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Pleural Effusion

Felix B. Chang Cruz, MD, FAAMA, ABIHM Reviewed 06/2020
 


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: Congestive heart f...

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
Aboudara M, Maldonado F. Update in the management of pleural effusions. Med Clin North Am.  2019;103(3):475–485.
2
Redden MD, Chin TY, van Driel ML. Surgical versus non-surgical managem...

ADDITIONAL READING

  • Kaul V, McCracken DJ, Rahman NM, et al. Contemporary approach to the diagnosis of malignant pleural effusion. Ann Am Thorac Soc.  2019;16(9):1099–1106.

  • Light RW, Macgregor MI, L...

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.

  • Measurement of adenosine deaminase may be helpful wh...

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