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.