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Pleural Effusion

Felix B. Chang Cruz, MD, FAAMA, ABIHM Reviewed 06/2019
 


BASICS

Abnormal accumulation of fluid in the pleural space 

DESCRIPTION

Types: transudate, exudate 
  • Congestive heart failure (CHF): 40%: transudate

  • Pneumonia 25%, malignancy 15%, and pulmonary embolism (P...

DIAGNOSIS

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

HISTORY

Dyspnea, fever, malaise, and weight loss; che...

TREATMENT

Oxygen support to >92% 

GENERAL MEASURES

  • Therapeutic thoracentesis, if symptomatic

  • Chest tube thoracostomy drainage: >1/2 hemithorax; complicated parapneumonic effusion (positive Gram sta...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Check for the amount and quality of fluid drained, air leak (bubbling), and oscillation.

  • Repeat a CXR when drainage decreases to <100 mL/day t...

REFERENCES

1
Sahn SA, Huggins JT, San Jose E, et al. The art of pleural fluid analysis. Clin Pulm Med.  2013;20(2):77–96. [View Abstract on OvidMedline]
2
Saguil A, Wyrick K, Hallgren J. Diagnostic ...

ADDITIONAL READING

Ryan H, Yoo J, Darsini P. Corticosteroids for tuberculous pleurisy. Cochrane Database Syst Rev.  2017;(3):CD001876. [View Abstract on OvidMedline] 

CODES

ICD10

  • J90 Pleural effusion, not elsewhere classified

  • J91.0 Malignant pleural effusion

  • J94.0 Chylous effusion

  • A15.6 Tuberculous pleurisy

  • J91.8 Pleural effusion in other conditions classified elsewhere

ICD9

CLINICAL PEARLS

  • Bilateral pleural effusion suggests heart failure, malignancy in absence of cardiomegaly, and TB or parasitic infection in children.

  • Ascites and pleural effusion suggest hepatic hydroth...

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