Etiology

Cardiovascular
- Congestive Heart Failure (see Congestive Heart Failure)
- Epidemiology
- Borderline Exudates May Be Seen in Some Long-Standing Cases
- Epidemiology
- Post-Cardiac Injury Syndrome (PCIS)/b> (see Post-Cardiac Injury Syndrome)
Endocrine/Reproductive
- Hypothyroidism (see Hypothyroidism)
- Epidemiology
- XXX
- Epidemiology
- Ovarian Hyperstimulation Syndrome (see Ovarian Hyperstimulation Syndrome)
- Epidemiology
- XXX
- Epidemiology
- Pregnancy (see Pregnancy)
- Epidemiology
- Small amounts of U/S-detected pleural effusion are a normal finding in pregnancy (unclear whether these are transudates or exudates)
- Epidemiology
- Meig’s Syndrome (see Meig’s Syndrome)
- Epidemiology
- XXX
- Epidemiology
- Endometriosis (see Endometriosis)
- Epidemiology
- XXX
- Epidemiology
Gastrointestinal
- Biliary-Pleural Fistula (see Pleural Effusion-Cholethorax)
- Cholecystitis (see xxxx)
- Epidemiology
- XXX
- Epidemiology
- Esophageal Rupture/Perforation (see Esophageal Perforation)
- Epidemiology
- XXX
- Epidemiology
- Esophageal Variceal Sclerotherapy (see Esophageal Varices)
- Epidemiology
- XXX
- Epidemiology
- Diaphragmatic Hernia (see Diaphragmatic Hernia)
- Hepatitis (see xxxx)
- Epidemiology
- XXX
- Epidemiology
- Inflammatory Bowel Disease (IBD) (see Inflammatory Bowel Disease)
- Movement of Liquid from Abdomen to Pleural Space
- Acute/Chronic Pancreatitis (see Acute Pancreatitis and Chronic Pancreatitis)
- Chylous Ascites (see xxxx)
- Malignant Ascites
- Meig’s Syndrome (see xxxx)
- Pancreatic Pseudocyst
- Splenic Infarction (see xxxx)
- Subdiaphragmatic/Hepatic/Splenic Abscess (see Abdominal Abscess)
- Post-Abdominal Surgery
- Orthotopic Liver Transplant (OLT) (see Liver Transplant)
Neoplastic
- Engraftment Syndrome (see Engraftment Syndrome)
- Epidemiology
- XXX
- Lung Cancer (see Lung Cancer)
- Epidemiology
- Pleural Mesothelioma (see Pleural Mesothelioma)
- Pleural Metastases (Malignant Pleural Effusion) (see Pleural Effusion-Malignant)
- Acute Lymphocytic Leukemia (ALL) (see Acute Lymphocytic Leukemia)
- Acute Myeloid Leukemia (AML) (see Acute Myeloid Leukemia)
- Angioimmunoblastic Lymphadenopathy (see Angioimmunoblastic Lymphadenopathy)
- Breast Cancer (see Breast Cancer): 25% of all cases
- Chronic Lymphocytic Leukemia (CLL) (see Chronic Lymphocytic Leukemia)
- Chronic Myeloid Leukemia (CML) (see Chronic Myeloid Leukemia)
- Lung Cancer (see Lung Cancer): 30% of all cases
- Lymphoma (see Lymphoma): 20% of all cases
- Multiple Myeloma (see Multiple Myeloma)
- Ovarian Cancer (see Ovarian Cancer): 6% of all cases
- Sarcomas and Melanoma (see Sarcoma and Melanoma): 3% of all cases
- Kaposi Sarcoma (see Kaposi Sarcoma)
- Unknown Primary Malignancy: 6% of all pleural metastatic cases
- Waldenstrom’s Macroglobulinemia (see Waldenstrom’s Macroglobulinemia)
- Solitary Fibrous Tumor of Pleura (see Solitary Fibrous Tumor of Pleura)
Pulmonary/Pleural
- Acute Eosinophilic Pneumonia (see Acute Eosinophilic Pneumonia)
- Epidemiology
- XXXX
- Epidemiology
- Acute Pulmonary Embolism (PE) (see Acute Pulmonary Embolism)
- Epidemiology
- 80% of Pleural Effusions are Exudative
- Epidemiology
- Acute Respiratory Distress Syndrome (ARDS) (see Acute Respiratory Distress Syndrome)
- Epidemiology
- XXXX
- Epidemiology
- Benign Asbestos Pleural Effusion (BAPE) (see Benign Asbestos Pleural Effusion)
- Epidemiology
- XXXXX
- Epidemiology
- Cholesterol Effusion
- Etiology
- Rheumatoid Arthritis (RA) (see Rheumatoid Arthritis)
- Tuberculosis (see Tuberculosis)
- Etiology
- Chylothorax (see Pleural Effusion-Chylothorax)
- Epidemiology
- XXXXX
- Epidemiology
- Hemothorax (see Pleural Effusion-Hemothorax)
- Epidemiology
- XXXXX
- Epidemiology
- Nonexpandable Lung (see Nonexpandable Lung)
- Etiology
- Lung Entrapment
- Trapped Lung
- Physiology
- Negative Intrapleural Pressure Results in the Formation of Pleural Effusion
- Etiology
- Post-Lung Transplant (see Lung Transplant)
- Epidemiology
- Pleural effusion is common in the first 2 weeks after lung transplant (sampling is not required unless effusion is large or infection is suspected)
- Cases of Pleural Effusion Associated with Acute Cellular Lung Transplant Rejection (see Acute Lung Transplant Rejection): lymphocytic exudate
- Epidemiology
- Post-Pulmonary Thrombendarterectomy (PTE) (see Chronic Thromboembolic Pulmonary Hypertension)
- Epidemiology
- In cases where pericardial window (with drainage to left pleural space) is created -> usually left-sided
- Epidemiology
- Pulmonary Infection (Pneumonia)
- Viral
- Acute Hepatitis B (see Hepatitis B Virus)
- Cytomegalovirus (CMV) (see Cytomegalovirus)
- Dengue Hemorrhagic Fever (see Dengue Virus)
- Epstein-Barr Virus (EBV) (see Epstein-Barr Virus): infectious mononucleosis
- Herpes Simplex Virus (HSV) (see Herpes Simplex Virus)
- Influenza Virus (see Influenza Virus)
- Lassa Virus (see Viral Hemorrhagic Fever)
- Hantavirus Cardiopulmonary Syndrome (see Hantavirus Cardiopulmonary Syndrome)
- Human Immunodeficiency Virus (HIV) (see Human Immunodeficiency Virus)
- Measles Virus (see Measles Virus)
- Respiratory Syncytial Virus (RSV) (see Respiratory Syncytial Virus)
- Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV2/COVID-19) (see Severe Acute Respiratory Syndrome Coronavirus-2)
- Bacterial
- Actinomycosis (see Actinomycosis)
- Bacillus Calmette-Guerin (BCG) (see Bacillus Calmette-Guerin): disseminated
- Inhalational Anthrax (see Bacillus Anthracis)
- Legionellosis (see Legionellosis)
- Lemierre’s Syndrome (see Lemierre’s Syndrome)
- Listeriosis (see Listeriosis)
- Melioidosis (see Burkholderia Pseudomallei)
- Mycoplasma (see Mycoplasma Pneumoniae)
- Nocardiosis (see Nocardiosis)
- Parapneumonic Effusion (see Pleural Effusion-Parapneumonic)
- Rhodococcus Equi (see Rhodococcus Equi): empyema may occur
- Tuberculosis (see Tuberculosis)
- Primary Tuberculosis: pleural effusion occurs in approximately 33% of primary tuberculosis cases (usually in the first 3-4 mo after infection, but may occur up to 1 yr later)
- Tuberculosis Pleuritis
- Tularemia (see Tularemia)
- Elevated Adenosine Deaminase
- Lymphocyte-Predominant
- Lung or Pleural Biopsy: may demonstrate granulomas
- Fungal
- Blastomycosis (see Blastomycosis)
- Coccidioidomycosis (see Coccidioidomycosis)
- Cryptococcosis (see Cryptococcosis)
- Histoplasmosis (see Histoplasmosis)
- Invasive Aspergillosis (see Invasive Aspergillosis)
- Pneumocystis Jirovecii (see Pneumocystis Jirovecii)
- Parasitic
- Amebiasis (see Amebiasis)
- Echinococcosis (see Echinococcosis)
- Paragonimiasis (see Paragonimiasis)
- Viral
- Radiation Pleuritis (see Radiation Pleuritis)
- Epidemiology
- Following Radiofrequency Ablation (RFA) of Pulmonary Neoplasm
- Following XXXXX
- Physiology
- Pleural Inflammation
- Epidemiology
- Sarcoidosis (see Sarcoidosis)
- Physiology
- Pleural Inflammation
- Physiology
Rheumatologic
- Adult-Onset Still’s Disease (see Adult-Onset Still’s Disease)
- Epidemiology
- XXXXX
- Diagnosis
- Neutrophil-Predominant Pleural Effusion
- Clinical
- XXXX
- Epidemiology
- Ankylosing Spondylitis (see Ankylosing Spondylitis)
- Epidemiology
- Pleural Effusion is Rare
- Clinical
- XXXX
- Epidemiology
- Behcet’s Syndrome (see Behcet’s Syndrome)
- Epidemiology
- Pleural Effusion is Uncommon
- Clinical
- XXXX
- Epidemiology
- Eosinophilic Granulomatosis with Polyangiitis (EGPA, Churg-Strauss Syndrome) (see Eosinophilic Granulomatosis with Polyangiitis)
- Epidemiology
- Pleural Effusion Occurs in 30% of Cases
- Clinical
- XXXX
- Epidemiology
- Granulomatosis with Polyangiitis (GPA, Wegener’s Granulomatosis) (see Granulomatosis with Polyangiitis>)
- Epidemiology
- XXXX
- Clinical
- XXXX
- Epidemiology
- Hypereosinophilic Syndrome (see Hypereosinophilic Syndrome)
- Epidemiology
- XXXX
- Clinical
- XXXX
- Epidemiology
- Microscopic Polyangiitis (see Microscopic Polyangiitis)
- Epidemiology
- Pleural Effusion Occurs in 10-30% of Cases
- Clinical
- XXXX
- Epidemiology
- Mixed Connective Tissue Disease (MCTD) (see Mixed Connective Tissue Disease)
- Epidemiology
- XXXX
- Clinical
- XXXX
- Epidemiology
- Polymyositis/Dermatomyositis (see Polydermatomyositis)
- Epidemiology
- Pleural Effusions is Rare
- Clinical
- XXXX
- Epidemiology
- Rheumatoid Arthritis (RA) (see Rheumatoid Arthritis)
- Epidemiology
- XXXX
- Clinical
- XXXX
- Epidemiology
- Scleroderma (see Scleroderma)
- Epidemiology
- XXXX
- Clinical
- XXXX
- Epidemiology
- Sjogren’s Syndrome (see Sjogren’s Syndrome)
- Epidemiology
- XXXX
- Clinical
- XXXX
- Epidemiology
- Systemic Lupus Erythematosus (SLE) (see Systemic Lupus Erythematosus)
- Epidemiology
- XXXX
- Clinical
- XXXX
- Epidemiology
Drugs
- Amiodarone (Cordarone) (see Amiodarone)
- β-Adrenergic Receptor Antagonists (β-Blockers) (se β-Adrenergic Receptor Antagonists)
- Bromocriptine (Parlodel, Cycloset, Brotin) (see Bromocriptine)
- Cabergoline (Dostinex, Cabaser) (see Cabergoline)
- Clozapine (Clozaril) (see Clozapine)
- Dantrolene (see Dantrolene)
- Dasatinib (Sprycel) (see Dasatinib)
- Docetaxel (Taxotere) (see Docetaxel)
- Ergotamine (see Ergotamine)
- Interleukin-2 (IL-2) (see Interleukin-2)
- Isotretinoin (Accutane) (see Isotretinoin)
- Mesalamine (5-ASA) (see Mesalamine)
- Methotrexate (see Methotrexate)
- Methysergide (see Methysergide)
- Metronidazole (Flagyl) (see Metronidazole)
- Mitomycin C (see Mitomycin)
- Nitrofurantoin (Macrodantin, Macrobid, Furadantin) (see Nitrofurantoin)
- Phenytoin (Dilantin) (see Phenytoin)
- Procarbazine (see Procarbazine)
- Propylthiouracil (PTU) (see Propylthiouracil)
- Sulfasalazine (Azulfidine) (see Sulfasalazine)
- Tretinoin (All-Trans Retinoic Acid/ATRA) (see Tretinoin)
Other
Capillary Leak Syndrome (Kidney Int, 2017) [MEDLINE]
- Etiology
- Autoimmune Disease
- Differentiation Syndrome (see Tretinoin)
- Engraftment Syndrome (see xxxx)
- XXXX
- Gemcitabine (XXXX) (see Gemcitabine)
- Hemophagocytic Lymphohistiocytosis (HLH) (see Hemophagocytic Lymphohistiocytosis)
- Idiopathic Systemic Capillary Leak Syndrome (Clarkson’s Disease)
- Interleukin-2 (IL-2) (see Interleukin-2)
- Ovarian Hyperstimulation Syndrome (see Ovarian Hyperstimulation Syndrome)
- Ricin (see Ricin)
- Sepsis (see Sepsis)
- Snakebite (see xxxx)
- Viral Hemorrhagic Fevers
- XXXX (see xxxx)
- Electrical Burns (see Electrical Burns)
- Epidemiology
- XXXX
- Epidemiology
- Extramedullary Hematopoiesis (see Extramedullary Hematopoiesis)
- Epidemiology
- XXXX
- Clinical
- XXXX
- Epidemiology
- Familial Mediterranean Fever (FMF) (see Familial Mediterranean Fever)
- Epidemiology
- XXXX
- Epidemiology
- Immunoglobulin G4-Related Disease (see Immunoglobulin G4-Related Disease)
- Epidemiology
- XXXX
- Epidemiology
- Inadvertent Central Venous Catheter (CVC) Placement Into Pleural Space (see Central Venous Catheter)
- Diagnosis
- Pleural fluid will have characteristics of the infusate, so may appear to be transudative or exudative
- Diagnosis
- Inadvertent Nasogastric (NG)/Orogastric (OG) Tube Placement Into Pleural Space (see Nasogastric-Orogastric Tube)
- Diagnosis
- Pleural fluid will have characteristics of the infusate, so may appear to be transudative or exudative
- Diagnosis
- Trauma
- Epidemiology
- XXXX
- Epidemiology
- Uremic Pleurisy (see Uremic Pleurisy)
- Epidemiology
- XXXXXX
- Epidemiology
- Yellow Nail Syndrome (see Yellow Nail Syndrome)
- Epidemiology
- XXXX
- Clinical
- XXXX
- Epidemiology
Diagnosis-Pleural Fluid Criteria (see Pleural Effusion-General)
General Comments
- LDH Ratio and Total Protein Ratio are Necessary from Light’s Criteria
- The pleural LDH <66% criterion does not add more in discriminative value
- Cut-Off Values for LDH and Total Protein Ratios: since there is not a discrete cut-off between values of LDH and total protein, the specified cut-off values give high sensitivity but lower specificity (ie: you will detect all true exudates, but you may misclassify some transudates as exudates, as in diuresed congestive heart failure cases)
Transudate (see Pleural Effusion-Transudate)
- Pleural LDH/Serum LDH Ratio <0.6
- Pleural Total Protein/Serum Total Protein Ratio <0.5
- Pleural LDH <66% of Upper Limit of Normal Range for Serum LDH
- Pleural Cholesterol <55-60 mg/L
- Pleural Cholesterol/Serum Cholesterol Ratio: normal
- Serum-Pleural Albumin Gradient (SPAG) >1.2 g/dL
- *If Fluid Clinically Appears to be a Transudate and SPAG >1.2, but Light’s Criteria Suggest Exudate, Pleural Fluid Can Be Assumed to Be a Transudate: due to the fact that albumin is lower molecular weight than other proteins and crosses capillary walls more easily
Exudate
- General Comments: pleural effusion is considered exudative if it meets any one of the following criteria, although LDH ratio and total protein ratio are the best criteria
- Pleural LDH/Serum LDH Ratio >0.6
- Pleural Total Protein/Serum Total Protein Ratio >0.5
- Pleural LDH >66% of Upper Limit of Normal Range for Serum LDH
- Pleural Cholesterol >55-60 mg/dL
- Pleural Cholesterol/Serum Cholesterol Ratio: elevated
- Serum-Pleural Albumin Gradient (SPAG) <1.2 g/dl
- If Fluid Clinically Appears to be a Transudate and SPAG >1.2, but Light’s Criteria Suggest Exudate, Pleural Fluid Can Be Assumed to Be a Transudate: due to the fact that albumin is lower molecular weight than other proteins and crosses capillary walls more easily
References
General
- Medical and surgical treatment of parapneumonic effusions : an evidence-based guideline. Chest. 2000 Oct;118(4):1158-71 [MEDLINE]
- Pleural effusions following cardiac surgery: prevalence, risk factors, and clinical features. Chest. 2009 Dec;136(6):1604-11. doi: 10.1378/chest.09-0689. Epub 2009 Jul 6 [MEDLINE]