Pleural effusion - management and disposition

Management should be aimed at treating the underlying disease process.

Small effusions that are not causing respiratory compromise may be managed by observation.

Taping the fluid can give symptomatic relief as well as being useful for diagnosis but the effusion is likely to reform. No more than 1.5L (some advocate 1L) should be removed at a single procedure as fluid shifts can result in re-expansion pulmonary oedema.

Chest drains are generally required for underlying empyema and haemothorax.

Patient’s requiring investigation of a new unilateral pleural effusion should initially be admitted under the respiratory team and referred, where appropriate, to cardiothoracics for invasive diagnostic or therapeutic procedures. Possible inpatient investigations/procedures include percutaneous pleural biopsy, thoracoscopy (commonly performed as a ‘VATS’ procedure), pleurodesis (medical vs surgical) and pleurodectomy.