Pleural effusion causes: Difference between revisions

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Revision as of 19:44, 4 October 2016

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Prince Tano Djan, BSc, MBChB [2]

Overview

Common causes of transudative pleural effusion include; left ventricular failure, pulmonary embolism, and cirrhosis, while common causes of exudative pleural effusions are bacterial pneumonia, cancer (with lung cancer, breast cancer, and lymphoma causing approximately 75% of all malignant pleural effusions), viral infection, and pulmonary embolism. Pulmonary embolism may lead to formation of either transudate or exudate however, an exudate is commonly observed.

Causes

Common Causes

Common causes of transudative pleural effusion include:

Common causes of exudative pleural effusion include:

Bacterial pneumonia
Malignancy (Lung cancer, breast cancer, and lymphoma)
Viral infection
Pulmonary embolism

Other causes of pleural effusion include, tuberculosis (though pleural fluid smears are rarely positive for AFB, this is the most common cause of pleural effusion in some developing countries), autoimmune disease such as systemic lupus erythematosus, bleeding (often due to chest trauma), chylothorax (most commonly caused by trauma), and accidental infusion of fluids. Less common causes include, esophageal rupture or pancreatic disease, intraabdominal abscess, rheumatoid arthritis, asbestos pleural effusion, Meig's syndrome (ascites and pleural effusion due to a benign ovarian tumor), and ovarian hyperstimulation syndrome.

Pleural effusions may also occur through medical/surgical interventions, including the use of medications (pleural fluid is usually eosinophilic), coronary artery bypass surgery, abdominal surgery, endoscopic variceal sclerotherapy, radiation therapy, liver or lung transplantation, and intra-or extravascular insertion of central lines.

Commonly asymptomatic patients presenting with a pleural effusion

Typically 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^[1]

Causes by Organ System

Cardiovascular	Central venous stenosis, congestive heart failure, constrictive pericarditis, Dressler's syndrome, pulmonary embolus, pulmonary hypertension, pulmonary infarction, restrictive cardiomyopathy, superior vena cava syndrome, Uhl anomaly, Wegener's granulomatosis, Churg-Strauss syndrome
Chemical / poisoning	No underlying causes
Dermatologic	Jaffe-Campanacci syndrome, yellow nail syndrome
Drug Side Effect	Bromocriptine, Bosutinib, cabergoline, dasatinib, everolimus, ethanolamine oleate, Hydroxocobalamin, lisuride, Meropenem, Oprelvekin, pergolide, Pertuzumab, piribedil, pramipexole, ropinirole, Sargramostim, minoxidil, sirolimus
Ear Nose Throat	No underlying causes
Endocrine	Myxedema
Environmental	No underlying causes
Gastroenterologic	Cirrhosis of liver, esophageal perforation, hepatic failure, pancreatitis, protein losing enteropathy, Whipple's disease, abdominal abscess
Genetic	No underlying causes
Hematologic	Diffuse large B-cell lymphoma, EBV associated lymphoproliferative syndrome, lymphoma, non-Hodgkin lymphoma, lymphangiomyomatosis
Iatrogenic	Abdominal surgery, CABG, central venous catheter, endoscopic variceal sclerotherapy, liver transplantation, lung transplantation, post open heart surgery, radiotherapy
Infectious Disease	Abdominal abscess, actinomycosis, anthrax, asbestosis, aspergillosis, atypical mycobacteria, blastomycosis, coccidioidomycosis, empyema, Francisella tularensis , hydatid disease, paragonimiasis, pneumonia, scrub typhus, subphrenic abscess, tuberculosis, Whipple's disease
Musculoskeletal / Ortho	Diaphragmatic hernia, Gorham's disease, Rheumatoid arthritis
Neurologic	Jaffe-Campanacci syndrome, Neurofibromatosis
Nutritional / Metabolic	Malnutrition
Obstetric/Gynecologic	Fetal indomethacin syndrome,^[2] ovarian hyperstimulation syndrome
Oncologic	Adenocarcinoma of lung, breast cancer, diffuse large B-cell lymphoma, EBV associated lymphoproliferative syndrome, Kaposi sarcoma, lung cancer, lymphoma, malignancy, Meigs' syndrome, mesothelioma, non-Hodgkin lymphoma, neurofibromatosis, bronchial neoplasm, bronchogenic carcinoma, lung cancer
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	bronchial neoplasm, bronchogenic carcinoma, chylothorax, extensive atelectasis, extramedullary haemopoiesis, haemothorax, lung cancer, lupus pleuritis, lymphangiomyomatosis, pleurisy, pleuritis, pulmonary edema, recurrent polyserositis, urinothorax, yellow nail syndrome , empyema, pneumonia, tuberculosis, Adenocarcinoma of lung, Lung cancer, Meigs' syndrome, Mesothelioma, Jaffe-Campanacci syndrome
Renal / Electrolyte	Chronic renal failure, nephrotic syndrome
Rheum / Immune / Allergy	Churg-Strauss syndrome, sarcoidosis, Sjogren's syndrome, systemic lupus erythematosus, Dressler's syndrome, rheumatoid arthritis, lupus pleuritis
Sexual	Jaffe-Campanacci syndrome
Trauma	Chest trauma
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	Hypoproteinemia, radiation

Causes in Alphabetical Order

References

↑ Light, Richard J. (2007). Pleural diseases. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-6957-4.
↑ ^2.0 ^2.1 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.

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[isbn0-7817-6957-4-1] Light, Richard J. (2007). Pleural diseases. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-6957-4.

[pmid8476835-2] 2.0 ^2.1 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.

[pmid7490917-3] 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.

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 ==Overview==
-Common causes of transudative pleural effusion include; [[heart failure|left ventricular failure]], [[pulmonary embolism]], and [[cirrhosis]], while common causes of exudative pleural effusions are bacterial [[pneumonia]], cancer (with [[lung cancer]], [[breast cancer]], and [[lymphoma]] causing approximately 75% of all malignant pleural effusions), viral infection, and [[pulmonary embolism]].  Although pulmonary embolism can produce either transudative or exudative pleural effusions, the latter is more common.
+Common causes of transudative pleural effusion include; [[heart failure|left ventricular failure]], [[pulmonary embolism]], and [[cirrhosis]], while common causes of exudative pleural effusions are bacterial [[pneumonia]], cancer (with [[lung cancer]], [[breast cancer]], and [[lymphoma]] causing approximately 75% of all malignant pleural effusions), viral infection, and [[pulmonary embolism]]. Pulmonary embolism may lead to formation of either transudate or exudate however, an exudate is commonly observed.
 ==Causes==