eMedicine Specialties > Pulmonology > Pleural Disorders

Pleural Effusion: Follow-up

Author: Jeffrey Rubins, MD, Director of Clinical Operations, Professor, Department of Internal Medicine, Division of Pulmonary Medicine, Minneapolis Veterans Affairs Medical Center, University of Minnesota Medical School
Contributor Information and Disclosures

Updated: Jun 5, 2008

Follow-up

Further Inpatient Care

Monitoring pleural drainage  

  • Record the amount and quality of fluid drained and monitor for an air leak (bubbling through the water seal) each shift.
  • Repeat the chest radiographs when drainage decreases to less than 100 mL/d to evaluate whether the effusion has been fully drained. If a large effusion persists radiographically, reevaluate the position of the chest catheter. If the catheter is positioned appropriately, consider injecting lytics through the chest tube to break up clots that may be obstructing drainage.
  • Large air leaks (steady streams of air throughout the respiratory cycle) may be indications of loose connectors or of a drainage port on the catheter that has migrated out to the skin. Alternatively, they may indicate large bronchopleural fistulae. Consequently, dressings should be taken down and the position of the catheter inspected at the puncture site. Clamping the catheter at the skin helps determine whether the air leak is emanating from within the pleural cavity (in which case it stops when the tube is clamped) or from outside the chest (in which case the leak persists).

Prognosis

Prognosis varies in accordance with the underlying etiology.  

  • Malignant effusions convey a very poor prognosis, with survival typically measured in months.7
  • Parapneumonic effusions, when recognized and treated promptly, typically resolve without significant sequelae. However, untreated or inappropriately treated parapneumonic effusions may lead to constrictive fibrosis.

Patient Education

For excellent patient education resources, visit eMedicine's Lung and Airway Center. Also, see eMedicine's patient education article Pleurisy.

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize potentially lethal underlying conditions producing pleural effusions, including pulmonary embolus and esophageal rupture
  • Discharge or transfer of a patient with an unrecognized pneumothorax following thoracentesis
  • Failure to prevent constrictive pleuritis from untreated parapneumonic effusions or hemothorax
  • Unnecessary attempts to perform thoracentesis
 


More on Pleural Effusion

Overview: Pleural Effusion
Differential Diagnoses & Workup: Pleural Effusion
Treatment & Medication: Pleural Effusion
Follow-up: Pleural Effusion
Multimedia: Pleural Effusion
References
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References

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Further Reading

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Keywords

pleural effusion, pleuritis, pleurisy, serous pleurisy, wet pleurisy, congestive heart failure, lung malignancy, lung infections, pulmonary infection, pulmonary emboli, pulmonary embolus, lung emboli, lung embolus, esophageal rupture, pneumothorax, thoracentesis

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Contributor Information and Disclosures

Author

Jeffrey Rubins, MD, Director of Clinical Operations, Professor, Department of Internal Medicine, Division of Pulmonary Medicine, Minneapolis Veterans Affairs Medical Center, University of Minnesota Medical School
Jeffrey Rubins, MD is a member of the following medical societies: American College of Chest Physicians
Disclosure: Nothing to disclose.

Medical Editor

Stephen P Peters, MD, PhD, Professor, Department of Medicine, Wake Forest University
Stephen P Peters, MD, PhD 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

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Harold L Manning, MD, Associate 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.

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD, Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center; Professor of Medicine, David Geffen School of Medicine at UCLA
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.

 
 
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