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Pleural Effusion

Christine Gamble, Medical Degree Reviewed 05/2023
 


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. Update in the Management of Pleural Effusions. Med Clin North Am. 2019;103(3):475-485.
2
Dipper A, Jones HE, Bhatnagar R, et al. Interventions for the management of ...

ADDITIONAL READING

SEE ALSO

Saguil A, Wyrick K, Hallgren J. Diagnostic Approach to Pleural Effusion. AmFamPhysician. 2014;90:99-104  

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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