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Diagnosis and Management of Pleural Effusions: A Practical Approach

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Comprehensive Therapy

Pleural effusion is defined as an abnormal amount of pleural fluid accumulation in the pleural space and is the result of an imbalance between excessive pleural fluid formation and pleural fluid absorption. Although the list of causes of pleural effusions is extensive, the great majority of the cases are caused by pneumonia, congestive heart failure, and malignancy. In this article, we provide an overview of the most common causes of pleural effusions likely to be encountered by the general practitioner, and a practical approach to the diagnosis and management of this common condition.

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References

  1. Noppen M, et al. Volume and cellular content of normal pleural fluid in humans examined by pleural lavage. Am J Respir Crit Care Med 2000;162(3 Pt 1):1023–6.

    PubMed  CAS  Google Scholar 

  2. Marel M, et al. The incidence of pleural effusion in a well-defined region. Epidemiologic study in central Bohemia. Chest 1993;104(5):1486–9.

    Article  PubMed  CAS  Google Scholar 

  3. Light RW. Pleural diseases. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2007. xiii, p. 427.

    Google Scholar 

  4. Bouros D, Pleural disease. Lung biology in health and disease; v. 186. New York: Marcel Dekker; 2004. xxxi, p. 1044.

    Google Scholar 

  5. Light RW. Clinical practice. Pleural effusion. N Engl J Med 2002;346(25):1971–7.

    Article  PubMed  Google Scholar 

  6. Gilmartin JJ, Wright AJ, Gibson GJ. Effects of pneumothorax or pleural effusion on pulmonary function. Thorax 1985;40(1):60–5.

    PubMed  CAS  Google Scholar 

  7. Traylor JJ, et al. Large pleural effusions producing signs of cardiac tamponade resolved by thoracentesis. Am J Cardiol 2002;89(1):106–8.

    Article  PubMed  Google Scholar 

  8. Rahman NM, Chapman SJ, Davies RJ. Pleural effusion: a structured approach to care. Br Med Bull 2004;72:31–47.

    Article  PubMed  Google Scholar 

  9. Kalantri S, et al. Accuracy and reliability of physical signs in the diagnosis of pleural effusion. Respir Med 2007;101(3):431–8.

    Article  PubMed  Google Scholar 

  10. Lange S, Stark P. Radiology of chest diseases. Stuttgart; New York: G. Thieme; Thieme Medical Publishers. 1990; viii, p. 293.

    Google Scholar 

  11. Moskowitz H, et al. Roentgen visualization of minute pleural effusion. An experimental study to determine the minimum amount of pleural fluid visible on a radiograph. Radiology 1973;109(1):33–5.

    PubMed  CAS  Google Scholar 

  12. Gryminski J, Krakowka P, Lypacewicz G. The diagnosis of pleural effusion by ultrasonic and radiologic techniques. Chest 1976;70(1):33–7.

    PubMed  CAS  Google Scholar 

  13. Azoulay E. Pleural effusions in the intensive care unit. Curr Opin Pulm Med 2003;9(4):291–7.

    Article  PubMed  Google Scholar 

  14. Doyle JJ, et al. Necessity of routine chest roentgenography after thoracentesis. Ann Intern Med 1996;124(9):816–20.

    PubMed  CAS  Google Scholar 

  15. Tarver RD, Broderick LS, Conces DJ Jr. Reexpansion pulmonary edema. J Thorac Imaging 1996;11(3):198–209.

    PubMed  CAS  Google Scholar 

  16. Jackson RM, et al. Re-expansion pulmonary edema. A potential role for free radicals in its pathogenesis. Am Rev Respir Dis 1988;137(5):1165–71.

    PubMed  CAS  Google Scholar 

  17. Jones PW, et al. Ultrasound-guided thoracentesis: is it a safer method? Chest 2003;123(2):418–23.

    Article  PubMed  Google Scholar 

  18. Light RW, et al. Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med 1972;77(4):507–13.

    PubMed  CAS  Google Scholar 

  19. Romero S, et al. Evaluation of different criteria for the separation of pleural transudates from exudates. Chest 1993;104(2):399–404.

    Article  PubMed  CAS  Google Scholar 

  20. Romero-Candeira S, et al. Influence of diuretics on the concentration of proteins and other components of pleural transudates in patients with heart failure. Am J Med 2001;110(9):681–6.

    Article  PubMed  CAS  Google Scholar 

  21. Heffner JE, Brown LK, Barbieri CA. Diagnostic value of tests that fdiscriminate between exudative and transudative pleural effusions. Primary Study Investigators. Chest 1997;111(4):970–80.

    PubMed  CAS  Google Scholar 

  22. Heffner JE, Sahn SA, Brown LK. Multilevel likelihood ratios for identifying exudative pleural effusions(*). Chest 2002;121(6):1916–20.

    Article  PubMed  Google Scholar 

  23. Colice GL, et al. Medical and surgical treatment of parapneumonic effusions : an evidence-based guideline. Chest 2000;118(4):1158–71.

    Article  PubMed  CAS  Google Scholar 

  24. Rodriguez-Panadero F, Lopez Mejias J. Low glucose and pH levels in malignant pleural effusions. Diagnostic significance and prognostic value in respect to pleurodesis. Am Rev Respir Dis 1989;139(3):663–7.

    PubMed  CAS  Google Scholar 

  25. Chandler TM, et al. Comparison of the use and accuracy of methods for determining pleural fluid pH. South Med J 1999;92(2):214–7.

    Article  PubMed  CAS  Google Scholar 

  26. Cheng DS, et al. Comparison of pleural fluid pH values obtained using blood gas machine, pH meter, and pH indicator strip. Chest 1998;114(5):1368–72.

    PubMed  CAS  Google Scholar 

  27. Adelman M, et al. Diagnostic utility of pleural fluid eosinophilia. Am J Med 1984;77(5):915–20.

    Article  PubMed  CAS  Google Scholar 

  28. Everts RJ, Reller LB. Pleural space infections: microbiology and antimicrobial therapy. Semin Respir Infect 1999;14(1):18–30.

    PubMed  CAS  Google Scholar 

  29. Jarvi OH, et al. The accuracy and significance of cytologic cancer diagnosis of pleural effusions. (A followup study of 338 patients). Acta Cytol 1972;16(2):152–8.

    PubMed  CAS  Google Scholar 

  30. Spriggs AI, Boddington MM. The cytology of effusions: pleural, pericardial, and peritoneal and of cerebrospinal fluid, by A.I. Spriggs and M.M. Boddington. 2nd ed. New York: Grune & Stratton; 1968. p. 174.

    Google Scholar 

  31. Hendrick DJ. Occupational disorders of the lung: recognition, management and prevention. London: W. B. Saunders; 2002. xiv, p. 638.

    Google Scholar 

  32. Light RW, et al. Large pleural effusions occurring after coronary artery bypass grafting. Cardiovascular Surgery Associates, PC. Ann Intern Med 1999;130(11):891–6.

    PubMed  CAS  Google Scholar 

  33. Sadikot RT, et al. Pleural fluid characteristics of patients with symptomatic pleural effusion after coronary artery bypass graft surgery. Arch Intern Med 2000;160(17):2665–8.

    Article  PubMed  CAS  Google Scholar 

  34. Engle MA, et al. Postpericardiotomy syndrome. A new look at an old condition. Mod Concepts Cardiovasc Dis 1975;44(11):59–64.

    PubMed  CAS  Google Scholar 

  35. Doerr CH, et al. Etiology of chylothorax in 203 patients. Mayo Clin Proc 2005;80(7):867–70.

    Article  PubMed  Google Scholar 

  36. Diaz-Guzman E, Culver DA, Stoller JK. Transudative chylothorax: report of two cases and review of the literature. Lung 2005;183(3):169–75.

    Article  PubMed  Google Scholar 

  37. Garcia-Zamalloa A, et al. Pseudochylothorax. Report of 2 cases and review of the literature. Medicine (Baltimore) 1999;78(3):200–7.

    Article  CAS  Google Scholar 

  38. Baumann MH, et al. Pleural tuberculosis in the United States: incidence and drug resistance. Chest 2007;131(4):1125–32.

    Article  PubMed  Google Scholar 

  39. Valdes L, et al. Tuberculous pleurisy: a study of 254 patients. Arch Intern Med 1998;158(18):2017–21.

    Article  PubMed  CAS  Google Scholar 

  40. Goto M, et al. Diagnostic value of adenosine deaminase in tuberculous pleural effusion: a meta-analysis. Ann Clin Biochem 2003;40(Pt 4):374–81.

    Article  PubMed  CAS  Google Scholar 

  41. Villena V, et al. Interferon gamma levels in pleural fluid for the diagnosis of tuberculosis. Am J Med 2003;115(5):365–70.

    Article  PubMed  CAS  Google Scholar 

  42. Shaw P, Agarwal R. Pleurodesis for malignant pleural effusions. Cochrane Database Syst Rev 2004;1:CD002916.

    PubMed  Google Scholar 

  43. Putnam JB Jr, et al. Outpatient management of malignant pleural effusion by a chronic indwelling pleural catheter. Ann Thorac Surg 2000;69(2):369–75.

    Article  PubMed  Google Scholar 

  44. Tremblay A, Michaud G. Single-center experience with 250 tunnelled pleural catheter insertions for malignant pleural effusion. Chest 2006;129(2):362–8.

    Article  PubMed  Google Scholar 

  45. Yataco JC, Dweik RA. Pleural effusions: evaluation and management. Cleve Clin J Med 2005;72(10):854–6, 858, 862–4 passim.

    PubMed  Google Scholar 

  46. Lloyd C, Sahn SA. Subarachnoid pleural fistula due to penetrating trauma: case report and review of the literature. Chest 2002;122(6):2252–6.

    Article  PubMed  Google Scholar 

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Correspondence to Raed A. Dweik.

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Diaz-Guzman, E., Dweik, R.A. Diagnosis and Management of Pleural Effusions: A Practical Approach. Compr Ther 33, 237–246 (2007). https://doi.org/10.1007/s12019-007-8016-5

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  • DOI: https://doi.org/10.1007/s12019-007-8016-5

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