Correct!
4. 1 or 3
Generally, we prefer to do a thoracentesis first because it can give a diagnosis of lung cancer metastatic to the pleura if malignancy is suspected. However, it would not be wrong to perform a bronchoscopy. The lesion is quite centrally located and bronchoscopy would be a much better choice for a biopsy.
A thoracentesis was performed. It revealed an exudative effusion with a protein 4.8 g/dL, LDH 363 U/L, and a differential showing 93% lymphocytes.
Although a pleural fluid cell differential is usually mostly macrophages and lymphocytes, a pleural fluid differential of > 80% lymphocytes is compatible which of the following diagnosis? (Click on the correct answer to proceed to the fourth of five panels)