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Feller-Kopman DJ, Reddy CB, DeCamp MM, et al. Management of Malignant Pleural Effusions. An Official ATS/STS/STR Clinical Practice Guideline. Am J Respir Crit Care Med. 2018 Oct 1;198(7):839-849. doi: 10.1164/rccm.201807-1415ST. PubMed PMID: 30272503.
Davies HE, Davies RJ, Davies CW; BTS Pleural Disease Guideline Group. Management of pleural infection in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010 Aug;65 Suppl 2:ii41-53. doi: 10.1136/thx.2010.137000. Review. PubMed PMID: 20696693.
Hooper C, Lee YC, Maskell N; BTS Pleural Guideline Group. Investigation of a unilateral pleural effusion in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010 Aug;65 Suppl 2:ii4-17. doi: 10.1136/thx.2010.136978. PMID: 20696692.
Also see Pleural Effusion.
Transudative pleural effusions accumulate in the pleural space as a result of increase in the hydrostatic pressure in the pleural capillaries (mainly in the parietal pleura), decrease in the osmotic or oncotic pressure, or less commonly as a result of fluid translocation from the peritoneal cavity.
A transudate is a clear pale-yellow fluid with low protein and lactate dehydrogenase (LDH) levels, pH usually >7.35, and low cell counts comprising mostly lymphocytes.
Causes: Heart failure, cirrhosis, mitral stenosis, diseases of the pericardium, pulmonary embolism (rare), hypothyroidism, hypoalbuminemia, nephrotic syndrome, peritoneal dialysis, and urinothorax (presence of urine in the pleural cavity due to retroperitoneal leakage of urinoma).
TreatmentTop
Treatment is limited to management of the underlying condition. In patients with cirrhosis and recurrent transudative pleural effusions, consider transjugular intrahepatic portosystemic shunt (TIPS).
