issue was that of Yamada (5), published in 1933, who punc-
tured the 9th or 10th intercostal space on the dorsal axillary
(Received in original form October 13, 1999 and in revised form April 3, 2000)
Supported by a Werkings-en ontwikkelingskrediet grant from the Academic Hos-
pital AZ-VUB.
Correspondence and requests for reprints should be addressed to Marc Noppen,
M.D., Ph.D., Respiratory Division, Academic Hospital Academisch Ziekenhuis
Vrÿe Universiteit Brussel, 101 Laarbeeklaan, B-1090 Brussels, Belgium. E-mail:
marc.noppen@az.vub.ac.be
Am J Respir Crit Care Med Vol 162. pp 1023–1026, 2000
Internet address: www.atsjournals.org
line in a group of healthy Japanese soldiers. In about 30% of
cases, some liquid was retrieved after a period of rest, and in
about 70% of cases some liquid was retrieved after exercise.
Usually, only a few drops of foam were collected, but in a few
(probably abnormal) cases, up to 20 ml of fluid was collected.
In this study, Yamada found a total white cell count of 4,500
cells/␮l (range: 1,700 to 6,200 cells/␮l). A differential cell
count showed 3% mesothelial cells, 53.7% cells “similar to
monocytes,” 10.2% lymphocytes, and 3.6% granulocytes, but
also 29.5% “deteriorated cells of difficult classification.” Hence,
because of the obvious technical difficulty in retrieving non-
traumatically the few milliliters of fluid present, the composi-
tion of normal pleural fluid remains one of the few last secrets
of human body fluid composition.
In our clinical practice, we weekly perform thoracoscopic
interventions for the treatment of severe essential hyperhidro-
sis in otherwise healthy subjects (6), thus having access to nor-
mal pleural spaces through a minimally invasive technique. In
analogy with bronchoalveolar lavage (BAL) (7), which allows
retrieval and examination of the few milliliters of epithelial
lining fluid in the examined lung, we designed a new tech-
nique, pleural lavage (PL), enabling retrieval and analysis of
the few milliliters of pleural fluid present in normal humans.
The purpose of the present study was to use PL to: (1) mea-
sure the volume of pleural fluid present in the pleural space of
normal humans; and (2) determine the total and differential
cell contents of this normal pleural fluid.
METHODS
Study Population
After having successfully performed a feasibility study in four patients,
we performed PL in 34 consecutive patients referred for thoracoscopic
treatment of severe essential hyperhidrosis. These patients included 21
nonsmokers (nine male and 12 female), aged 25.4 ⫾ 8.0 yr (mean ⫾
SD) (range: 17 to 45 yr), and 13 smokers (five male and eight female),
aged 26.5 ⫾ 8.7 yr (range: 18 to 50 yr). Total and differential counts
were compared in the nonsmoking (n ⫽ 21) and smoking (n ⫽ 15) sub-
jects. Among the nonsmoking subjects, cell counts were compared in
male (n ⫽ 9) and female (n ⫽ 12) subjects. In five subjects, PL was per-
formed bilaterally for within-subject right–left pleural fluid comparison.
In a subgroup of 16 nonsmoking subjects (five male and 11 fe-
male), values of right pleural fluid volume (Vpv) were determined
with a modified urea dilution method. In five of these subjects, se-
quential right- and left-sided Vpv determinations were also performed
for within-subject comparisons.
The subjects had no history of prior pulmonary or pleural disease,
and a detailed history and physical examination, chest radiography,
and complete pulmonary function testing confirmed that all subjects
were in perfect health except for the presence of invalidating essential
hyperhidrosis at the palmar (100%) and/or axillary (40%) level. In-
formed consent was obtained from every patient, and the study was
approved by our local ethics committee.
PL Technique
PL was performed during the thoracoscopic sympathicolysis proce-
dure. All procedures were performed under strict aseptic conditions
1024 AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
in a fully equipped operating theater. After intramuscular premedica-
tion with midazolam (0.1 mg/kg) and glycopyrolate (0.2 mg), patients
were anesthetized with propofol, alfentanil, and atracurium. Patients
were in the supine, 30-degree trunk-up position. Intubation was per-
formed with a single-lumen Hi-Lo jet endotracheal tube (Mallinckrodt,
Northampton, UK), and ventilation and oxygenation were assured by
use of an AMS 1000 high-frequency jet ventilator (Acutronic, Jona,
Switzerland).
A right-sided pneumothorax was created by blunt puncture of the
parietal pleura at the 2nd intercostal space with a Küss or Boutin nee-
dle and insufflation of ⵑ 250 ml of ambient air. The puncture site was
bluntly enlarged to ⵑ 10 mm, and a 7-mm trocar was gently intro-
duced into the pleural cavity. After quick inspection with a thoraco-
scope (Richard Wolf, Knittlingen, Germany), a second 5-mm trocar
was gently and bluntly introduced 3 to 4 cm laterally from the first tro-
car. A nontraumatic 14-gauge polyvinyl chloride catheter (Medico-
plast, Jillingen, Germany) was introduced via the second trocar and
positioned under direct thoracoscopic control in the lowest portion of
the lateroposterior costophrenic angle.
A volume of 150 ml of prewarmed, sterile saline was injected, and
was immediately and gently aspirated (minimal dwell time). The aspi-
rated fluid was collected in a sterile jar and immediately transported
on ice to the laboratory for processing.
After the PL procedure, sympathicolysis was performed as de-
scribed elsewhere (6). In the subjects in whom PL was performed bi-
laterally for within-subject comparison, the same procedure as de-
scribed earlier was performed on the left hemithorax, after termination
of the right-sided intervention.
PL Fluid Processing
Cellular analysis. The PL fluid was processed in a manner similar to
bronchoalveolar lavage fluid (BALF) (except for mucus filtration)
(8). After measurement of the total volume of PL fluid, a drop of the
well-mixed fluid was introduced into a Bürker chamber for total cell
counting. Red and white blood cells were counted separately.
The PL fluid was then centrifuged (3 min at 1,000 ⫻ g). Ten millili-
ters of supernatant fluid were removed and frozen at ⫺80⬚ C for later
solute analysis. The cell pellet was washed twice with 1 ml of phos-
phate-buffered saline (PBS)–1% albumin. Thereafter, the cells were
resuspended in PBS–5% albumin until a suspension of approximately
106 cells/ml was obtained. Cytospins were then made with a cytocen-
trifuge (Cytospin-3; Shandon Scientific Limited, Astmoor, UK). The
cytospin preparations were air-dried and one slide was stained with
May–Grünwald–Giemsa and the other slides were frozen at ⫺20⬚ C.
Differential counts were made on the May–Grünwald–Giemsa-
stained slide by counting 500 cells by light microscopy (⫻1,150). Mac-
rophages, mesothelial cells, neutrophils, eosinophils, basophils, and lym-
phocytes were differentiated.
Immunophenotyping of the cells was performed with monoclonal
antibodies and immunogold–silver staining (9). Air-dried cytocentri-
fuge preparations were incubated with monoclonal antibodies (mAbs)
obtained from Becton-Dickinson Immunocytometry (Mountain
View, CA) and directed against leukocyte cell-surface antigens. Sur-
face antigens studied were CD3 (Leu4), CD4 (Leu3a), CD8 (Leu2a),
and CD19 (Leu12); mouse IgG1 and CD45 (Hle-1) were used as
negative and positive controls. Only the CD4⫹ to CD8⫹ cell ratio is
reported here. Colloidal gold-labeled goat antimouse IgG ⫹ IgM
antibodies were purchased from Amersham–Pharmacia–Biotech (Roo-
sendaal, The Netherlands). Light microscopy-grade reagens with 5-mm
gold particles were used. Silver enhancement was performed with the
silver enhancing kit (British Biocell International, Cardiff, UK), fol-
lowing the recommendations of the manufacturer.
Details of the immunogold–silver staining procedure performed
on the cytocentrifuge preparations are summarized elsewhere (10). In
short, air-dried preparations were fixed for 30 s at room temperature
(RT) with phosphate-buffered 9.25% formol and 45% acetone, pH
6.6. The preparations were rinsed in PBS and then incubated in the
horizontal position for 10 min in a humidified chamber with 25 ␮l of
0.01 M PBS containing 5% nonfat dry milk. Following this, 25 ␮l of
the appropriate dilution of mAb was added and the mixture was left
for 30 min at RT. The preparation was rinsed with PBS to remove the
excess reagent, and was incubated with PBS–milk–mAb. Twenty-five
VOL 162 2000
microliters of a 1:75 dilution of the goat antimouse IgG ⫹ IgM re-
agent was added and left for 30 min at RT. After being rinsed with
PBS, the preparations were postfixed with buffered formol-acetone
for 2 min at RT. After rinsing with distilled water (thrice for 5 min
each), silver enhancement was performed for 30 min at 26⬚ C. The
preparations were then rinsed again, were air dried, and were coun-
terstained with May–Grünwald–Giemsa stain and mounted in DPX
Mountant (BDH, Montreal, Canada).
The labeled preparations were then examined with a Dialux 22 EB
brightfield microscope (Leitz, Wetzlaar, Germany). The cells were
identified by their morphology. Four hundred cells were examined,
and the percentage of positive cells was determined.
Volume Analysis
In a subgroup of 16 nonsmoking patients (five male and 11 female;
age 24.1 ⫾ 6.5 yr; range 17 to 37 yr), volume analysis of the pleural
fluid present in the right hemithorax was performed. In five of these
patients, volume measurements were made in the right and left
hemithorax.
In analogy with the estimation method of volume of epithelial lin-
ing fluid recovered by BAL with urea used as an endogenous marker
of dilution (11), the subsequently described methodology was de-
signed.
Measurement of the effective volume of pleural fluid present in a
hemithorax was based on the assumption that the urea concentrations
in plasma and in normal pleural fluid are equal (since urea diffuses
freely throughout the body, including passage through alveolar mem-
branes [12] and probably also through pleural membranes [13]), on
the principle of conservation of mass, and on the assumption that af-
ter induction of a pneumothorax, most of the pleural fluid present
would drain by gravity to the lowest portion of the pleural space (3).
Starting from the original situation of VPV in milliliters of pleural
fluid present, the total amount of urea (MU) present in this fluid can
be expressed as MU ⫽ CPV ⫻ VPV (1), where CPV equals the concen-
tration of urea in the original pleural fluid (in mg/ml). After pleural
lavage with 150 ml of saline, the conservation of mass principle states
that MU ⫽ (150 ⫹ VPV) ⫻ CPL, where CPL is the measured concentra-
tion of urea (in mg/ml) in the retrieved PL fluid.
Therefore, CPV ⫻ VPV ⫽ (150 ⫹ VPV) ⫻ CPL. Hence, VPV ⫽ (150 ⫻
CPL)/(CPV ⫺ CPL). Since it is assumed that CPV equals Cplasma (where
Cplasma is the concentration of urea in plasma) (12): VPV ⫽ (150 ⫻
CPL)/(Cplasma ⫺ CPL). To minimize the possible effects of urea influx
into the pleural space during the lavage procedure, the dwell time of
the lavage fluid was kept to a minimum (a few seconds to 1 min) (14).
Cplasma was measured on the day of PL with an endpoint urease
method and a Vitros 950 analyzer (Johnson & Johnson Clinical Diag-
nostics Inc., Rochester MA), using dedicated dry chemistry reagents.
To determine the (low) concentrations of urea in the retrieved PL
fluid (CPL), a modified kinetic enzymatic method, including urease and
glutamate dehydrogenase (Unimate 5 Urea; Hoffmann-La Roche, Ba-
sel, Switzerland) and adapted to a Cobas Mora S analyzer (Hoffmann-
La Roche), was used. The sensitivity of the method, originally de-
signed for the measurement of urea concentrations in serum, plasma,
or urine, was improved by increasing the sample volume fraction from
0.01 to 0.16. All samples were measured in a single analytical run.
Within-run coefficients of variation (n ⫽ 8) ranged from 4.7% to
8.8% for urea concentrations between 1.1 mg/dl and 0.4 mg.dl. The
limit of detection was 0.024 mg/dl. The VPV in one hemithorax is ex-
pressed per kilogram of body mass.
Statistical Analysis
Cellular data are expressed as medians and interquartile ranges (IRs)
because of the apparent nonnormal distribution of the results. Com-
parisons between data for smokers and nonsmokers were made with
chi-square analysis for sex and the Mann–Whitney U test for cell
counts (15). Comparisons of data for males and females were made
with the Mann–Whitney U test. Within-subject right–left paired com-
parisons were made with Wilcoxon’s signed ranks test. Volume data
are expressed as mean ⫾ SD because of the apparent normal distribu-
tion of data. Within-subject paired comparisons of right- and left
hemithorax pleural fluid volumes were made with a paired t test. Sig-
nificance was accepted at p ⬍ 0.05.
Noppen, De Waele, Li, et al.: Normal Pleural Fluid Analysis 1025

RESULTS
All PL procedures were uneventful and prolonged the thora-
coscopy procedure by only 3 to 5 min. The recovered volume
of fluid was 141.2 ⫾ 10 ml (mean ⫾ SD) (94% of the injected
volume). Postoperative chest radiographs never showed visi-
ble residual fluid. In all subjects, the macroscopic appearance
was that of clear fluid, and there was no macroscopically visi-
ble contamination with blood.
Results of Cellular Analysis
Results of total (red and white blood cells) and differential cell
counts in nonsmokers and smokers are summarized in Table 1.
There were no significant differences in cell counts for non-
smokers and smokers, except for neutrophils, which were
present in slightly but significantly higher numbers in the smok-
ing group (median: 1% versus 0%; IR: 1% to 3% versus 0% to
1%; p ⫽ 0.015, Mann–Whitney U test). Within the smoking
group, cigarette consumption was 11.4 ⫾ 14.1 pack-years. There
was no correlation between pack-years smoked and PL neutro-
phil content. (Spearman’s rank correlation, p ⬎ 0.05).
Within-subject right–left comparison showed no significant
differences in total or differential cell counts between the right
and left pleural cavities (data not shown). Within the non-
smoking group, total and differential cell counts of the male
and female subjects were also compared. There were no sig-
nificant sex differences (data not shown).
Results of Analysis of Vpv
In all cases studied, plasma and PL fluid urea concentrations
could be measured. The right CPL was 1.16 ⫾ 0.41 mg/dl
(range: 0.51 to 2.12 mg/dl).
Cplasma was 23.07 ⫾ 4.47 mg/dl (range: 16 to 31 mg/dl).
Hence, the original Vpv in the right pleural cavity was 8.4 ⫾
4.3 ml (range: 3.7 to 17.8 ml). PL with an instilled volume of
150 ml of saline therefore represents a dilution factor of (150 ⫹
8.4): 8.4 ⫽ 18.86.
Hence, the median total WBC count of 91 ⫻ 103 cells/ml in
the diluted PL fluid corresponds to a total WBC count of 91 ⫻
18.86 ⫽ 1,716 ⫻ 103 WBC/ml in the original pleural fluid. Ex-
pressed per kilogram of body weight, the right-sided Vpv was
0.13 ⫾ 0.06 ml/kg (range: 0.06 to 0.25 ml/kg).
In five subjects, measured values of Vpv in the right and
left hemithorax were not significantly different (p ⫽ 0.6), at
12.6 ⫾ 5.3 ml (range: 3.9 to 17.9 ml) and 11.8 ⫾ 6.8 ml (range:
2.8 to 18.3 ml), respectively.
Therefore, the total (right ⫹ left) Vpv calculated for the
whole nonsmoking study population and expressed per kilo-
gram of body weight, averaged 0.26 ⫾ 0.1 ml/kg.
DISCUSSION
This is the first report of measurement of the actual volume
and total and differential cell contents of the pleural fluid
present in normal subjects, done through a minimally invasive,
atraumatic thoracoscopic PL technique performed on other-
wise healthy hyperhydrosis patients.
Using urea as an endogenous dilution marker, we deter-
mined the Vpv of normal humans to be 0.26 ⫾ 0.1 (mean ⫾
SD) ml/kg body mass. This corresponds quite well with the an-
imal-derived proposed volume of 0.3 ml/kg body weight (2).
Urea has been used in the past to estimate the volume of epi-
thelial lining fluid recovered by BAL, on the assumptions that
the concentrations of urea in plasma and epithelial lining fluid
are similar and constant across time (i.e., no movement of
urea occurs between the vascular and air space compartments
during lavage [11]). In the specific context of BAL, this tech-
nique, in which urea is used as an endogenous marker, has
been largely abandoned because enough urea may enter the
air spaces during the BAL procedure to significantly alter the
calculated values of dilution, hence leading to more than a
threefold overestimation of actual epithelial lining fluid vol-
umes (14). This is mainly due to the relatively long dwell time
of the BAL solution (2 min or more) and the often increased
permeability of the barrier separating the plasma and air
spaces in pathologic states (16). However, in the context of the
PL technique, urea may be an accurate endogenous marker of
dilution because: (1) dwell time is kept to a minimum (i.e., a
few seconds to 1 min maximum, hence minimizing urea flux
across the membranes during the procedure; and (2) measure-

TABLE 1
RESULTS OF TOTAL AND DIFFERENTIAL CELL COUNTS IN PLEURAL LAVAGE FLUID
OF NONSMOKERS, SMOKERS, AND AGGREGATE STUDY POPULATION

RBC WBC N EO L MC M␾
M/F Ratio (⫻ 103/ml ) (⫻ 103/ml ) (%) (%) (%) (%) (%) CD4⫹/CD8⫹

Nonsmokers (n ⫽ 21) 9/12

Median 36 91 0 0 23 1 75 0.75
Minimum 6 38 0 0 15 0 58 0.18
Maximum 1,070 297 3 1 38 7 92 2.7
Geometric mean 41 115 — — 24 — 73 0.77
Interquartile range 20–47 74–198 0–1 0–0 18–36 0–2 64–80 0.6–1
Smokers (n ⫽ 13) 5/8
Median 78 147 1 0 20 1 75 0.72
Minimum 1 53 0 0 11 0 60 0.4
Maximum 481 443 14 1 40 10 86 1.5
Geometric mean 58 161 — — 19 — 73 0.76
Interquartile range 19–180 117–224 1–3 0–0 12–28 0–2 69–81 0.4–1.4
Difference (p value) 0.6 0.37 0.1 0.015 0.52 0.18 0.8 0.87 0.81
Aggregate sample (n ⫽ 34) 14/20
Median 38.5 125 1 0 23 1 75 0.74
Minimum 1 38 0 0 11 0 58 0.18
Maximum 1,070 443 14 1 40 10 92 2.7
Geometric mean 46.5 130.6 — — 22 — 73 0.77
Interquartile range 19–121 83–214 0–2 0–0 16–31 0–2 64–81 0.47–1.36

Definition of abbreviations: EO ⫽ eosinophils; L ⫽ lymphocytes; MC ⫽ mesothelial cells; M/F ⫽ male/female; M␾ ⫽ macrophages; N ⫽

neutrophils; RBC ⫽ total red blood cell count; WBC ⫽ total white blood cell count.
1026 AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
ments are made in healthy pleural cavities with intact visceral
and parietal pleura. Furthermore, admixture with blood
caused by the (small) trauma of creation of the pneumothorax
could in our study be excluded, since only very small numbers
of red blood cells were present in the PL fluid.
In the nonsmoking subjects in our study, a median of 91 ⫻
103 (IR: 74 to 198 ⫻ 103) WBC/ml of PL fluid was measured.
Since the originally measured Vpv was 8.4 ⫾ 4.3 ml (corre-
sponding to a lavage-induced dilution factor of 18.86), the to-
tal WBC count in the original pleural fluid can be calculated at
1,716 ⫻ 103 cells/ml. This corresponds well with total cell
counts made on original pleural fluid in rabbits and dogs,
which varied from 1,500 to 2,450 ⫻ 103 cells/ml (3, 4), but is in
the lower range of the 1,700 to 6,200 ⫻ 103 cells/ml measured
in the only available (but poorly reliable) human study done
by Yamada (5).
Differential cell counts done on the PL fluid in our study
showed that the bulk of its cellular content consisted of mac-
rophages (median: 75%; IR: 64% to 80%) and lymphocytes
(median: 23%; IR: 18% to 36%), with a median CD4⫹-to-
CD8⫹ T-cell ratio of 0.75 (IR: 0.6 to 1). Mesothelial cells ac-
counted for only 1% (IR: 0% to 2%), and neutrophils (me-
dian: 0%; IR: 0% to 1%) and eosinophils (median: 0%; IR:
0%) were only marginally present.
The difference between these results and the differential
count proposed by Yamada (5) may be due to the almost cer-
tainly present (3) contamination by blood in Yamada’s series,
owing to the traumatic retrieval technique that was used, and/or
to the differences in staining techniques and interpretation
(especially for mesothelial cells and macrophages) in Ya-
mada’s paper and the present study.
Interestingly, as compared with nonsmokers, smoking sub-
jects showed a slight but statistically significant increase in
pleural fluid neutrophils (median: 1%; IR: 1% to 3%; p ⫽
0.02). An analogous increase in BAL neutrophils has been ob-
served in smokers (17). Smoking, however, induces numerous
other cellular and solute changes in BALF (e.g., a decrease in
the CD4⫹-to-CD8⫹ lymphocyte ratio without a change in total
T-cell number). In PL fluid, however, only changes in neutro-
phil content were observed. The mechanism by which this
phenomenon occurs is unclear, but it probably reflects “trans-
visceral” extension of the neutrophil influx into the lower air-
ways caused by smoking (18).
In conclusion, application of a new and simple PL tech-
nique performed during thoracoscopy has allowed the first
measurement of volume and of total and differential cell
counts in the pleural fluid of normal humans.
VOL 162 2000
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