From the Guidelines
Bilateral pleural effusion is likely to present with decreased or absent breath sounds on both sides of the chest, along with other symptoms such as shortness of breath and chest pain. The clinical presentation of bilateral pleural effusion can vary depending on the underlying cause, but common symptoms include:
- Shortness of breath
- Chest pain
- Cough
- Decreased breath sounds on both sides of the chest Management of bilateral pleural effusion involves identifying and treating the underlying cause, which can include heart failure, liver cirrhosis, nephrotic syndrome, or malignancy, as noted in the European Respiratory Journal study 1. The diagnostic workup for bilateral pleural effusion typically includes:
- Chest X-ray
- Thoracic ultrasound
- Thoracentesis to analyze pleural fluid Treatment for symptomatic effusions involves therapeutic thoracentesis to remove fluid, which can provide immediate relief, as suggested by the study 1. For cases where the aetiology is fluid overload, aggressive medical management or renal replacement therapy (RRT) can adequately treat pleural effusions, but the choice of treatment should be guided by patient choice and available treatment methods, with serial thoracocentesis offered as the first treatment option, and indwelling pleural catheters (IPCs) or attempted talc pleurodesis reserved for refractory cases, as recommended by the authors of the study 1. Supplemental oxygen should be provided for hypoxemia, and respiratory therapy with incentive spirometry can help prevent atelectasis. The prognosis varies significantly depending on the underlying cause, with malignant effusions generally carrying a poorer prognosis than those caused by treatable conditions like heart failure.
From the Research
Clinical Presentation of Bilateral Pleural Effusion
- Bilateral pleural effusions are typically seen in conditions such as congestive heart failure, renal failure, and hepatic cirrhosis 2
- The fluid in bilateral pleural effusions due to heart failure usually meets the biochemical characteristics of a transudate, although in some cases it may fall into the exudative range 2
- Patients with bilateral pleural effusions may present with symptoms such as dyspnea, cough, and chest pain 3, 4
- Lung sounds in bilateral pleural effusion may include decreased breath sounds, dullness to percussion, and crackles 4
Management of Bilateral Pleural Effusion
- The management of bilateral pleural effusion depends on the underlying cause, with medical management being the mainstay for many conditions 5, 2
- Treatment options for bilateral pleural effusion include diuretics for heart failure, antibiotics for infections, and chemotherapy or radiation therapy for malignancies 3, 4
- In some cases, interventions such as thoracentesis, tunneled indwelling pleural catheter, or pleurodesis may be necessary to manage the effusion 5, 6
- Point-of-care ultrasound can be used to guide thoracentesis and reduce complications 4
- The use of natriuretic peptides, such as NT-proBNP, can aid in diagnosing or excluding heart failure in patients with pleural effusion of unknown origin 2