Pathological accumulation of fluid in the pleural space, classified as transudate or exudate by Light's criteria.
Investigations
- • CXR (blunted costophrenic angle) and thoracic ultrasound before any tap
- • Pleural fluid protein, LDH, pH, glucose, cytology, culture
- • Serum protein and LDH for Light's criteria
- • CT with contrast if exudative and undiagnosed
Management
- • Treat the cause: diuretics for heart failure transudate
- • Chest drain if empyema, pH <7.2 or frank pus
- • Therapeutic aspiration ≤1.5 L at a time (re-expansion oedema)
- • Indwelling pleural catheter or talc pleurodesis for malignant effusion
Clinical pearls
- • Light's criteria over-call exudates in diuresed heart failure — use serum-effusion albumin gradient >12 g/L
- • Never insert a drain without ultrasound guidance
Related in WardRound
Educational — verify locally.
