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Pleural Effusion, Emergency Medicine

Reviewed 06/2017



  • Normal conditions:

    • Pleural space contains 0.1–0.2 mL/kg (30 mL in an adult) of clear, low-protein fluid that facilitates movement of the pulmonary parenchyma within the thoracic space...


Signs and Symptoms

  • Small effusions are often asymptomatic.

  • Dyspnea, pleuritic chest pain, and/or cough

  • Tachypnea, hypoxia, decreased breath sounds, and/or dullness to percussion


  • Underlyin...



IV access, high-flow oxygen, cardiac monitor, and pulse oximeter. 

Initial Stabilization/Therapy

  • ABCs

  • High-flow oxygen for shortness of breath

  • Emergent thoracentesis for significant ...



Admission Criteria

  • Respiratory compromise

  • Unknown cause of the effusion

  • Primary process requires hospitalization

  • Presence or suspected parapneumonic effusion or empyema

  • Observation for...

Pearls and Pitfalls

  • The most common causes of pleural effusion are CHF, pneumonia, and malignancy.

  • Identify and treat the underlying cause of the pleural effusion.

  • Bedside US can help characterize the e...

Additional Reading

  • Blok  B. Thoracentesis. In: Roberts  JR, Hedges  JR. Clinical Procedures in Emergency Medicine. 5th ed. Philadelphia, PA: Saunders Elsevier; 2009.

  • Gordon  CE, Feller-Kopman  D, Bal...



  • 511.1 Pleurisy with effusion, with mention of a bacterial cause other than tuberculosis

  • 511.9 Unspecified pleural effusion

  • 511.89 Other specified forms of effusion, except tuberculous

  • 511.81 Ma...

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