From the Research
The cause of pleural effusion in yellow nail syndrome is primarily lymphatic dysfunction, as evidenced by the most recent and highest quality study 1, which suggests that the syndrome is associated with impaired lymphatic drainage, leading to the accumulation of fluid in the pleural space.
Pathophysiology of Yellow Nail Syndrome
The pathophysiology of yellow nail syndrome involves increased capillary permeability and reduced lymphatic clearance, causing fluid to accumulate in the pleural space. This lymphatic dysfunction appears to be congenital in some cases but can also develop later in life, sometimes in association with other conditions such as malignancies, autoimmune diseases, or certain medications.
Characteristics of Pleural Effusion in Yellow Nail Syndrome
The pleural fluid in yellow nail syndrome is typically exudative with high protein content and predominantly lymphocytic, as reported in a systematic review of 112 studies 2. The appearance of the fluid is usually serous, but can also be milky or purulent. The pleural effusion is often bilateral and can be treated with pleurodesis or decortication/pleurectomy.
Treatment of Pleural Effusion in Yellow Nail Syndrome
Treatment of pleural effusion in yellow nail syndrome focuses on managing the effusion through thoracentesis or pleurodesis, rather than addressing the underlying lymphatic abnormality, which is generally not reversible. According to a review of management options 1, pleurodesis and decortication/pleurectomy are effective in treating symptomatic pleural effusions. Additionally, octreotide has been used to treat pleural effusions in yellow nail syndrome, with some success 3.
Key Points
- Lymphatic dysfunction is the primary cause of pleural effusion in yellow nail syndrome
- The pleural fluid is typically exudative with high protein content and predominantly lymphocytic
- Treatment focuses on managing the effusion through thoracentesis or pleurodesis
- Pleurodesis and decortication/pleurectomy are effective in treating symptomatic pleural effusions
- Octreotide may be used to treat pleural effusions in yellow nail syndrome, but its effectiveness is variable.