important considerations in evaluation of patient with a pleural effusion

Last reviewed 01/2021

evaluation of patients with pleural effusion

A complete history and physical examination should be performed in all patients. The initial history should be aimed at identify the severity and rate of onset of symptoms in order to decide the need for intervention, and for exploration of any potential causes.

Rapid development (over hours to days rather than weeks to months) of effusion may be caused by limited number of conditions e.g. - injury to the chest wall or recent chest infection (parapneumonic). A chronic process should be suspected in effusions which appear more slowly

Important points to inquire from patients with suspected or confirmed effusions include:

• severity, duration, and rate of onset of breathlessness, cough, or chest pain
  
  
• constitutional symptoms (fevers, sweats, or weight loss) which may indicate empyema, malignancy, or tuberculous pleuritis
  
  
• recent injury or interventions to the chest
  
  
• history of malignancy, or current active malignancy
  
  
• previous exposure to tuberculosis
  
  
• occupational history
• specially exposure to asbestosis and the level of exposure
  
  
• history of tobacco smoking
  
  
• complete history of medications used and any recent changes to prescriptions
  
  
• evidence of uncontrolled cardiac, hepatic, or renal failure

Opinion of secondary care providers may be necessary in patients with unexplained unilateral effusion, non-resolving bilateral effusions, or effusions due to suspected chronic infection, malignancy, or haemothorax (1).

Reference:

• (1) Bhatnagar R, Maskell N. The modern diagnosis and management of pleural effusions. BMJ. 2015;351:h4520.