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 is the prognosis of malignant pleural effusion?
Presentation
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?
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?
When should malignancy be suspected in the evaluation of pleural effusion (fluid on the lungs)?
When are tumor markers suggestive of malignant pleural effusions?
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)?
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)?
Which risk factors are often overlooked in undiagnosed exudative pleural effusions?
What is the role of medical thoracoscopy in the workup for 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?
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)?
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?
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) 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)?
Which medications in the drug class Vasodilators are used in the treatment of Pleural Effusion?
Which medications in the drug class Diuretics are used in the treatment of Pleural Effusion?
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Large right-sided pleural effusion. This effusion was malignant.
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Left-sided pleural effusion.
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Left lateral decubitus film displaying freely layering left-sided pleural effusion.
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Lung entrapment with right hydropneumothorax and pleural drain in place.
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Massive right pleural effusion resulting in mediastinal shift to the left.
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Right-sided pleural effusion after partial drainage showing improved left mediastinal shift.
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Bilateral pleural effusions with loss of bilateral costophrenic sulci (meniscus sign). Anteroposterior, upright chest radiograph. Image courtesy of Allen R. Thomas, MD.
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Isolated, left-sided pleural effusion with visualized loss of left, lateral costophrenic sulcus. Posteroanterior upright chest radiograph. Image courtesy of Allen R. Thomas, MD.
Tables
What would you like to print?
- Overview
- Presentation
- DDx
- Workup
- Approach Considerations
- Distinguishing Transudates From Exudates
- Pleural Fluid LDH, Glucose, and pH
- Pleural Fluid Cell Count Differential
- Pleural Fluid Culture and Cytology
- Additional Laboratory Tests
- CT Scanning and Ultrasonography
- Chest Radiography
- Diagnostic Thoracentesis
- Idiopathic Exudative Effusions
- Biopsy
- Show All
- Treatment
- Guidelines
- Medication
- Questions & Answers
- Media Gallery
- References