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Pleural Effusion

Felix B. Chang, ABIHM, FAAMA, ABIM , MD. Reviewed 06/2022
 


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; radiographic area <2 intercostal spaces (<300 mL) are asymptomatic. 

HISTORY

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

TREATMENT

MEDICATION

First Line

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

ISSUES FOR REFERRAL

Uncertain eti...

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 ...

REFERENCES

1
Aboudara M, Maldonado F. Upate in the Management of Pleural Effusions. Med Clin North Am. 2019 May;103(3):475-485.
2
Gordon CE, Feller-Kopman D, Balk EM, Smetana GW. Pneumothorax following t...

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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