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Derrame pleural

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 21 Jul 2025
Last updated: 23 Apr 2025

Summary

Definition

History and exam

Key diagnostic factors

  • presença de fatores de risco
  • dispneia
  • macicez à percussão
Full details

Other diagnostic factors

  • dor torácica pleurítica
  • tosse
  • ausência ou redução de murmúrio vesicular
  • frêmito tátil diminuído ou ausente
Full details

Risk factors

  • insuficiência cardíaca congestiva
  • pneumonia
  • neoplasia maligna
  • embolia pulmonar
  • cirurgia de revascularização miocárdica recente
  • infarto do miocárdio recente
  • doença pulmonar ocupacional
  • artrite reumatoide
  • lúpus eritematoso sistêmico
  • insuficiência renal
  • derrame pleural induzido por medicamento
  • tratamento recente de estimulação ovariana
  • quilotórax
Full details

Diagnostic investigations

1st investigations to order

  • radiografia torácica póstero-anterior e lateral
  • ultrassonografia pleural
  • lactato desidrogenase (LDH) e proteína no líquido pleural e no soro
  • contagem de eritrócitos no líquido pleural
  • contagem de leucócitos e diferencial do líquido pleural
  • citologia do líquido pleural
  • cultura do líquido pleural
  • pH do líquido pleural
  • glicose no líquido pleural
  • gradiente de proteína
  • Hemograma completo
  • proteína C-reativa
  • hemocultura
  • coloração de Gram e cultura do escarro
  • Fragmento N-terminal do peptídeo natriurético tipo B (NT-proPNB) no líquido pleural
Full details

Investigations to consider

  • nível de colesterol no líquido pleural
  • tomografia computadorizada (TC) do tórax
  • ressonância nuclear magnética (RNM) torácica
  • TC helicoidal
  • amilase no líquido pleural
  • nível de adenosina desaminase (ADA) no líquido pleural
  • análise lipídica do líquido pleural
  • Análise do líquido pleural por fator antinuclear (FAN)
  • toracoscopia
  • broncoscopia
  • biópsia pleural
  • gamainterferona no líquido pleural e reação em cadeia da polimerase do líquido pleural em tempo real
  • procalcitonina
Full details

Emerging tests

  • marcadores tumorais no líquido pleural

Treatment algorithm

ACUTE

insuficiência cardíaca congestiva

infecciosa

maligna: capacidade funcional desfavorável ou vida útil limitada (escore de Karnofsky ≤30% ou escore do ECOG de ≥2)

maligna: boa capacidade funcional (escore de Karnofsky >30% ou escore do ECOG de 0 ou 1)

ONGOING

empiema persistente apesar de dreno torácico

derrames malignos sintomáticos recorrentes

derrame benigno recorrente

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.

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

    • Espessamento pleural
    • Colapso e condensação pulmonares
    • Cúpula diafragmática elevada
    More Differentials

  • Guidelines

    • ACR appropriateness criteria: chylothorax treatment planning
    • ACR appropriateness criteria: workup of pleural effusion or pleural disease
    More Guidelines

  • Patient information

    Derrame pleural

    Inserção de dreno torácico

    More Patient information

  • Videos

    Demonstração animada de uma aspiração pleural

    Inserção de dreno intercostal, técnica de Seldinger: vídeo de demonstração

    More videos
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