Hydrothorax in congestive heart failure

Management of Transudative Effusions

“…Of the patients with unilateral effusion, 46% had either pneumonia or pulmonary embolus. In this autopsy series 12 the mean volume of fluid in the right pleural space (1,084 ml) was just slightly greater than the mean volume of fluid in the left pleural space (913 ml).…”

“…This conclusion is also supported by an autopsy study of nearly 300 patients with congestive heart failure. 12 In this series 88% of the patients had bilateral pleural effusions, 8.3% had unilateral right-sided effusions, and 3.8% had unilateral left-sided effusions. Of the patients with unilateral effusion, 46% had either pneumonia or pulmonary embolus.…”

Transudative effusions

“…Indeed, in a large autopsy series, 290 of 402 (72%) patients with congestive failure had pleural effusions. Bilateral effusions were found in 88%; only 8 and 4% had unilateral effusions in the right and left hemithoraces, respectively [3].…”

“…Atypical radiographic presentation should arouse clinical suspicion of other causes for the effusion(s). Unilateral effusions do occur but, as noted above, are uncommon [3]. Similarly, bilateral effusions in the absence of cardiomegaly are usually not due to congestive heart failure [12].…”

Pleural Effusions from Pulmonary Thromboembolism

“…The awareness of this point becomes more important considering that autopsy series of patients with congestive heart failure and pleural effusions demonstrate a 21% incidence of pulmonary embolism. 32 The foregoing information indicates that the pleural fluid profile in pulmonary embolism is so highly variable that no characteristic pattern emerges. A bloody effusion, however, should suggest the diagnosis, particularly if trauma, malignancy, and postcardiac injury syndrome are not diagnostic considerations.…”