Pleural effusion causes
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Prince Tano Djan, BSc, MBChB [2]; Nate Michalak, B.A.
Overview
Common causes of transudative pleural effusion include left ventricular failure, nephrotic syndrome, and cirrhosis.[1][2][3][4][5] Common causes of exudative pleural effusions include: bacterial pneumonia, cancer (with lung cancer, breast cancer, and lymphoma causing approximately 75% of all malignant pleural effusions), viral infection, and pulmonary embolism.[6] Pulmonary embolism may lead to formation of either transudate or exudate, however, an exudate is commonly observed.
Causes of Transudates
Most Common Causes
Most common causes of transudative pleural effusion include:[1][2][3][4][5][7][8][9]
Less Common Causes
- Hypothyroidism
- Mitral stenosis
- Pulmonary embolism (tends to produce a comparatively small effusion but disproportionate dyspnea and pleuritic pain; 80% are exudates, 20% are transudates).
Rare Causes
- Superior vena cava obstruction (usually due to lung cancer)
- Constrictive pericarditis
- Ovarian hyperstimulation
- Meigs' syndrome (benign ovarian tumor, ascites, and pleural effusion)
Causes of Exudates
Most Common Causes
Most common causes of exudative pleural effusion include:[6]
- Bacterial pneumonia
- Malignancy (lung cancer, breast cancer, and lymphoma)
- Pulmonary embolism
Less Common Causes
- Pulmonary infarction (usually resulting from pulmonary embolism)
- Autoimmune disease, especially rheumatoid arthritis and systemic lupus erythematosus
- Asbestos exposure
- Pancreatitis
- Complication of acute myocardial infarction (Dressler's syndrome)
- Tuberculosis (TB) (the most common cause of pleural effusion in some developing countries where TB is endemic)
- Multiple myeloma[10]
Rare Causes
- Yellow nail syndrome (yellow nails, lymphoedema, pleural effusion and bronchiectasis)
- Adverse drug reactions (the most common are methotrexate, amiodarone, nitrofurantoin, and phenytoin)
- Fungal infections
- Accidental infusion of fluids
- Esophageal rupture or pancreatic disease
- Intraabdominal abscess
- Radiation therapy
- Operative procedures as seen in coronary artery bypass surgery, liver or lung transplantation, abdominal surgery, endoscopic variceal sclerotherapy, and insertion of central lines
Common Asymptomatic Patients Presenting with Pleural Effusion
- Benign asbestos pleural effusion (BAPE)
- Hypoalbuminemia
- Nephrotic syndrome
- Peritoneal dialysis
- Rheumatoid pleurisy
- Trapped lung
- Urinothorax
- Yellow nail syndrome
Typical Symptomatic Patients Presenting with a Pleural Effusion
- Bacterial pneumonia
- Pleural effusion associated with malignancy
- Congestive heart failure
- Lupus pleuritis
- Malignant mesothelioma
- Postcardiac injury syndrome (PCIS)
- Pulmonary embolism
- Tuberculous pleural effusion
- Viral pleurisy[11]
Causes by Organ System
Causes in Alphabetical Order
References
- ↑ 1.0 1.1 Chawla RK, Madan A, Chawla A, Arora HN, Chawla K (2015). "Bilateral Pleural Effusion: A Rare Case Report". Indian J Chest Dis Allied Sci. 57 (4): 243–5. PMID 27164734.
- ↑ 2.0 2.1 Gilbert CR, Yarmus LB, Feller-Kopman DJ, Lee HJ, Gorden JA (2016). "The Undefined Value of Pleural Interventions in Advanced Heart Failure and Recurrent Pleural Effusions". Ann Am Thorac Soc. 13 (3): 447–8. doi:10.1513/AnnalsATS.201512-825LE. PMID 26963358.
- ↑ 3.0 3.1 Riccio E, Argentino G, Pisani A, Memoli B (2013). "Pleural effusion in peritoneal dialysis: overload or leakage?". Clin Exp Nephrol. 17 (6): 907. doi:10.1007/s10157-013-0794-8. PMID 23494296.
- ↑ 4.0 4.1 Shah S, Robson N, Sajid S (2015). "Pleuro-Peritoneal Fistula – An Important Condition to Consider in Patients using Peritoneal Dialysis". Acute Med. 14 (2): 69–71. PMID 26305084.
- ↑ 5.0 5.1 Asim M, Hamid EM (2013). "Pleuroperitoneal leak in a peritoneal dialysis patient". BMJ Case Rep. 2013. doi:10.1136/bcr-2013-200130. PMC 3736585. PMID 23853026.
- ↑ 6.0 6.1 Lee J, Lim JK, Lee SY, Yoo SS, Lee SY, Cha SI; et al. (2016). "Neutrophilic Loculated Tuberculous Pleural Effusion: Incidence, Characteristics and Differentiation From Complicated Parapneumonic Effusion". Am J Med Sci. 351 (2): 153–9. doi:10.1016/j.amjms.2015.11.010. PMID 26897270.
- ↑ Butani L, Polinsky MS, Kaiser BA, Baluarte HJ (1998). "Pleural effusion complicating acute peritoneal dialysis in hemolytic uremic syndrome". Pediatr Nephrol. 12 (9): 772–4. PMID 9874325.
- ↑ Hanna J, Truemper E, Burton E (1997). "Superior vena cava thrombosis and chylothorax: relationship in pediatric nephrotic syndrome". Pediatr Nephrol. 11 (1): 20–2. PMID 9035166.
- ↑ Jenkins PG, Shelp WD (1974). "Recurrent pleural transudate in the nephrotic syndrome. A new approach to treatment". JAMA. 230 (4): 587–8. PMID 4479274.
- ↑ Wang Z, Xia G, Lan L, Liu F, Wang Y, Liu B; et al. (2016). "Pleural Effusion in Multiple Myeloma". Intern Med. 55 (4): 339–45. doi:10.2169/internalmedicine.55.4733. PMID 26875957.
- ↑ Light, Richard J. (2007). Pleural diseases. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-6957-4.
- ↑ 12.0 12.1 Murray HG, Stone PR, Strand L, Flower J (1993). "Fetal pleural effusion following maternal indomethacin therapy". Br J Obstet Gynaecol. 100 (3): 277–9. PMID 8476835.
- ↑ Bartlett RP, Greipp PR, Tefferi A, Cupps RE, Mullan BP, Trastek VF (1995). "Extramedullary hematopoiesis manifesting as a symptomatic pleural effusion". Mayo Clin Proc. 70 (12): 1161–4. doi:10.1016/S0025-6196(11)63442-3. PMID 7490917.