Pleural effusion


Key articles

Light RW. The undiagnosed pleural effusion. Clin Chest Med. 2006 Jun;27(2):309-19. Abstract

McGrath EE, Anderson PB. Diagnosis of pleural effusion: a systematic approach. Am J Crit Care. 2011 Mar;20(2):119-27. Abstract

Rahman NM, Maskell NA, West A, et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med. 2011 Aug 11;365(6):518-26. Abstract

Reference articles

1. Feller-Kopman D, Light R. Pleural Disease. N Engl J Med. 2018 Feb 22;378(8):740-751.Full text  Abstract

2. Light RW. Pleural diseases. 3rd ed. Baltimore, MD: Williams and Wilkins; 1995.

3. Wilcox ME, Chong CA, Stanbrook MB, et al. Does this patient have an exudative pleural effusion? The Rational Clinical Examination systematic review. JAMA. 2014 Jun 18;311(23):2422-31. Abstract

4. Light RW. Pleural effusions. Med Clin North Am. 2011 Sep 25;95(6):1055-70. Abstract

5. Light RW. Clinical practice. Pleural effusion. N Engl J Med. 2002 Jun 20;346(25):1971-7. Abstract

6. Light RW. The undiagnosed pleural effusion. Clin Chest Med. 2006 Jun;27(2):309-19. Abstract

7. Porcel JM, Light RW. Pleural effusions. Dis Mon. 2013 Feb;59(2):29-57. Abstract

8. Light RW, Rogers JT, Moyers JP, et al. Prevalence and clinical course of pleural effusions at 30 days after coronary artery and cardiac surgery. Am J Respir Crit Care Med. 2002 Dec 15;166(12 Pt 1):1567-71. Abstract

9. Srivali N, Thongprayoon C, Cheungpasitporn W, et al. Unusual cause of pleural effusion: ovarian hyperstimulation syndrome. QJM. 2016 Mar;109(3):197-8.Full text  Abstract

10. Irani M, Robles A, Gunnala V, et al. Unilateral pleural effusion as the sole clinical presentation of severe ovarian hyperstimulation syndrome: a systematic review. Gynecol Endocrinol. 2018 Feb;34(2):92-99.Full text  Abstract

11. Light RW. Pleural effusion due to pulmonary emboli. Curr Opin Pulm Med. 2001 Jul;7(4):198-201. Abstract

12. Saguil A, Wyrick K, Hallgren J. Diagnostic approach to pleural effusion. Am Fam Physician. 2014 Jul 15;90(2):99-104.Full text  Abstract

13. Bialkowski A, Poets CF, Franz AR, et al. Congenital chylothorax: a prospective nationwide epidemiological study in Germany. Arch Dis Child Fetal Neonatal Ed. 2015 Mar;100(2):F169-72. Abstract

14. Imazio M, Brucato A, Rovere ME, et al. Colchicine prevents early postoperative pericardial and pleural effusions. Am Heart J. 2011 Sep;162(3):527-32.e1. Abstract

15. Imazio M. Prevention of the postpericardiotomy syndrome, postoperative effusions, and atrial fibrillation after cardiac surgery, efficacy and safety of colchicine: evidence from the COPPS trial and substudies [in Italian]. G Ital Cardiol (Rome). 2012 Oct;13(10):665-72. Abstract

16. McGrath EE, Anderson PB. Diagnosis of pleural effusion: a systematic approach. Am J Crit Care. 2011 Mar;20(2):119-27. Abstract

17. Chalmers JD, Singanayagam A, Hill AT. C-reactive protein is an independent predictor of severity in community-acquired pneumonia. Am J Med. 2008 Mar;121(3):219-25. Abstract

18. Zou MX, Zhou RR, Wu WJ, et al. The use of pleural fluid procalcitonin and C-reactive protein in the diagnosis of parapneumonic pleural effusions: a systemic review and meta-analysis. Am J Emerg Med. 2012 Nov;30(9):1907-14. Abstract

19. Petersen WG, Zimmerman R. Limited utility of chest radiograph after thoracentesis. Chest. 2000 Apr;117(4):1038-42. Abstract

20. McGrath EE, Blades Z, Anderson PB. Chylothorax: aetiology, diagnosis and therapeutic options. Respir Med. 2010 Jan;104(1):1-8. Abstract

21. McGrath EE, Warriner D, Anderson PB. The use of non-routine pleural fluid analysis in the diagnosis of pleural effusion. Respir Med. 2010 Aug;104(8):1092-100. Abstract

22. Romero-Candeira S, Fernández C, Martín C, et al. Influence of diuretics on the concentration of proteins and other components of pleural transudates in patients with heart failure. Am J Med. 2001 Jun 15;110(9):681-6. Abstract

23. Kummerfeldt CE, Chiuzan CC, Huggins JT, et al. Improving the predictive accuracy of identifying exudative effusions. Chest. 2014 Mar 1;145(3):586-92. Abstract

24. Zhou Q, Ye ZJ, Su Y, et al. Diagnostic value of N-terminal pro-brain natriuretic peptide for pleural effusion due to heart failure: a meta-analysis. Heart. 2010 Aug;96(15):1207-11. Abstract

25. Janda S, Swiston J. Diagnostic accuracy of pleural fluid NT-pro-BNP for pleural effusions of cardiac origin: a systematic review and meta-analysis. BMC Pulm Med. 2010 Nov 20;10:58.Full text  Abstract

26. Majdalany BS, Murrey DA Jr, et al; Expert Panel on Vascular Imaging and Interventional Radiology. ACR appropriateness criteria®: chylothorax treatment planning. J Am Coll Radiol. 2017 May;14(5s):S118-26.Full text  Abstract

27. Jimenez D, Diaz G, Garcia-Rull S, et al. Routine use of pleural fluid cultures. Are they indicated? Limited yield, minimal impact on treatment decisions. Respir Med. 2006 Nov;100(11):2048-52. Abstract

28. Menzies SM, Rahman NM, Wrightson JM, et al. Blood culture bottle culture of pleural fluid in pleural infection. Thorax. 2011 Aug;66(8):658-62. Abstract

29. Bhatnagar R, Maskell N. The modern diagnosis and management of pleural effusions. BMJ. 2015 Sep 8;351:h4520. Abstract

30. Liang QL, Shi HZ, Wang K, et al. Diagnostic accuracy of adenosine deaminase in tuberculous pleurisy: a meta-analysis. Respir Med. 2008 May;102(5):744-54. Abstract

31. Aggarwal AN, Agarwal R, Sehgal IS, et al. Meta-analysis of Indian studies evaluating adenosine deaminase for diagnosing tuberculous pleural effusion. Int J Tuberc Lung Dis. 2016 Oct;20(10):1386-91.Full text  Abstract

32. Oba Y, Abu-Salah T. The prevalence and diagnostic significance of eosinophilic pleural effusions: a meta-analysis and systematic review. Respiration. 2012;83(3):198-208. Abstract

33. Jiang J, Shi HZ, Liang QL, et al. Diagnostic value of interferon-gamma in tuberculous pleurisy: a metaanalysis. Chest. 2007;131:1133-1141. Abstract

34. Kalantri Y, Hemvani N, Chitnis DS. Evaluation of real-time polymerase chain reaction, interferon-gamma, adenosine deaminase, and immunoglobulin A for the efficient diagnosis of pleural tuberculosis. Int J Infect Dis. 2011;15:e226-e231. Abstract

35. Mollo B, Jouveshomme S, Philippart F, et al. Biological markers in the diagnosis of tuberculous pleural effusion [in French]. Ann Biol Clin (Paris). 2017 Feb 1;75(1):19-27. Abstract

36. Zhou Q, Chen YQ, Qin SM, et al. Diagnostic accuracy of T-cell interferon-γ release assays in tuberculous pleurisy: a meta-analysis. Respirology. 2011;16:473-480. Abstract

37. Porcel JM, Pardina M, Bielsa S, et al. Derivation and validation of a CT scan scoring system for discriminating malignant from benign pleural effusions. Chest. 2015 Feb;147(2):513-9. Abstract

38. Heffner JE, Klein JS. Recent advances in the diagnosis and management of malignant pleural effusions. Mayo Clin Proc. 2008 Feb;83(2):235-50. Abstract

39. Porcel JM, Light RW. Pleural effusions due to pulmonary embolism. Curr Opin Pulm Med. 2008 Jul;14(4):337-42. Abstract

40. Mohan AC, Chandra S, Agarwal D, et al. Utility of semirigid thoracoscopy in the diagnosis of pleural effusions: a systematic review. J Bronchology Interv Pulmonol. 2010 Jul;17(3):195-201. Abstract

41. Agarwal R, Aggarwal AN, Gupta D. Diagnostic accuracy and safety of semirigid thoracoscopy in exudative pleural effusions: a meta-analysis. Chest. 2013 Dec;144(6):1857-67. Abstract

42. Bibby AC, Dorn P, Psallidas I, et al. ERS/EACTS statement on the management of malignant pleural effusions. Eur Respir J. 2018 Jul;52(1):.Full text  Abstract

43. Schuetz P, Wirz Y, Sager R, et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database Syst Rev. 2017 Oct 12;10:CD007498.Full text  Abstract

44. Huang DT, Yealy DM, Filbin MR, et al. Procalcitonin-guided use of antibiotics for lower respiratory tract infection. N Engl J Med. 2018 Jul 19;379(3):236-249.Full text  Abstract

45. Wong CL, Holroyd-Leduc J, Straus SE. Does this patient have a pleural effusion? JAMA. 2009 Jan 21;301(3):309-17. Abstract

46. Mayo PH, Doelken P. Pleural ultrasonography. Clin Chest Med. 2006 Jun;27(2):215-27. Abstract

47. Prakash UB, Reiman HM. Comparison of needle biopsy with cytologic analysis for the evaluation of pleural effusion: analysis of 414 cases. Mayo Clin Proc. 1985 Mar;60(3):158-64. Abstract

48. Romero-Candieira S, Hernandez L. The separation of transudates and exudates with particular reference to the protein gradient. Curr Opin Pulm Med. 2004 Jul;10(4):294-8. Abstract

49. Traill ZC, Davies RJ, Gleeson FV. Thoracic computed tomography in patients with suspected malignant pleural effusions. Clin Radiol. 2001 Mar;56(3):193-6. Abstract

50. Lama A, Ferreiro L, Toubes ME, et al. Characteristics of patients with pseudochylothorax - a systematic review. J Thorac Dis. 2016 Aug;8(8):2093-101.Full text  Abstract

51. Feng M, Zhu J, Liang L, et al. Diagnostic value of tumor markers for lung adenocarcinoma-associated malignant pleural effusion: a validation study and meta-analysis. Int J Clin Oncol. 2016 Dec 18;22(2):283-90. Abstract

52. Liang QL, Shi HZ, Qin XJ, et al. Diagnostic accuracy of tumour markers for malignant pleural effusion: a meta-analysis. Thorax. 2008 Jan;63(1):35-41. Abstract

53. Fafliora E, Hatzoglou C, Gourgoulianis KI, et al. Systematic review and meta-analysis of vascular endothelial growth factor as a biomarker for malignant pleural effusions. Physiol Rep. 2016 Dec;4(24):e12978.Full text  Abstract

54. Woolhouse I, Bishop L, Darlison L, et al. BTS guideline for the investigation and management of malignant pleural mesothelioma. BMJ Open Respir Res. 2018 Feb 14;5(1):e000266.Full text  Abstract

55. Jiang J, Shi HZ, Liang QL, et al. Diagnostic value of interferon-gamma in tuberculous pleurisy: a metaanalysis. Chest. 2007 Apr;131(4):1133-41. Abstract

56. Kalantri Y, Hemvani N, Chitnis DS. Evaluation of real-time polymerase chain reaction, interferon-gamma, adenosine deaminase, and immunoglobulin A for the efficient diagnosis of pleural tuberculosis. Int J Infect Dis. 2011 Apr;15(4):e226-31. Abstract

57. Zhou Q, Chen YQ, Qin SM, et al. Diagnostic accuracy of T-cell interferon-gamma release assays in tuberculous pleurisy: a meta-analysis. Respirology. 2011 Apr;16(3):473-80. Abstract

58. O'Driscoll BR, Howard LS, Earis J, et al. BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax. 2017 Jun;72(Suppl 1):ii1-90.Full text  Abstract

59. American College of Radiology. ACR appropriateness criteria: intensive care unit patients. 2020 [internet publication].Full text

60. National Patient Safety Alert - NHS England & NHS Improvement. Deterioration due to rapid offload of pleural effusion fluid from chest drains. Dec 2020 [internet publication].Full text

61. Association of Respiratory Nurse Specialists. Royal College of Nursing. Good practice standards for controlled removal of fluid from chest drains (adults). Dec 2020 [internet publication].Full text

62. Light RW, Girard WM, Jenkinson SG, et al. Parapneumonic effusions. Am J Med. 1980 Oct;69(4):507-12. Abstract

63. Sahn SA. Diagnosis and management of parapneumonic effusions and empyema. Clin Infect Dis. 2007 Oct 24;45(11):1480-6.Full text  Abstract

64. Maskell NA, Batt S, Hedley EL, et al. The bacteriology of pleural infection by genetic and standard methods and its mortality significance. Am J Respir Crit Care Med. 2006 Oct 1;174(7):817-23. Abstract

65. Tokuda Y, Matsushima D, Stein GH, et al. Intrapleural fibrinolytic agents for empyema and complicated parapneumonic effusions: a meta-analysis. Chest. 2006 Mar;129(3):783-90. Abstract

66. Altmann ES, Crossingham I, Wilson S, et al. Intra-pleural fibrinolytic therapy versus placebo, or a different fibrinolytic agent, in the treatment of adult parapneumonic effusions and empyema. Cochrane Database Syst Rev. 2019 Oct 30;2019(10):.Full text  Abstract

67. Rahman NM, Maskell NA, West A, et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med. 2011 Aug 11;365(6):518-26. Abstract

68. Guinde J, Georges S, Bourinet V, et al. Recent developments in pleurodesis for malignant pleural disease. Clin Respir J. 2018 Oct;12(10):2463-2468.Full text  Abstract

69. Simoff MJ, Lally B, Slade MG, et al. Symptom management in patients with lung cancer. Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013 May;143(5 suppl):e455-97S.Full text  Abstract

70. Bhatnagar R, Luengo-Fernandez R, Kahan BC, et al. Thoracoscopy and talc poudrage compared with intercostal drainage and talc slurry infusion to manage malignant pleural effusion: the TAPPS RCT. Health Technol Assess. 2020 Jun;24(26):1-90.Full text  Abstract

71. Kheir F, Shawwa K, Alokla K, et al. Tunneled pleural catheter for the treatment of malignant pleural effusion: a systematic review and meta-analysis. Am J Ther. 2016 Nov/Dec;23(6):e1300-6. Abstract

72. Thomas R, Fysh ET, Smith NA, et al. Effect of an indwelling pleural catheter vs talc pleurodesis on hospitalization days in patients with malignant pleural effusion: the AMPLE randomized clinical trial. JAMA. 2017 Nov 21;318(19):1903-12.Full text  Abstract

73. Davies HE, Mishra EK, Kahan BC, et al. Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion: the TIME2 randomized controlled trial. JAMA. 2012 Jun 13;307(22):2383-9. Abstract

74. Dipper A, Jones HE, Bhatnagar R, et al. Interventions for the management of malignant pleural effusions: a network meta-analysis. Cochrane Database Syst Rev. 2020 Apr 21;4:CD010529.Full text  Abstract

75. Tan C, Sedrakyan A, Browne J, et al. The evidence on the effectiveness of management for malignant pleural effusion: a systematic review. Eur J Cardiothorac Surg. 2006 May;29(5):829-38.Full text  Abstract

76. Sherman S, Ravikrishnan KP, Patel AS, et al. Optimum anesthesia with intrapleural lidocaine during chemical pleurodesis with tetracycline. Chest. 1988 Mar;93(3):533-6. Abstract

77. Rahman NM, Pepperell J, Rehal S, et al. Effect of opioids vs NSAIDs and larger vs smaller chest tube size on pain control and pleurodesis efficacy among patients with malignant pleural effusion: the TIME1 randomized clinical trial. JAMA. 2015 Dec 22-29;314(24):2641-53.Full text  Abstract

78. Harris K, Chalhoub M. The use of a PleurX catheter in the management of recurrent benign pleural effusion: a concise review. Heart Lung Circ. 2012 Nov;21(11):661-5. Abstract

79. Tremblay A, Mason C, Michaud G. Use of tunnelled catheters for malignant pleural effusions in patients fit for pleurodesis. Eur Respir J. 2007 Oct;30(4):759-62.Full text  Abstract

80. Van Meter ME, McKee KY, Kohlwes RJ. Efficacy and safety of tunneled pleural catheters in adults with malignant pleural effusions: a systematic review. J Gen Intern Med. 2011 Jan;26(1):70-6.Full text  Abstract

81. Davies CW, Traill ZC, Gleeson FV, et al. Intrapleural streptokinase in the management of malignant multiloculated pleural effusions. Chest. 1999 Mar;115(3):729-33. Abstract

82. Gilkeson RC, Silverman P, Haaga JR. Using urokinase to treat malignant pleural effusions. AJR Am J Roentgenol. 1999 Sep;173(3):781-3.Full text  Abstract

83. Hsu LH, Soong TC, Feng AC, et al. Intrapleural urokinase for the treatment of loculated malignant pleural effusions and trapped lungs in medically inoperable cancer patients. J Thorac Oncol. 2006 Jun;1(5):460-7.Full text  Abstract

84. Valenza-Demet G, Valenza M, Cabrera-Martos I, et al. The effects of a physiotherapy programme on patients with a pleural effusion: a randomized controlled trial. Clin Rehabil. 2014 Nov;28(11):1087-95. Abstract

85. British Thoracic Society. BTS Pleural disease guideline 2010. August 2010 [internet publication]. [This guideline has been archived by the British Thoracic Society. The BTS website states that guidelines that are more than 5 years old are marked as archived because their recommendations have not been checked to confirm continued validity at the date of archival. A BMJ Best Practice expert adviser has confirmed that these guidelines still reflect current practice in the UK.]Full text

86. National Patient Safety Agency. Rapid response report: risks of chest drain insertion. May 2008. (last accessed 26 October 2017).Full text

87. Akram AR, Hartung TK. Intercostal chest drains: a wake-up call from the National Patient Safety Agency rapid response report. J R Coll Physicians Edinb. 2009;39:117-120.Full text

88. American College of Surgeons Committee on Trauma. Advanced trauma life support (ATLS) student course manual. 8th ed. Chicago, IL: American College of Surgeons; 2008.

89. Nakitende D, Gottlieb M, Ruskis J, et al. Ultrasound for confirmation of thoracostomy tube placement by emergency medicine residents. Trauma (United Kingdom). 2015;19(1):35‐8.

90. Jenkins JA, Gharahbaghian L, Doniger SJ, et al. Sonographic identification of tube thoracostomy study (SITTS): confirmation of intrathoracic placement. West J Emerg Med. 2012 Sep;13(4):305-11.Full text  Abstract

91. Wiederhold BD, O'Rourke MC. StatPearls: thoracentesis. Treasure Island, FL: StatPearls Publishing; 2018.Full text  Abstract

92. Dresler CM, Olak J, Herndon JE 2nd, et al. Phase III intergroup study of talc poudrage vs talc slurry sclerosis for malignant pleural effusion. Chest. 2005 Mar;127(3):909-15. Abstract

93. Ryan H, Yoo J, Darsini P. Corticosteroids for tuberculous pleurisy. Cochrane Database Syst Rev. 2017 Mar 14;(3):CD001876.Full text  Abstract

94. Rahman NM, Kahan BC, Miller RF, et al. A clinical score (RAPID) to identify those at risk for poor outcome at presentation in patients with pleural infection. Chest. 2014 Apr;145(4):848-55. Abstract

95. Clive AO, Kahan BC, Hooper CE, et al. Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score. Thorax. 2014 Dec;69(12):1098-104.Full text  Abstract

96. Psallidas I, Kanellakis NI, Gerry S, et al. Development and validation of response markers to predict survival and pleurodesis success in patients with malignant pleural effusion (PROMISE): a multicohort analysis. Lancet Oncol. 2018 Jul;19(7):930-939.Full text  Abstract

97. Brims FJ, Meniawy TM, Duffus I, et al. A Novel Clinical Prediction Model for Prognosis in Malignant Pleural Mesothelioma Using Decision Tree Analysis. J Thorac Oncol. 2016 Apr;11(4):573-82.Full text  Abstract

98. Barnes TW, Morgenthaler TI, Olson EJ, et al. Sonographically guided thoracentesis and rate of pneumothorax. J Clin Ultrasound. 2005 Dec;33(9):442-6. Abstract

99. Diacon AH, Brutsche MH, Solèr M. Accuracy of pleural puncture sites: a prospective comparison of clinical examination with ultrasound. Chest. 2003 Feb;123(2):436-41. Abstract

100. Raptopoulos V, Davis LM, Lee G, et al. Factors affecting the development of pneumothorax associated with thoracentesis.AJR Am J Roentgenol. 1991 May;156(5):917-20.Full text  Abstract

101. Light RW. Parapneumonic effusions and empyema. Proc Am Thorac Soc. 2006;3(1):75-80. Abstract

102. Harris RJ, Kavuru MS, Mehta AC, et al. The impact of thoracoscopy on the management of pleural disease. Chest. 1995 Mar;107(3):845-52. Abstract

103. Wilsher ML, Veale AG. Medical thoracoscopy in the diagnosis of unexplained pleural effusion. Respirology. 1998 Jun;3(2):77-80. Abstract

104. Venekamp LN, Velkeniers B, Noppen M. Does ‘idiopathic pleuritis’ exist? Natural history of non-specific pleuritis diagnosed after thoracoscopy. Respiration. 2005 Jan-Feb;72(1):74-8. Abstract

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