Pleural effusion

Pleural effusion predominantly presents with breathlessness, but cough and pleuritic chest pain can be a feature. The etiology of the pleural effusion determines other signs and symptoms.

Diagnosis of pleural effusion involves clinical evaluation, imaging studies (chest x-ray, ultrasound, computed tomography) pleural fluid analysis (biochemistry, cytology, culture), and establishing the nature of the effusion and the underlying cause.

The patient’s history and physical exam should guide workup. Early diagnosis is important to minimize invasive interventions and to identify serious underlying conditions, such as malignancy.

Treatment is based on the nature of the effusion and underlying condition.

Therapeutic thoracentesis with nearly complete removal of the fluid collection alleviates dyspnea and cough in most circumstances.

A pleural effusion results when fluid collects between the parietal and visceral pleural surfaces of the thorax. A thin layer of fluid is always present in this space for lubrication and ease of movement of the lung during inspiration and expiration. If the normal flow of fluid is disrupted, with either too much fluid produced or not enough removed, then fluid accumulates, resulting in a pleural effusion.[1]Feller-Kopman D, Light R. Pleural Disease. N Engl J Med. 2018 Feb 22;378(8):740-751.