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2012 ; 4
(ä): 31-52
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Pleural effusion: diagnosis, treatment, and management
#MMPMID27147861
Karkhanis VS
; Joshi JM
Open Access Emerg Med
2012[]; 4
(ä): 31-52
PMID27147861
show ga
A pleural effusion is an excessive accumulation of fluid in the pleural space. It
can pose a diagnostic dilemma to the treating physician because it may be related
to disorders of the lung or pleura, or to a systemic disorder. Patients most
commonly present with dyspnea, initially on exertion, predominantly dry cough,
and pleuritic chest pain. To treat pleural effusion appropriately, it is
important to determine its etiology. However, the etiology of pleural effusion
remains unclear in nearly 20% of cases. Thoracocentesis should be performed for
new and unexplained pleural effusions. Laboratory testing helps to distinguish
pleural fluid transudate from an exudate. The diagnostic evaluation of pleural
effusion includes chemical and microbiological studies, as well as cytological
analysis, which can provide further information about the etiology of the disease
process. Immunohistochemistry provides increased diagnostic accuracy.
Transudative effusions are usually managed by treating the underlying medical
disorder. However, a large, refractory pleural effusion, whether a transudate or
exudate, must be drained to provide symptomatic relief. Management of exudative
effusion depends on the underlying etiology of the effusion. Malignant effusions
are usually drained to palliate symptoms and may require pleurodesis to prevent
recurrence. Pleural biopsy is recommended for evaluation and exclusion of various
etiologies, such as tuberculosis or malignant disease. Percutaneous closed
pleural biopsy is easiest to perform, the least expensive, with minimal
complications, and should be used routinely. Empyemas need to be treated with
appropriate antibiotics and intercostal drainage. Surgery may be needed in
selected cases where drainage procedure fails to produce improvement or to
restore lung function and for closure of bronchopleural fistula.