Pleural Effusion Questions & Answers

Updated: Dec 28, 2018
  • Author: Kamran Boka, MD, MS; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Questions & Answers

Overview

What is a pleural effusion (fluid on the lungs)?

What is the anatomy of the pleural space?

What is the role of the pleural space in respiration?

What causes the formation of a pleural effusion (fluid on the lungs)?

What are the physiological effects of pleural effusion (fluid on the lungs)?

How are pleural effusions (fluid on the lungs) classified?

What causes transudates in pleural effusions (fluid on the lungs)?

How do exudative effusions develop in pleural effusions (fluid on the lungs)?

What causes exudates in pleural effusions (fluid on the lungs)?

What is the incidence of pleural effusions (fluid on the lungs) in the US?

What is the worldwide prevalence of pleural effusions (fluid on the lungs)?

Are pleural effusions (fluid on the lungs) more common in men or women?

Are there racial differences in the prevalence of pleural effusions (fluid on the lungs)?

Does the risk for development of pleural effusions (fluid on the lungs) vary by age?

What is the effect of early treatment on the prognosis of pleural effusions (fluid on the lungs)?

What factors affect the morbidity and mortality rates associated with pleural effusions (fluid on the lungs)?

What is the prognosis of malignant pleural effusion?

What is the role of pleural fluid analysis in determining the prognosis of malignant pleural effusion?

Presentation

Why is a detailed medical history required from patients presenting with pleural effusion (fluid on the lungs)?

What are the signs and symptoms of a pleural effusion (fluid on the lungs)?

What are the physical findings of pleural effusion (fluid on the lungs)?

DDX

What should be considered in the differential diagnoses of transudative pleural effusion?

Which conditions should be considered in the differential diagnoses of exudative pleural effusion (fluid on the lungs)?

Workup

When is thoracentesis indicated in the evaluation of pleural effusion (fluid on the lungs)?

What is the role of lab testing in the evaluation of pleural effusion (fluid on the lungs)?

What are the characteristics of normal pleural fluid?

How is pleural fluid used to differentiate transudates from exudates in the evaluation of pleural effusion (fluid on the lungs)?

Which factors may lead to misclassification of transudates and exudates in the evaluation of pleural effusion (fluid on the lungs)?

Can pleural fluid levels of N-terminal pro-brain natriuretic peptide (NT-proBP) be used as a marker for heart failure–related pleural effusions?

Can pleural fluid cholesterol levels be used to differentiate exudates from transudates in the evaluation of pleural effusion (fluid on the lungs)?

What is the role of pleural fluid LDH levels in the workup for pleural effusion (fluid on the lungs)?

What is the role of pleural fluid glucose and pH levels in the evaluation pleural effusion (fluid on the lungs)?

How are pleural fluid samples collected and handled during the evaluation of pleural effusion (fluid on the lungs)?

What should be done if an exudate is suspected in the pleural fluid during the workup for pleural effusion (fluid on the lungs)?

What is the role of pleural fluid lymphocytosis in the evaluation of pleural effusion (fluid on the lungs)?

What is the role of pleural fluid eosinophilia in the workup for pleural effusion (fluid on the lungs)?

What is the relevance of mesothelial cells found during the workup for pleural effusions (fluid on the lungs)?

How often do cultures of pleural fluid yield positive results in the workup for pleural effusion (fluid on the lungs)?

When should malignancy be suspected in the evaluation of pleural effusion (fluid on the lungs)?

How much pleural fluid is recommended for cytology testing in the workup for pleural effusion (fluid on the lungs)?

When are tumor markers suggestive of malignant pleural effusions?

When should tuberculous pleuritis be suspected in the workup for pleural effusion (fluid on the lungs)?

Are acid-fast bacillus stains of pleural fluid useful in the diagnosis of tuberculous pleural effusions?

How are pleural fluid levels of adenosine deaminase (ADA) and interferon-gamma used in the diagnosis of tuberculous pleuritis?

When are specialized lab tests considered in the workup for pleural effusion (fluid on the lungs)?

How is ultrasonography used in the workup for pleural effusion (fluid on the lungs)?

What is the role of chest CT scanning in the diagnosis of suspected pleural effusion (fluid on the lungs)?

Which findings on chest radiography suggest pleural effusions (fluid on the lungs)?

Which type of chest radiography is more reliable in the detection of small pleural effusions?

When is diagnostic thoracentesis indicated in the workup for pleural effusion (fluid on the lungs)?

When is a specialist needed for assistance in performing diagnostic thoracentesis in the workup for pleural effusion (fluid on the lungs)?

What are the contraindications to diagnostic thoracentesis the workup for pleural effusion (fluid on the lungs)?

What are the possible complications of diagnostic thoracentesis in the workup for pleural effusion (fluid on the lungs)?

Which devices are used as guidance in a diagnostic thoracentesis the workup for pleural effusions (fluid on the lungs)?

How is the diagnostic thoracentesis performed in the workup for pleural effusion (fluid on the lungs)?

How much fluid is typically removed during a diagnostic thoracentesis procedure in the workup for pleural effusion (fluid on the lungs)?

How should patients be positioned during a diagnostic thoracentesis procedure in the workup for pleural effusion (fluid on the lungs)?

Should supplemental oxygen be administered during diagnostic thoracentesis in the workup for pleural effusion (fluid on the lungs)?

How can complications from diagnostic thoracentesis be reduced during workup for pleural effusion (fluid on the lungs)?

Is chest radiography recommended following diagnostic thoracentesis in the workup for pleural effusion (fluid on the lungs)?

Which risk factors are often overlooked in undiagnosed exudative pleural effusions?

After the primary evaluation of undiagnosed pleural effusions (fluid on the lungs), which clinical conditions must be met before discontinuing further evaluation?

When are further invasive procedures considered in the evaluation of undiagnosed exudative pleural effusions?

What is the role of medical thoracoscopy in the workup for pleural effusion (fluid on the lungs)?

When should CT scan–guided cutting-needle pleural biopsy (CT-CNPB) be considered in the workup of pleural effusion (fluid on the lungs)?

Treatment

What are the treatment considerations in transudative pleural effusion?

What are the treatment considerations in exudative pleural effusion?

What is the role of medications in the development of pleural effusion (fluid on the lungs)?

Is pleural effusion drainage safe in patients on mechanical ventilation?

Why is the identification of parapneumonic effusions the highest diagnostic priority for patients with pleural effusion (fluid on the lungs)?

What are the indications for urgent drainage of parapneumonic effusions?

When is drainage of malignant pleural effusions indicated?

What is the preferred treatment for lung entrapment due to malignant pleural effusions?

What is the treatment for tuberculous pleuritis?

How are chylous effusions managed?

When is surgery indicated for pleural effusion (fluid on the lungs)?

Which surgical procedures are used in the treatment of pleural effusion (fluid on the lungs)?

When are consultations advisable for pleural effusion (fluid on the lungs)?

What should be considered during a therapeutic thoracentesis in pleural effusion (fluid on the lungs)?

Which symptoms indicate that a therapeutic thoracentesis should be stopped immediately in patients with pleural effusion (fluid on the lungs)?

Which findings on chest radiography help identify candidates for therapeutic thoracentesis among patients with pleural effusions (fluid on the lungs)?

When is drainage via tube thoracostomy indicated in the treatment of pleural effusion (fluid on the lungs)?

Are alteplase and deoxyribonuclease (DNase) effective treatments for pleural effusion (fluid on the lungs)?

How is pleurodesis (pleural sclerosis) used in the treatment of pleural effusions (fluid on the lungs)?

When is pleurodesis (pleural sclerosis) indicated in the treatment of pleural effusion (fluid on the lungs)?

Is pleurodesis (pleural sclerosis) an effective treatment in pleural effusion (fluid on the lungs)?

Which sclerosing agents may prevent the recurrence of malignant pleural effusions?

What are the adverse effects of sclerosing agents used to prevent the recurrence of malignant pleural effusions?

How can pain from the use of sclerosing agents be reduced in patients with pleural effusion (fluid on the lungs)?

What are the alternative treatments to pleurodesis (pleural sclerosis) for malignant pleural effusion?

What are the possible complications of tunneled pleural catheters (TPC) used to treat malignant pleural effusions?

Are diet restrictions recommended in the treatment of pleural effusion (fluid on the lungs)?

How should the pleural fluid drainage be monitored in pleural effusion (fluid on the lungs)?

Are chest radiographs useful in the monitoring of pleural fluid drainage in pleural effusions?

Guidelines

What treatment guidelines have been released for malignant pleural effusions?

What are the British Thoracic Society (BTS) guidelines for the investigation of a unilateral pleural effusion?

What are the British Thoracic Society (BTS) treatment guidelines for malignant pleural effusions?

Medications

When are antibiotics indicated in the management of pleural effusion (fluid on the lungs)?

How are antibiotics selected in the management of pleural effusion (fluid on the lungs)?