Pleural effusions: collections of fluid in the pleural space.

Etiologies of Pleural Effusions

Pleural Fluid Analysis

Light's Criteria

Criteria	Cutoff
LDH
Protein

Classification and Management of Pleural Effusions

Transudative Effusions

Exudative Effusions

Complicated Parapneumonic Effusion

Empyema

Malignant Pleural Effusions

Typically lung, breast, and lymphomas. Most likely from malignant seeding to visceral pleural and other mechanisms such as direct invasion, hematogenous of lymphangitic spread are also possible.

This is very often a palliative event. The median survival is approximately 4 months after recognition of a malignant pleural effusion. The prognosis also depends on whether the underlying tumour will respond to systemic or targeted therapies.

Treatment depends on the goals of care and symptom burden. Leave asymptomatic ones alone. If symptomatic, then consider therapy for the underlying tumour --> palliative therapy directed at the pleural space such as indwelling catheter drains.

Chylothorax and Pseudochylothorax

Pseudochylothorax generally from chronic inflammation (RA, TB).

Management of Pleural Effusions

Referenecs

1. BTS Guidelines
2. IMR 2023
3. McMaster IM Review Course