2 Cases of Pleural Effusion

Today we discussed 2 interesting cases of pleural effusions.

1) 56 yo Haitian man presented with DOE, LE edema and large right-sided pleural effusion. Thoracentesis showed a transudative effusion. His final diagnosis was systolic heart failure. Don’t forget, heart failure is known to lead to unilateral effusions on the right. No one knows why, it is speculated that larger pleural surface on right leads to greater surface for fluid to “leak” out. Remember that in order of incidence, you will see: bilateral effusions > right-sided unilateral effusion > left-sided unilateral effusions.

Pleural Effusions from Congestive Heart Failure – Semin Respir Crit Care Med. 2010 Dec;31(6):689-97.

2) 75 yo Haitian woman presents with left-sided chest pain and is found to have moderate-sized right pleural effusion. Workup included CT-Thorax, which found pulmonary embolus. Is pulmonary embolus a common reason for moderate to large effusions? It’s a lot more common than you think! Think about ruling out PE in patients with pleural effusions, particularly those with risk factors.

Pleural Effusion In Pulmonary Embolism – Semin Respir Crit Care Med. 2010 Dec;31(6):716-22. Epub 2011 Jan 6.

Finally, getting pleural fluid is central in the diagnosis of pleural effusions. However, the risk of pneumothorax is often what makes people nervous about thoracentesis. This meta-analysis, with our own Craig Gordon as an author, describes factors that lead to better outcomes.

Pneumothorax Following Thoracentesis – ARCH INTERN MED/ VOL 170 (NO. 4), FEB 22, 2010