Pleural Effusion in Adults—Etiology, Diagnosis, and Treatment

Abstract

Background: Pleural effusion is common in routine medical practice and can be due to many different underlying diseases. Precise differential diagnostic categorization is essential, as the treatment and prognosis of pleural effusion largely depend on its cause. Methods: This review is based on pertinent publications retrieved by a selective search in PubMed and on the authors' personal experience. Results: The most common causes of pleural effusion are congestive heart failure, cancer, pneumonia, and pulmonary embolism. Pleural fluid puncture (pleural tap) enables the differentiation of a transudate from an exudate, which remains, at present, the foundation of the further diagnostic work-up. When a pleural effusion arises in the setting of pneumonia, the potential development of an empyema must not be overlooked. Lung cancer is the most common cause of malignant pleural effusion, followed by breast cancer. Alongside the treatment of the underlying disease, the specific treatment of pleural effusion ranges from pleurodesis, to thoracoscopy and video-assisted thoracoscopy (with early consultation of a thoracic surgeon), to the placement of a permanently indwelling pleural catheter. Conclusion: The proper treatment of pleural effusion can be determined only after meticulous differential diagnosis. The range of therapeutic options has recently become much wider. More data can be expected in the near future concerning diagnostic testing for the etiology of the effusion, better pleurodetic agents, the development of interventional techniques, and the genetic background of the affected patients.

CT characteristics and diagnostic value of COVID-19 in pregnancy

“…The infection might have caused thickening and congestion of the visceral pleura, and increased vascular permeability, resulting in induction of pleural effusion. The gradient movement of exudate across the visceral pleura in a gradient might have resulted in pleural effusion [6]. c) All the patients in this group were women with late pregnancy at 36-38 weeks of gestation, and late pregnant women are prone to chest leakage due to increased blood volume.…”

The Diagnose of Pleura Effusion

“…Suatu penelitian di Jerman menyatakan bahwa insidensi efusi pleura disana mencapai kira-kira 400-500 ribu per tahun. Penelitian ini juga menyatakan bahwa penyebab paling umum dari efusi pleura ialah gagal jantung kongestif, kanker, pneumonia, dan embolisme pulmonal (Jany & Welte, 2019). Insidensi di Amerika mencapai angka 1.5 juta per tahun.…”

“…Faktor 'banyaknya cairan yang didrainase' menjelaskan bahwa bukan karena banyak cairan yang didrainase hingga menyebabkan rekurensi, namun faktor ini hanya menjadi marker untuk kejadian rekurensi (Boshuizen, Vincent, & Heuvel, 2013;Grosu et al, 2019). Penelitian ini juga menemukan bahwa adanya kecurigaan tinggi terhadap pneumonia, efusi kontralateral, dan hasil sitologi yang negatif menjadi faktor penurun probabilitas terjadinya rekurensi (Grosu et al, 2019 (Light, MacGregor, Luchsinger, & Ball, 1972 (Han et al, 2015;Jany & Welte, 2019). Kejadian hepatik hidrotoraks diperiksa lebih lanjut dengan pengukuran biomarker transaminase sebagai penanda terjadinya sirosis hepatis.…”

“…Efusi pleura juga dapat terjadi pada pasien dengan gagal ginjal. Kerusakan ginjal dapat diketahui dengan melakukan pengukuran pada kadar protein urin (Jany & Welte, 2019).…”

“…Terapi diberikan berdasarkan etiologi yang telah ditemukan. Efusi pleura diharapkan untuk membaik setelah etiologi dihilangkan (Jany, 2019) (Jany & Welte, 2019).…”