Clinical Relevance of Pleural Effusion in Patients with Pulmonary Embolism

Abstract

Background: Data regarding pleural effusion due to pulmonary embolism (PE) are limited. Objectives: The aim of this study was to investigate the clinical characteristics of PE patients with pleural effusion caused by PE. Methods: Patients with PE were retrospectively analyzed and divided into 2 groups based on computed tomography: a group with pleural effusion due to PE (effusion group) and a group without pleural effusion (control group). Clinical characteristics were compared between the 2 groups. Results: The study population consisted of the effusion group (n = 127) and the control group (n = 651). Serum C-reactive protein (CRP) level was significantly higher in the effusion group than in the control group. The percentages of high-risk Simplified PE Severity Index (57 vs. 47%, p = 0.008), central PE (84 vs. 73%, p = 0.013), right ventricular dilation (45 vs. 36%, p = 0.053), and pulmonary infarction (40 vs. 8%, p < 0.001) were higher in the effusion group than in the control group. Multivariate analysis demonstrated that pulmonary infarction (odds ratio [OR] 6.20, 95% confidence interval [CI] 3.49-10.91, p < 0.001) and CRP level (OR 1.05, 95% CI 1.101-1.09, p = 0.023) were independent predictors of pleural effusion due to PE. The presence of pleural effusion was not a predictor of short-term outcomes or length of hospital stay. Conclusions: Patients with more severe PE are likely to have pleural effusion caused by PE. However, pleural effusion was not a proven predictor of short-term outcome or length of hospital stay. Pulmonary infarction and CRP levels were independent risk factors for the development of pleural effusion.

Pulmonary infarction secondary to pulmonary embolism: An evolving paradigm

“…In agreement with the characterization of PI by Revel et al ., we found that PIs commonly demonstrated central lucency, were semicircular in shape, without air bronchograms, and were frequently associated with a feeding vessel . An ipsilateral pleural effusion was also significantly more frequent in patients with PI, an association that remained significant on multivariate analysis . PCP was also an independent predictor for PI.…”

“…PIs were lower lobe predominant—a phenomenon observed in multiple other reports . An understanding of the physiology of pulmonary blood flow offers insight into this phenomenon.…”

“…PCP was also an independent predictor for PI. Although inflammatory mediators from platelet‐rich emboli can increase pulmonary capillary permeability, necrosis following infarction could potentiate this inflammatory reaction, further increasing capillary permeability, inducing clinically appreciable pleural effusions through haemorrhage into the pleural space . This inflammatory reaction likely manifests as PCP.…”

Clinical relevance of bilateral pleural effusion in patients with acute pulmonary embolism

“…Recently published retrospective cohort studies have addressed the prognostic impact of pleural effusion in patients with PE. [9][10][11] This study shows that comorbidities play a key role in the development of pleural effusion in many patients with acute PE. Thus, discussion on pleural effusion as prognostic factor should address underlying comorbidities.…”

“…7,8 However, recent retrospective studies that addressed the prognostic impact of pleural effusion in cohorts of patients with acute PE have reported contradictory results. [9][10][11] It is not uncommon to observe bilateral pleural effusion (BPE) on CTPA scans of patients with acute PE. The clinical relevance of bilateral effusion may differ from that of unilateral effusion.…”