BACKGROUND
A pleural effusion (PE) occurs due to a disturbance in the balance between pleural fluid (PF) formation and removal.1 It does not arise as a disease by itself; instead is an outcome of underlying pathology. Therefore, diagnosing PE requires a physician to determine its cause to treat PE appropriately. Still, in nearly 20% of cases, the etiology of PE remains unclear. Therefore, a careful history with good clinical examination should aid in diagnosing, especially in patients with atypical presentations. Thoracocentesis is the crucial step to determine the various etiologies. Considering the PF biochemistry, cytology, and signs and symptoms; PE diagnosis can be established in the vast majority of the cases.2 PF analysis can be classified as exudative or transudative. Treating the underlying cause is the typical management strategy for transudative effusions.
Massive PE refers to an effusion that fills almost all the hemithorax. A prospective study was conducted to establish the most common causes of pleural effusions. Malignant effusion is the leading cause of massive effusion, followed by PE secondary to cirrhosis. On the other hand, massive pleural effusions were far less likely to be caused by congestive heart failure or infections.3 The study added to the growing body of evidence that, whatever the source, a substantial, refractory PE, whether transudate or exudate, symptomatic relief could be established by drainage.