Pleural Effusion Differential Diagnoses

  • Author: Jeffrey Rubins, MD; Chief Editor: Zab Mosenifar, MD   more...
 
Updated: May 21, 2012
 
 

Diagnostic Considerations

Sjögren syndrome, liver or lung transplantation, upper genitourinary trauma, and abdominal trauma are among the conditions to consider in the differential diagnosis of pleural effusion, but note they are rare.

Transudative pleural effusion

Considerations in the differential diagnosis of transudative pleural effusion include the following:

  • Congestive heart failure (most common)
  • Cirrhosis with hepatic hydrothorax
  • Nephrotic syndrome
  • Peritoneal dialysis/continuous ambulatory peritoneal dialysis
  • Hypoproteinemia
  • Glomerulonephritis
  • Superior vena cava obstruction
  • Fontan procedure
  • Urinothorax
  • CSF leak to the pleural space

Exudative pleural effusion

Conditions to consider in the differential diagnosis of exudative pleural effusion include the following:

  • Malignancy
  • Pneumonia
  • Tuberculosis
  • Pulmonary embolism
  • Fungal infection
  • Pancreatic pseudocyst
  • Intra-abdominal abscess
  • After coronary artery bypass graft surgery
  • Postcardiac injury syndrome
  • Pericardial disease
  • Meigs syndrome
  • Ovarian hyperstimulation syndrome
  • Rheumatoid pleuritis
  • Lupus erythematosus
  • Drug-induced pleural disease
  • Asbestos pleural effusion
  • Yellow nail syndrome
  • Uremia
  • Trapped lung
  • Chylothorax
  • Pseudochylothorax
  • Acute respiratory distress syndrome
  • Chronic pleural thickening
  • Malignant mesothelioma

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Jeffrey Rubins, MD  Professor of Medicine, University of Minnesota Medical School; Director, Palliative Medicine, Hennepin County Medical Center

Jeffrey Rubins, MD is a member of the following medical societies: American Academy of Hospice and Palliative Medicine, American College of Chest Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD  Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Professor and Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society

Disclosure: Nothing to disclose.

Additional Contributors

Harold L Manning, MD Professor, Departments of Medicine, Anesthesiology and Physiology, Section of Pulmonary and Critical Care Medicine, Dartmouth Medical School

Harold L Manning, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

Stephen P Peters, MD, PhD, FACP, FAAAAI, FCCP, FCPP Professor of Genomics and Personalized Medicine Research, Internal Medicine, and Pediatrics, Associate Director, Center for Genomics and Personalized Medicine Research, Director of Research, Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest University School of Medicine

Stephen P Peters, MD, PhD, FACP, FAAAAI, FCCP, FCPP is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Thoracic Society, and Sigma Xi

Disclosure: See below for list of all activities None None

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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Large, malignant, right-sided pleural effusion.
Chest radiograph showing left-sided pleural effusion.
Left lateral decubitus film showing freely layering pleural effusion.
Lung entrapment with right hydropneumothorax and pleural drain in place
Massive right pleural effusion with shift of mediastinum towards left
Right pleural effusion after partial drainage showing decrease in shift of mediastinum towards left
Anteroposterior, upright chest radiograph shows bilateral pleural effusions and loss of bilateral costophrenic angles (meniscus sign). Image courtesy of Allen R. Thomas, MD.
Chest radiograph, lateral view, shows loss of bilateral, posterior costophrenic angles. Image courtesy of Allen R. Thomas, MD.
Posteroanterior, upright chest radiograph shows isolated, left-sided pleural effusion and loss of left, lateral costophrenic angle. Image courtesy of Allen R. Thomas, MD.
 
 
 
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