Pleural effusion: recognition, triage and treatment
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Pleural effusion has many possible causes, some of which are life-threatening and require urgent treatment, but is often not recognised because of its nonspecific presentation. Three cases illustrate the steps in recognising and triaging patients with pleural effusion.
- Pleural effusion can be a complication of a range of acute and chronic lung and extrapulmonary diseases, some of which are life-threatening and require urgent treatment.
- Patients with pleural effusion often present first to their GP with nonspecific respiratory symptoms.
- GPs should be vigilant and have a low threshold for excluding or confirming the diagnosis of pleural effusion, for example by ordering a chest x-ray.
- Triage of patients with pleural effusion for urgent, semi-urgent or elective referral is based on clinical parameters (e.g. presence of infective symptoms, recent trauma or bleeding risk, effusion size and suspicion of pulmonary embolism or malignancy).
- Patients with suspected empyema, haemothorax, pulmonary embolism-related pleural effusion or massive pleural effusion require urgent referral to a centre with pleural specialist support.
Pleural effusion is common and can be a complication of a wide range of lung and extrapulmonary diseases. Many patients with pleural effusion present first to their GP, but the diagnosis can be easily missed, partly because of the nonspecific presentation of most pleural effusions. If clinicians fail to recognise or suspect a pleural effusion then patients may be sent down an incorrect pathway for unnecessary investigations. More importantly, the diagnosis of any underlying (and often sinister) cause may be missed. Hence, the recognition of pleural effusions poses a significant challenge to GPs in their daily practice.
Pleural disorders
Lung diseases
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