Abstract

Pleural effusion is the result of an imbalance between absorption and secretion of pleural fluid. The etiology can be malignant or benign. Congestive heart failure and pneumonia are the two most common causes of benign pleural effusion, while lung and breast cancer are the most common causes of a malignant pleural effusion. Typical symptom is a pleuritic chest pain and in case of a large effusion dry cough and shortness of breath can accompany chest pain. Most effusions can be recognized on plain chest X-ray. Chest CT can give additional information on the status of underlying lung parenchyma and hence the possible etiology of the effusion. Thoracentesis should be performed if an effusion is found. The fluid should be undergo biochemical, microbiological and cytologic analysis and the treatment should be determined according to the etiology. Primary disease is the target of treatment in benign pleural effusions. In malignant pleural effusions, the recurrence of effusion is common and should be prevented. Median survival in a patient with malignant pleural effusion is 3 months. Eighty-four percent of patients die within 6 months. If the lung expands following drainage of the fluid, pleurodesis should be performed. Pleurodesis can be done at bedside or in the operating room using VATS. Pleurodesis can be performed by using talc, bleomycin and tetracycline. Talc has a 95% success rate, but can cause lung edema in rare instances. If lung does not expand following drainage of pleural fluid, chronic drainage options should be considered. Chronic pleural catheter and pleuroperitoneal shunt are among those options. In several series success rates with these techniques have been reported to 90%. Decortication can be another option for patients with longer survival expectations.