title: The diagnosis of pleural effusions.
abstract: Pleural effusions arise from a variety of systemic, inflammatory, infectious and malignant conditions. Their precise etiological diagnosis depends on a combination of medical history, physical examination, imaging tests and pertinent pleural fluid analyses; including specific biomarkers (e.g., natriuretic peptides for heart failure, adenosine deaminase for tuberculosis, or mesothelin for mesothelioma). Invasive procedures, such as pleuroscopic biopsies, may be required for persistently symptomatic effusions which remain undiagnosed after the analysis of one or more pleural fluid samples. However, whenever parietal pleural nodularity or thickening exist, image-guided biopsies should first be attempted. This review addresses the current diagnostic approach to pleural effusions secondary to heart failure, pneumonia, cancer, tuberculosis and other less frequent conditions.
authors.affiliation: a Pleural Medicine Unit, Department of Internal Medicine , Arnau de Vilanova University Hospital, Biomedical Research Institute of Lleida , Lleida , Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Porcel
authors.affiliation: b Respiratory Department , Sir Charles Gairdner Hospital , Perth , Western Australia.
authors.forename: M
authors.initials: M
authors.lastname: Azzopardi
authors.affiliation: c Division of Pulmonology, Department of Medicine , Stellenbosch University and Tygerberg Academic Hospital , Cape Town , South Africa.
authors.forename: C F
authors.initials: CF
authors.lastname: Koegelenberg
authors.affiliation: d Division of Allergy, Pulmonary and Critical Care Medicine , Vanderbilt University , Nashville , TN , USA.
authors.forename: F
authors.initials: F
authors.lastname: Maldonado
authors.affiliation: e Oxford Centre for Respiratory Medicine , Oxford University Hospitals NHS Trust , Oxford , UK.
authors.forename: N M
authors.initials: NM
authors.lastname: Rahman
authors.affiliation: b Respiratory Department , Sir Charles Gairdner Hospital , Perth , Western Australia.
authors.forename: Y C G
authors.initials: YC
authors.lastname: Lee
mesh_terms: D006801:Humans; D010996:Pleural Effusion / Q000175:diagnosis* / Q000209:etiology
keywords: chylothorax; empyema; heart failure; hepatic hydrothorax; malignant pleural effusion; mesothelioma; pleural effusion; tuberculosis