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Derrame pleural

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 20 Aug 2025
Last updated: 09 Sep 2025

Summary

Definition

History and exam

Key diagnostic factors

  • presencia de factores de riesgo
  • disnea
  • matidez a la percusión
Full details

Other diagnostic factors

  • dolor torácico pleurítico
  • tos
  • ausencia o disminución de los ruidos respiratorios
  • frémito táctil reducido o ausente
Full details

Risk factors

  • insuficiencia cardíaca congestiva
  • neumonía
  • neoplasia maligna
  • embolia pulmonar
  • reciente injerto de derivación (bypass) de arterias coronarias
  • reciente infarto agudo de miocardio
  • enfermedad pulmonar laboral
  • artritis reumatoide
  • lupus eritematoso sistémico
  • insuficiencia renal
  • derrame pleural inducido por fármacos
  • tratamiento reciente de estimulación ovárica
  • quilotórax
Full details

Diagnostic investigations

1st investigations to order

  • radiografía de tórax posteroanterior y lateral
  • ultrasonido pleural
  • niveles pleurales y séricos de lactato deshidrogenasa (LDH) y proteínas
  • recuento de eritrocitos en el líquido pleural
  • recuento de leucocitos y diagnóstico diferencial del líquido pleural
  • citología del líquido pleural
  • cultivo del líquido pleural
  • pH del líquido pleural
  • glucosa en el líquido pleural
  • gradiente de proteínas
  • hemograma completo (HC)
  • proteína C-reactiva
  • hemocultivo
  • tinción de Gram y cultivo de esputo
  • N-terminal del pro-péptido natriurético cerebral (NT-pro-BNP) en el líquido pleural
Full details

Investigations to consider

  • nivel de colesterol en el líquido pleural
  • exploración de tórax por tomografía computarizada (TC)
  • imagen por resonancia magnética (IRM) torácica
  • exploración por tomografía computarizada (TC) helicoidal
  • amilasa en el líquido pleural
  • nivel de adenosina desaminasa (ADA) en el líquido pleural
  • análisis lipídico del líquido pleural
  • análisis de anticuerpos antinucleares (ANA) del líquido pleural
  • toracoscopia
  • broncoscopia
  • biopsia pleural
  • interferón gamma en el líquido pleural y reacción en cadena de la polimerasa (PCR) en tiempo real del líquido pleural
  • procalcitonina
Full details

Emerging tests

  • marcadores tumorales en el líquido pleural

Treatment algorithm

ACUTE

insuficiencia cardíaca congestiva

derrame infeccioso

maligno: estado de rendimiento deficiente o vida útil limitada (puntuación de Karnofsky ≤30% o puntuación ECOG de ≥2)

maligno: buen estado general (puntuación de Karnofsky >30% o puntuación ECOG de 0 o 1)

ONGOING

empiema persistente a pesar del drenaje por tubo torácico

derrames malignos sintomáticos recurrentes

derrame benigno recurrente

Contributors

Authors

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

Consultant Respiratory Physician

Chelsea and Westminster Hospital NHS Foundation Trust

London

UK

Disclosures

OO declares that he has no competing interests.

Acknowledgements

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.

Disclosures

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.

Peer reviewers

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

Disclosures

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

Disclosures

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

Disclosures

SS declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Roberts ME, Rahman NM, Maskell NA, et al. British Thoracic Society guideline for pleural disease. Thorax. 2023 Jul;78(suppl 3):s1-42.Full text

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

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Derrame pleural images

  • Differentials

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  • Guidelines

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    • ACR appropriateness criteria: chylothorax treatment planning
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  • Patient information

    Derrame pleural

    More Patient information

  • Videos

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