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.
EtiologyTop
Pleural exudate is caused by inflammation or malignancy, leading to high protein and lactate dehydrogenase (LDH) levels.
Causes: Pneumonia (most often bacterial, including tuberculosis; less commonly viral or parasitic pneumonia), tuberculosis, malignancy (including lung malignancy and ovarian fibroma or sex-cord stromal tumor [Meigs syndrome]), pulmonary embolism (usually serosanguineous fluid is present, almost always accompanied by pulmonary infarction), esophageal perforation, pancreatitis, injuries to lymphatic or vascular systems causing chylothorax or hemothorax, thoracic or abdominal surgery, autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus), drug-induced reactions (amiodarone, nitrofurantoin, phenytoin, methotrexate, carbamazepine, procainamide, propylthiouracil, penicillamine, cyclophosphamide, and bromocriptine), cardiac surgery, and thoracic irradiation.