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Pleural Disease: Malignant and Benign Pleural Effusions

  • María F. Landaeta
  • Macarena R. VialEmail author
Reference work entry

Abstract

Pleural effusion is a common problem in intensive care unit (ICU) patients. Proper diagnosis involves three steps: confirmation of the effusion with imaging studies, classification as transudates or exudates and identifying the underlying cause. Imaging studies such as chest X-ray, ultrasound, and CT scan are useful to confirm the diagnosis and may also suggest the underlying cause. Ultrasound is particularly helpful in the ICU setting due to its portability and ability to characterize the effusion and guide pleural procedures. If an effusion is clinically significant or the diagnosis is unknown, then drainage and fluid analysis are essential. Mechanical ventilation is not associated with increased complications of pleural drainage and can be safely performed if indicated. Drainage also has a therapeutic objective, and it is mandatory and urgent if an infection is suspected but also indicated in patients with large effusions, a noncompliant chest wall, or severe respiratory failure requiring higher positive end-expiratory pressures (PEEP). In patients with a suspected malignant effusion, effusion will recur, and a definitive treatment may be considered if the patient survives the ICU.

Keywords

Pleural effusion Malignancy Exudate Transudate Empyema Chest tube Ultrasound Thoracentesis Pleurodesis Mesothelioma Indwelling pleural catheter 

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Lincoln Medical and Mental Health CenterNew YorkUSA
  2. 2.Interventional Pulmonology UnitClínica Alemana de Santiago-Universidad del DesarrolloSantiagoChile
  3. 3.Servicio de Enfermedades Respiratorias, Unidad de Neumologia IntervencionalClinica Alemana de SantiagoVitacuraChile

Section editors and affiliations

  • Yenny Cardenas
    • 1
  1. 1.Critical Care DepartmentUniversidad del Rosario Hospital Universitario Fundacion Santa Fe deBogotaColombia

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