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Pleural Effusion

Erik Colegrove, MD Reviewed 04/2024
 


BASICS

Abnormal accumulation of fluid in the pleural space 

DESCRIPTION

Types: transudate (low protein/low specific gravity) and exudate (high protein and cellular debris). Transudate: commonly caused b...

DIAGNOSIS

Presumptive diagnosis in 50% of cases. Small pleural effusions; (<2 intercostal spaces) (<300 mL) are asymptomatic. 

HISTORY

Dyspnea, fever, malaise, and weight loss; chest pain, cough, ...

TREATMENT

MEDICATION

First Line

CHF: diuretics (75% clearing in 48 hours); parapneumonic effusion: antibiotics; rheumatologic conditions/inflammation: steroids and NSAID 

Second Line

Intrapleural Treatmen...

ONGOING CARE

COMPLICATIONS

Pleural effusion: constrictive fibrosis, pleurocutaneous fistula. 40% of pneumonia patients will developed up to 40% parapneumonic effusion and close to 10% will progress to ...

REFERENCES

1
Sorino C, Mondoni M, Lococo F, et al. Optimizing the management of complicated pleural effusion: From intrapleural agents to surgery. Respir Med. 2022;191:106706. doi: 10.1016/j.rmed.2021....

CODES

ICD10

  • J86.9 Pyothorax without fistula

  • J86.0 Pyothorax with fistula

  • J91.0 Malignant pleural effusion

  • J91 Pleural effusion in conditions classified elsewhere

  • J86 Pyothorax

  • J90 Pleural effusion, not else...

CLINICAL PEARLS

Rare causes of pleural exudates include constrictive pericarditis, urinothorax, Meigs syndrome. Most common pleural exudates include malignancy, parapneumonic effusions, tuberculosis, ...

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