Pulmonology Book

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Pleural Effusion Causes

Aka: Pleural Effusion Causes, Transudate Pleural Effusion Causes, Exudate Pleural Effusion Causes, Empyema Pleural Effusion Causes, Bloody Pleural Effusion Causes, Parapneumonic Effusion
  1. See Also
    1. Pleural Effusion
    2. Thoracentesis
    3. Pleural Fluid Interpretation
    4. Medication Causes of Pleural Effusion
  2. Causes: Most Common
    1. Transudate
      1. Congestive Heart Failure
      2. Cirrhosis
    2. Exudate
      1. Pneumonia
      2. Cancer
      3. Pulmonary Embolism
      4. Viral respiratory infection
      5. Coronary Artery Bypass Graft (CABG) Surgery (or other recent cardiac surgery)
    3. References
      1. Light (2002) N Engl J Med 346:1971-7 [PubMed]
  3. Causes: Transudate
    1. See Transudate Pleural Effusion Findings
    2. Congestive Heart Failure
    3. Pneumonia
    4. Nephrotic Syndrome or hypoalbuminemia
    5. Pulmonary Atelectasis
    6. Peritoneal Dialysis
    7. Constrictive Pericarditis
    8. Obstruction of superior vena cava
    9. Cirrhosis
  4. Causes: Exudate
    1. See Exudate Pleural Effusion Findings
    2. See Medication Causes of Pleural Effusion
    3. Cardiovascular
      1. Pulmonary Embolism
      2. Pulmonary vein stenosis
      3. Pericarditis
    4. Parapneumonic Effusion (Pneumonia with effusion)
      1. Bacterial Pneumonia
      2. Mycobacterium tuberculosis
    5. Malignancy
      1. Lung Cancer (36%) including Mesothelioma
      2. Breast Cancer (25%)
      3. Lymphoma (10%)
      4. Primary pleural malignancy
      5. Meigs Syndrome (history of ovarian tumor)
    6. Dressler's Syndrome
      1. Post-Myocardial Infarction
      2. Post-Cardiotomy
    7. Gastrointestinal Disease
      1. Esophageal Perforation
      2. Pancreatitis
      3. Intraabdominal abscess
    8. Genitourinary conditions
      1. Endometriosis
      2. Ovarian hyperstimulation syndrome
      3. Postpartum effusion
    9. Medications
      1. See Medication Causes of Pleural Effusion
    10. Miscellaneous exudative causes
      1. Chylothorax
      2. Pseudochylothorax
      3. Nephrotic Syndrome
      4. Rheumatoid Arthritis
      5. Yellow Nail Syndrome
  5. Causes: Grossly Bloody Effusion (>100,000 cells/cu mm)
    1. See Bloody Pleural Effusion Findings
    2. Hemothorax due to Trauma (including recent chest surgery)
    3. Pulmonary Embolism
    4. Malignancy
    5. Pneumonia
  6. Causes: Empyema (pus collection, Bronchopleural Fistula)
    1. See Empyema Pleural Effusion Findings
    2. Infection
      1. Pneumonia (50% of empyema causes)
      2. Abscess
        1. Lung Abscess
        2. Subphrenic abscess
      3. Mycobacterium tuberculosis
      4. Fungal infections
    3. Chest Trauma (especially penetrating chest wounds)
    4. Spontaneous Pneumothorax
  7. Causes: Other findings
    1. Lymphocytosis
      1. Lymphoma (esp. if >90%)
      2. Mycobacterium tuberculosis (esp. if >90%)
      3. Other causes which less commonly cause Lymphocytosis
        1. Pulmonary Embolism
        2. Post-CABG effusion
        3. Rheumatoid Arthritis
        4. Sarcoidosis
        5. Chylothorax
    2. Loculated Effusion
      1. Empyema
      2. Hemothorax
      3. Tuberculosis
    3. Massive pulmonary effusion
      1. Cancer (represents >50% of cases)
      2. Empyema
      3. Mycobacterium tuberculosis
  8. References
    1. Light (2002) N Engl J Med 346:1971-7 [PubMed]
    2. Medford (2005) Postgrad Med J 81 (961):702-10 [PubMed]
    3. Porcel (2006) Am Fam Physician 73:1211-20 [PubMed]
    4. Rabman (2005) Br Med Bull 72:31-47 [PubMed]
    5. Saguil (2014) Am Fam Physician 90(2): 99-104 [PubMed]

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