When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Pleural effusion

Última revisão: 24 Mar 2025
Última atualização: 23 Apr 2025

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • congestive heart failure, pneumonia, and malignancy
  • dyspnea
  • dullness to percussion
Detalhes completos

Outros fatores diagnósticos

  • pleuritic chest pain
  • cough
  • absent or decreased breath sounds
  • decreased or absent tactile fremitus
Detalhes completos

Fatores de risco

  • congestive heart failure
  • pneumonia
  • malignancy
  • pulmonary embolism
  • recent coronary artery bypass graft surgery
  • recent myocardial infarction
  • occupational lung disease
  • rheumatoid arthritis
  • systemic lupus erythematosus
  • renal failure
  • drug-induced pleural effusion
  • recent ovarian stimulation treatment
  • chylothorax
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • posteroanterior and lateral chest x-ray
  • pleural ultrasound
  • LDH and protein in pleural fluid and serum
  • red blood cell count in pleural fluid
  • WBC count and differential of pleural fluid
  • cytology of pleural fluid
  • culture of pleural fluid
  • pH of pleural fluid
  • glucose in pleural fluid
  • protein gradient
  • CBC
  • CRP
  • blood culture
  • sputum Gram stain and culture
  • N-terminal pro-brain natriuretic peptide (NT-pro-BNP) in pleural fluid
Detalhes completos

Investigações a serem consideradas

  • pleural fluid cholesterol level
  • thoracic CT scan
  • thoracic MRI
  • helical CT scan
  • amylase in pleural fluid
  • adenosine deaminase (ADA) level in pleural fluid
  • lipid analysis of pleural fluid
  • antinuclear antibody (ANA) analysis of pleural fluid
  • thoracoscopy
  • bronchoscopy
  • pleural biopsy
  • interferon-gamma in pleural fluid and real-time polymerase chain reaction of pleural fluid
  • procalcitonin
Detalhes completos

Novos exames

  • tumor markers in pleural fluid

Algoritmo de tratamento

AGUDA

congestive heart failure

infective

malignant: poor performance status or limited lifespan (Karnofsky score ≤30% or ECOG score of ≥2)

malignant: good performance status (Karnofsky score >30% or ECOG score of 0 or 1)

CONTÍNUA

persistent empyema despite chest tube

recurrent symptomatic malignant effusions

recurrent benign effusion

Colaboradores

Autores

Orhan Orhan, MBBS, BSc, FRCP, SFHEA, MSc

Consultant Respiratory Physician

Chelsea and Westminster Hospital NHS Foundation Trust

London

UK

Declarações

OO declares that he has no competing interests.

Agradecimentos

Dr Orhan Orhan would like to gratefully acknowledge Drs Clare Ross, Philip W. Ind, Anob M. Chakrabarti, Richard Light, Amber Degryse, Rachel J. Davies, and Peter M. George, previous contributors to this topic.

Declarações

RL received speaking fees provided by Cardinal Health; owned stock in Denver Biomaterials until it was purchased by Cardinal Health; received fees for consulting from Denver Biomaterials; and is an author of references cited in this topic. CR, PWI, AMC, AD, RJD, and PMG declare that they have no competing interests.

Revisores

Y.C. Gary Lee, MBChB, PhD, FCCP, FRACP

Consultant Chest Physician and Senior Lecturer

Oxford Centre for Respiratory Medicine and University of Oxford Churchill Hospital

Oxford

UK

Declarações

YCGL declares that he has no competing interests.

Clare Hooper, MBBS

Pleural Research Registrar

North Bristol Lung Centre

Southmead Hospital

Westbury on Trym

Bristol

UK

Declarações

CH declares that she has no competing interests.

Steven Sahn, MD

Professor of Medicine and Director

Division of Pulmonary/Critical Care/Allergy/Sleep Medicine

Medical University of South Carolina

Charleston

SC

Declarações

SS declares that he has no competing interests.

  • Pleural effusion images
  • Diagnósticos diferenciais

    • Pleural thickening
    • Pulmonary collapse and consolidation
    • Elevated hemidiaphragm
    Mais Diagnósticos diferenciais
  • Diretrizes

    • ACR appropriateness criteria: chylothorax treatment planning
    • Pleural disease
    Mais Diretrizes
  • Folhetos informativos para os pacientes

    Pleural effusion

    Chest drain insertion

    Mais Folhetos informativos para os pacientes
  • Videos

    Pleural aspiration animated demonstration

    Insertion of intercostal drain, Seldinger technique: animated demonstration

    Mais vídeos
  • padlock-lockedConectar-se ou assinar para acessar todo o BMJ Best Practice

O uso deste conteúdo está sujeito ao nosso aviso legal