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Pleural Effusion

Pleural Effusion is a topic covered in the 5-Minute Emergency Consult.

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  • Normal conditions:
    • Pleural space contains 0.1–0.2 mL/kg (30 mL in an adult) of clear, low-protein fluid that facilitates movement of the pulmonary parenchyma within the thoracic space.
    • Fluid formation and reabsorption are governed by hydrostatic and oncotic forces.
    • Normally, the sum of these forces results in movement of fluid into the pleural space from the parietal surface and reabsorption at the visceral surface.
    • Lymphatics help remove any excess fluid.
  • Alteration of any of the above factors results in abnormal fluid accumulation.
  • Classification:
    • Transudative effusion:
      • An ultrafiltrate of serum, containing low protein and cells
      • Results from increase in hydrostatic pressure and/or decrease in oncotic pressure
      • Pleural surface is not involved in the primary pathologic process.
    • Exudative effusion:
      • Contains high protein and cells
      • Results from pathologic disease of the pleural surface leading to membrane permeability and/or disruption of lymphatic reabsorption


  • Transudative effusions:
    • Congestive heart failure (CHF)
    • Peritoneal dialysis
    • Cirrhosis with ascites
    • Pulmonary embolism
    • Acute atelectasis
    • Nephrotic syndrome
    • Myxedema
    • Hypoproteinemia
    • Superior vena cava syndrome
    • Meigs syndrome:
      • Triad of ascites, benign ovarian tumor, and pleural effusion
  • Exudative effusions:
    • Pulmonary or pleural infection:
      • Bacterial, viral, fungal, tuberculosis (TB), parasitic
    • Primary lung cancer
    • Mesothelioma
    • Metastasis (often from breast cancer, ovarian cancer, or lymphoma)
    • Pericarditis
    • Pulmonary embolism
  • Intra-abdominal disorders:
    • Pancreatitis, hepatitis, cholecystitis
    • Subdiaphragmatic abscess
    • Esophageal rupture
    • Peritonitis
    • Meigs syndrome
  • Rheumatologic disease:
    • Systemic lupus erythematosus
    • Rheumatoid arthritis
    • Sarcoidosis
  • Trauma:
    • Hemothorax
    • Chylothorax
  • Drugs:
    • Drug-induced lupus
    • Nitrofurantoin, methysergide, dantrolene, amiodarone, bromocriptine
    • Crack cocaine

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Rosen, Peter, et al., editors. "Pleural Effusion." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307132/0.1/Pleural_Effusion.
Pleural Effusion. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307132/0.1/Pleural_Effusion. Accessed June 18, 2019.
Pleural Effusion. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307132/0.1/Pleural_Effusion
Pleural Effusion [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 June 18]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307132/0.1/Pleural_Effusion.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Pleural Effusion ID - 307132 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307132/0.1/Pleural_Effusion PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -