Elsevier

Disease-a-Month

Volume 59, Issue 2, February 2013, Pages 29-57
Disease-a-Month

Pleural effusions

https://doi.org/10.1016/j.disamonth.2012.11.002Get rights and content

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Epidemiology of pleural effusions

Approximately 1.5 million people develop pleural effusions in the United States each year.1 Many different diseases may cause them. In an unpublished series of 2900 consecutive patients submitted to a diagnostic thoracentesis in a University Hospital (Lleida, Spain) during the last 17 years, the leading etiologies of pleural effusions were: cancer (27%), heart failure (20%), pneumonia (18%), tuberculosis (9%), pericardial diseases (3.5%), and cirrhosis (3%). It should be noted that figures for

Pathogenesis of pleural effusions

Normally, the pleural space contains a small amount of fluid (about 0.26 ± 0.1 mL/kg body weight) which allows the lungs to expand and deflate with minimal friction during respiratory movements.4 Pleural fluid normally originates in the capillaries of the parietal pleura, filtrates into the pleural space, and is then absorbed by the parietal pleural lymphatics. Effusions accumulate whenever the rate of pleural fluid formation exceeds that of its reabsorption, usually the result of simultaneous

Approach to patients with pleural effusions

Key elements to uncover the etiology of pleural effusions are clinical evaluation, imaging, pleural fluid analysis, and when applicable pleural biopsy.

Management of selected diseases causing pleural effusions

In this section, salient features of several common causes of pleural effusions will be succinctly reviewed, but a more comprehensive discussion for readers can be found elsewhere.9

Bedside pleural techniques

General practitioners need to be familiar with the basic pleural techniques aimed at diagnosing (diagnostic thoracentesis) and treating (therapeutic thoracentesis and chest catheters) patients with pleural effusions.104 These procedures should ideally be performed with bedside ultrasound guidance for patient safety. A wide variety of portable ultrasound machines can be used for pleural abnormalities visualization. A machine with a convex, microconvex (preferred) or sector probe of 3.5–5 MHz is

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