MANAGEMENT OF UNDIAGNOSED PERSISTENT PLEURAL EFFUSIONS - 09/09/11

The development of a pleural effusion is a common manifestation of pulmonary disease. Approximately 4% of all patients presenting to one pulmonary practice had pleural effusions,<sup>14 Dev G., Basran G.S. Pleural Effusion - a review Monaldi Arch Chest Dis 1994 ;  49 : 25-35

Cliquez ici pour aller à la section Références</sup> indicating that the problem is not uncommonly encountered in clinical practice. In about half of all cases of pleural effusion, the diagnosis is usually apparent after a thorough history and physical examination are conducted and a work-up, including thoracentesis and other selected diagnostic tests, is performed. The remaining pleural effusions are more difficult to diagnose. Unfortunately, as many as 15% to 20% of all pleural effusions remain undiagnosed despite intensive efforts.<sup>23 Hirsch A., Ruffie P., Cretein J. , et al. Pleural effusion - laboratory tests in 300 cases Thorax 1979 ;  34 : 106-112  [cross-ref]

Cliquez ici pour aller à la section Références</sup> That diagnostic uncertainty is, of course, problematic for the clinician and the patient. In this article, we first describe the approach we use to discern the cause of difficult-to-diagnose pleural effusions. We then review the strategy we use to evaluate and manage persistent pleural effusions.