Differential Diagnosis for Pleural Effusions
The following is a list of potential causes of pleural effusions, categorized by their likelihood and potential impact on patient outcomes.
Single Most Likely Diagnosis
- Congestive Heart Failure (CHF): This is often the most common cause of pleural effusions, especially in patients with a history of heart disease. CHF leads to fluid buildup in the lungs, which can cause pleural effusions.
Other Likely Diagnoses
- Pneumonia: Bacterial, viral, or fungal infections can cause pleural effusions, especially if the infection spreads to the pleural space.
- Malignancy: Lung cancer, breast cancer, and lymphoma are common causes of malignant pleural effusions.
- Pulmonary Embolism (PE): A blood clot in the lungs can cause a pleural effusion, especially if the clot is large or if there is associated lung infarction.
- Nephrotic Syndrome: Severe proteinuria and hypoalbuminemia can lead to fluid accumulation in the pleural space.
Do Not Miss Diagnoses
- Tuberculosis (TB): Although less common in some regions, TB is a critical diagnosis to consider, as untreated TB can be fatal.
- Esophageal Rupture: A rupture of the esophagus can lead to a pleural effusion, which can be life-threatening if not promptly treated.
- Trauma: Traumatic injuries, such as a rib fracture or penetrating trauma, can cause a pleural effusion, especially if there is associated bleeding or lung injury.
Rare Diagnoses
- Asbestos-Related Disease: Asbestos exposure can cause pleural effusions, often in the context of other asbestos-related diseases, such as asbestosis or mesothelioma.
- Sarcoidosis: This autoimmune disease can cause pleural effusions, although this is a less common manifestation.
- Lymphangioleiomyomatosis (LAM): A rare lung disease that can cause pleural effusions, often in women of childbearing age.
- Chylothorax: A rare condition where lymphatic fluid accumulates in the pleural space, often due to trauma, surgery, or malignancy.