What happens if a pleural effusion does not get treated with a thoracentesis (pleural fluid drainage procedure)?

From the Guidelines

If a pleural effusion is not treated with thoracentesis, it can lead to severe complications, including respiratory failure, infection spread, and decreased quality of life, emphasizing the importance of prompt intervention. The fluid accumulation in the pleural space can progressively worsen, causing increasing compression of the lung tissue, which can lead to breathing difficulties, shortness of breath, and decreased oxygen levels in the blood 1. In severe cases, untreated pleural effusions can cause respiratory failure requiring emergency intervention. Additionally, if the effusion is due to infection (empyema), the infection can spread and worsen without drainage, potentially leading to sepsis. Malignant effusions that remain untreated can contribute to cancer progression and worsening quality of life. Some key considerations for managing pleural effusions include:

• The use of a “definitive” pleural procedure after recurrence of pleural fluid after an initial thoracentesis, as recommended by guidelines 1
• The importance of definitive pleural intervention at the appropriate time in the treatment process, as it can reduce the need for additional pleural procedures, emergency department visits, and complications 1
• The role of pleurodesis, which involves the administration of a drug or material in the pleural space to cause adhesions between the parietal and visceral pleura, and prevention of fluid reaccumulation, with talc being the most widely used and effective pleurodesis agent 1. Large effusions can also cause mediastinal shift, where the heart and other structures are pushed away from their normal position, potentially compromising cardiac function. The fluid may also become loculated (divided into compartments) over time, making later drainage procedures more difficult and less effective. Some effusions, particularly smaller ones caused by conditions that resolve on their own, may reabsorb naturally without intervention, but significant effusions typically require thoracentesis or other interventions to prevent these complications and relieve symptoms.

From the Research

Untreated Plural Effusion

• If a plural effusion does not get treated with a thoracentesis, it can lead to various complications, including worsening of symptoms such as dyspnea, cough, and pleuritic chest pain 2.
• The etiology of the pleural effusion remains unclear in nearly 20% of cases, making it essential to determine the underlying cause to provide appropriate treatment 2.
• Untreated pleural effusions can progress to more severe conditions, such as empyema, which requires prompt antibiotic treatment and intercostal drainage 3.

Consequences of Not Treating Plural Effusion

• Failure to treat a plural effusion can result in a large, refractory pleural effusion, which must be drained to provide symptomatic relief 2.
• Malignant effusions, if left untreated, can lead to significant morbidity and mortality, emphasizing the need for prompt diagnosis and treatment 4, 5.
• The management of pleural effusion depends on the underlying etiology, and untreated cases can lead to prolonged hospitalization, increased healthcare costs, and decreased quality of life 6.

Importance of Thoracentesis

• Thoracentesis is a crucial diagnostic and therapeutic procedure for pleural effusions, allowing for the differentiation of transudates from exudates and guiding further treatment 2, 5.
• The procedure can provide symptomatic relief, improve lung function, and prevent complications associated with untreated pleural effusions 4, 6.
• Thoracentesis can be performed safely and effectively, with minimal complications, making it a vital component of pleural effusion management 4.