The Undiagnosed Pleural Effusion
Section snippets
Diseases that cause undiagnosed persistent pleural effusions
When a patient with a persistent undiagnosed pleural effusion is encountered, the first step to be considered is the list of the diseases most likely to be associated with a persistent undiagnosed pleural effusion (Box 1). The first question to answer in a patient with a persistent undiagnosed pleural effusion is whether the effusion is a transudate or an exudate. For the past several decades, this differentiation has been made by measuring the levels of protein and lactate dehydrogenase (LDH)
Congestive heart failure
Congestive heart failure is the most common cause of pleural effusion [7]. At times in patients with persistent pleural effusion, it is not obvious that the heart failure is the cause of the effusion. Certainly, symptoms of congestive heart failure, such as dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, and nocturia, should be sought when the history is taken. In addition, signs of congestive heart failure, such as basilar rales, S3 gallop, distended neck veins, and pedal edema,
Malignant pleural effusion
There is no doubt that malignancy causes more persistent undiagnosed exudative pleural effusions than any other cause. It should be emphasized that there is no huge hurry to establish this diagnosis, however, because (1) the presence of the effusion indicates that the patient has metastases to the pleura and the malignancy cannot be cured surgically, (2) most malignant pleural effusions are attributable to tumors that cannot be cured with chemotherapy, and (3) there is no evidence that attempts
History
There are certain points in the patient's history that should receive special attention if the patient has a persistent undiagnosed pleural effusion. If a patient has a transudative pleural effusion, particular attention should be paid to symptoms of congestive heart failure, such as dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, and nocturia. In addition, historical evidence of cirrhosis, alcoholism, or chronic hepatitis should be sought with the possibility of a hepatic
Summary
When faced with a patient with an undiagnosed pleural effusion, the first question to be answered is whether the patient has a transudate or an exudate. This is most commonly done with Light's criteria. If it seems clinically that the patient has a transudative effusion but Light's exudative criteria are met, the demonstration of a serum pleural fluid protein gradient of greater than 3.1 g/dL indicates that the effusion is transudative. The diagnosis of congestive heart failure is strongly
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Tracheal, Lung, and Diaphragmatic Applications of M-Mode Ultrasonography in Anesthesiology and Critical Care
2021, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :Large pleural effusions are an underdiagnosed condition that can lead to or aggravate hypoxemia and arterial hypotension in perioperative and critical care settings. Etiologic factors for pleural effusion include acute or chronic cardiopulmonary, gastrointestinal, malignant, and systemic inflammatory disorders, trauma, and thoracoabdominal surgery (ie, iatrogenic).59,60 In both spontaneous breathing and mechanical ventilation, pleural effusions not only affect the respiratory system (eg, reduced pulmonary compliance, intrapulmonary shunt, diaphragmatic dysfunction)61,62 but also can impair cardiac function by producing cardiac tamponade physiology,63 and these effects all tend to improve after drainage of the pleural fluid.64,65
Estimation of Pleural Effusion Volume through Chest Ultrasound: Validation of Two Multiplanar Models
2020, Ultrasound in Medicine and BiologyCitation Excerpt :It is especially useful in people affected by congestive heart failure, who account for the vast majority of transudative pleural effusion cases, to monitor and optimize their response to the therapy (Picano et al. 2018). In people with end-stage renal failure undergoing peritoneal dialysis (Bakirci et al. 2007) or in those with nephrotic syndrome (Light 2006), an overload of pulmonary fluid can have major therapeutic and prognostic implications. For instance, the number of lung comets and the presence of pleural effusion are strong inverse correlates to left ventricular ejection fraction and selected indexes of a diastolic function (Miglioranza et al. 2013).
Pleural tuberculosis mimicking malignant mesothelioma
2020, Respiratory Medicine Case ReportsHepatic hydrothorax
2018, Annals of HepatologyCitation Excerpt :The composition of HH is transudative in nature and therefore similar to the ascetic fluid.42 –44 However, total protein and albumin may be slightly higher in HH compared with levels in the ascitic fluid because of the greater efficacy of water absorption by the pleural surface.12,34,39,40,44,45 In uncomplicated HH, total protein is < 2.5 g/dL in HH with low LDH and glucose levels similar to that in serum.12,42
Diagnosis and Management of Pleural Transudates
2017, Archivos de Bronconeumologia