![]() 3 Postcardiac injury syndrome should be considered in cases of fever, dyspnea, and pleuritic chest pain up to 3 weeks following cardiac surgery. Physical findings such as ascites may indicate cirrhosis, ovarian cancer, or Meigs syndrome. Recent esophageal procedures or history of alcohol binging suggest pleural effusion related to esophageal rupture. Previous exposure to asbestos may be the cause of benign or malignant effusion related to mesothelioma. Trauma may result in hemothorax or chylothorax. Recent leg swelling or deep vein thrombosis may result in an effusion related to pulmonary embolism. Older age, weight loss, and a history of smoking point towards a diagnosis of malignant pleural effusion. A history of cardiac, renal, or liver impairment can suggest transudative effusion. A history of pneumonia suggests parapneumonic effusion, either complicated (empyema or empyema-like) or uncomplicated. History provides information about the possible etiology of pleural effusion and guidelines for necessary investigations. Surgery may be needed in selected cases where drainage procedure fails to produce improvement or to restore lung function and for closure of bronchopleural fistula. Empyemas need to be treated with appropriate antibiotics and intercostal drainage. Percutaneous closed pleural biopsy is easiest to perform, the least expensive, with minimal complications, and should be used routinely. Pleural biopsy is recommended for evaluation and exclusion of various etiologies, such as tuberculosis or malignant disease. Malignant effusions are usually drained to palliate symptoms and may require pleurodesis to prevent recurrence. Management of exudative effusion depends on the underlying etiology of the effusion. However, a large, refractory pleural effusion, whether a transudate or exudate, must be drained to provide symptomatic relief. Transudative effusions are usually managed by treating the underlying medical disorder. Immunohistochemistry provides increased diagnostic accuracy. The diagnostic evaluation of pleural effusion includes chemical and microbiological studies, as well as cytological analysis, which can provide further information about the etiology of the disease process. Laboratory testing helps to distinguish pleural fluid transudate from an exudate. Thoracocentesis should be performed for new and unexplained pleural effusions. However, the etiology of pleural effusion remains unclear in nearly 20% of cases. To treat pleural effusion appropriately, it is important to determine its etiology. ![]() Patients most commonly present with dyspnea, initially on exertion, predominantly dry cough, and pleuritic chest pain. It can pose a diagnostic dilemma to the treating physician because it may be related to disorders of the lung or pleura, or to a systemic disorder. A pleural effusion is an excessive accumulation of fluid in the pleural space.
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