title: A pleural effusion of multiple causes.
abstract: Multiple medical disorders can lead to the development of pleural effusions. Most effusions are given a single diagnosis in clinical practice. However, the cause of the effusion can change during the disease course, and concomitant yet distinct causes are often underrecognized. We highlight this point by reporting a complex case of recurrent pleural effusions with different predominant causes during the disease course. Five causes for the pleural effusion were diagnosed, namely malignant pleural effusion, empyema, chylothorax, transudative pleural effusion secondary to hypoalbuminemia, and esophagopleural fistula. This case serves as a reminder to clinicians that recurrent pleural effusion, even within the same pleural space, can arise from different causes and, whenever clinically appropriate, reinvestigation of the pleural effusion may be needed.
authors.affiliation: School of Medicine and Pharmacology and Centre for Asthma, Allergy and Respiratory Research, University of Western Australia, Australia; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.
authors.forename: Edward T H
authors.initials: ETH
authors.lastname: Fysh
authors.affiliation: Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.
authors.forename: Ranjan L
authors.initials: RL
authors.lastname: Shrestha
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Western Australia, Australia.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Wood
authors.affiliation: School of Medicine and Pharmacology and Centre for Asthma, Allergy and Respiratory Research, University of Western Australia, Australia; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia. Electronic address: gary.lee@uwa.edu.au.
authors.forename: Y C Gary
authors.initials: YCG
authors.lastname: Lee
mesh_terms: D002916:Chylothorax / Q000150:complications; D016724:Empyema, Pleural / Q000150:complications; D004937:Esophageal Fistula / Q000150:complications; D005122:Exudates and Transudates; D005402:Fistula / Q000150:complications; D006801:Humans; D034141:Hypoalbuminemia / Q000150:complications; D010995:Pleural Diseases / Q000150:complications; D010996:Pleural Effusion / Q000209:etiology*; D016066:Pleural Effusion, Malignant / Q000175:diagnosis; D012008:Recurrence