Effusion, Pneumothorax & Pleural Disease

• Light’s criteria distinguish exudate from transudate. In suspected pleural infection, pus or pleural pH ≤7.2 supports chest drainage when there is a safely accessible fluid collection on ultrasound.
• Tension pneumothorax requires immediate decompression. For spontaneous pneumothorax, choose conservative, ambulatory, aspiration or chest-drain management according to symptoms, physiological compromise, primary versus secondary disease and available follow-up.
• Symptomatic malignant effusions may need therapeutic drainage. For recurrence, discuss an indwelling pleural catheter and pleurodesis according to symptom response, lung expansion and patient preference.
• Guiding every thoracentesis with ultrasound reduces pneumothorax.
• Selected primary spontaneous pneumothorax can be managed ambulatorily with a one-way valve.

Pneumothorax / tension pneumothorax

First tests: Bedside respiratory and hemodynamic assessment.

Only if indicated: Lung/pleural ultrasound, Chest X-ray, CT chest.

Repeat monitoring: Oxygenation and respiratory examination.

Pleural effusion / pleural infection

First tests: Lung/pleural ultrasound, Chest X-ray.

Only if indicated: Pleural fluid analysis, Pleural fluid pH and glucose, Pleural fluid Gram stain and culture, Pleural fluid cytology, Contrast CT chest.

Repeat monitoring: Chest X-ray.

• Workup of the Undiagnosed Effusion
• Workup and Care of Pleural Fluid Following Thoracentesis
• Care of Parapneumonic Effusions
• Care of Recurrent Malignant Effusions
• Care of Pneumothorax