From the Guidelines
The treatment for pleural effusion is primarily palliative, aiming to relieve symptoms such as breathlessness, with options including therapeutic thoracentesis, chest tube insertion with intrapleural sclerosant, thoracoscopy with talc poudrage, and indwelling pleural catheter drainage.
Treatment Options
- Therapeutic thoracentesis: provides transient and rapid relief of dyspnea, but has a high recurrence rate and risks iatrogenic empyema and pneumothorax 1
- Chest tube insertion with intrapleural sclerosant: has a success rate of over 60%, but may cause side effects from the sclerosants 1
- Thoracoscopy with talc poudrage: has a high success rate of around 90%, but is an invasive procedure and may not be widely available 1
- Indwelling pleural catheter drainage: suitable for outpatient setting, but may lead to local infection and has a modest success rate 1
Patient Selection
The choice of treatment depends on the patient's symptoms, general health, functional status, and expected survival, with the major indication for treatment being relief of dyspnea 1.
Pleurodesis
Pleurodesis is a common treatment approach, with talc pleurodesis being a highly effective option, but requiring complete lung expansion to be successful 1.
Treatment of Pleurodesis Failure
In cases of pleurodesis failure, alternatives such as repeat pleurodesis, pleuroperitoneal shunting, or pleurectomy may be considered, depending on the patient's clinical condition and expected survival 1.
From the Research
Treatment Options for Pleural Effusion
The treatment of pleural effusion depends on the underlying cause and can range from medical therapies to invasive surgical procedures 2, 3, 4, 5, 6.
- The treatment of the underlying disease is crucial in managing pleural effusion.
- Specific treatment options for pleural effusion include:
- Pleurodesis: a procedure that involves introducing a substance into the pleural space to cause inflammation and adhesion of the pleural membranes, preventing further fluid accumulation 2, 5, 6.
- Thoracoscopy and video-assisted thoracoscopy: minimally invasive surgical procedures that allow for the drainage of pleural fluid and the diagnosis of underlying conditions 2.
- Placement of a permanently indwelling pleural catheter: a procedure that allows for the continuous drainage of pleural fluid and can be used in patients with recurrent pleural effusions 2, 6.
- Therapeutic thoracentesis: a procedure that involves the removal of pleural fluid for diagnostic and therapeutic purposes 3, 4, 5.
Management of Transudative and Exudative Effusions
- Transudative effusions are usually managed by treating the underlying medical disorder, such as congestive heart failure, cirrhosis, or nephrosis 3, 4, 5.
- Exudative effusions require further evaluation to determine the underlying cause, and treatment depends on the etiology of the effusion 3, 4, 5.
- Malignant effusions are usually drained to palliate symptoms and may require pleurodesis to prevent recurrence 2, 4, 6.
Diagnostic Evaluation
- The diagnostic evaluation of pleural effusion includes chemical and microbiological studies, as well as cytological analysis, which can provide further information about the etiology of the disease process 3, 4, 5.
- Light's criteria can help differentiate exudates from transudates, and pleural fluid puncture (pleural tap) enables the differentiation of a transudate from an exudate 2, 3, 5.
- Point-of-care ultrasound can guide thoracentesis and reduce complications, and computed tomography of the chest can exclude other causes of dyspnea and suggest complicated parapneumonic or malignant effusion 3.