Pleural effusion in an asymptomatic patient. Spectrum and frequency of causes and management considerations

Our plain-English summary of Pleural effusion in an asymptomatic patient. Spectrum and frequency of causes and management considerations, by N.A. Smyrnios, P.J. Jederlinic, R.S. Irwin (Chest, 1990).

The study

• Authors: N.A. Smyrnios, P.J. Jederlinic, R.S. Irwin
• Journal: Chest
• Published: 1990;97(1):192-6
• Type of article: Review
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We conducted retrospective chart and literature reviews to analyze the frequency and spectrum of causes of asymptomatic pleural effusion (APE). In our series, 16 percent of patients undergoing thoracentesis for PE were asymptomatic and the spectrum of causes was similar to that for symptomatic patients. Asymptomatic PEs were evenly distributed among transudates, exudates and indeterminate effusions. More symptomatic (S) PE were exudates, although the difference was not statistically significant (p greater than 0.1). In comparison to SPE, APE were more often free flowing and small. In both groups, the four most common diagnoses were malignancy, CHF, parapneumonic and postoperative effusions accounting for greater than 70 percent of each group. Review of the literature demonstrated the following associations with APE: recent childbirth or abdominal surgery, benign asbestos effusion, uremia, malignancy, and tuberculosis. In the uncomplicated postpartum or postoperative setting or in patients with typical findings of left ventricular failure, observation without diagnostic studies is appropriate. In all other situations, APE should be evaluated in traditional fashion. If thoracentesis is non-diagnostic and the effusion is an exudate, closed pleural biopsy and less often, fiberoptic bronchoscopy, should follow. Once malignant or granulomatous pleuritis has been excluded, it may be appropriate to observe for a period of time before proceeding to more invasive procedures.

In plain English

This article combined a retrospective chart review with a literature review on pleural effusion (fluid around the lungs) in patients without chest symptoms. The authors examined records of patients who had chest fluid drawn (thoracentesis) at the University of Massachusetts Medical Center from July 1986 to June 1987. Of 94 patients suitable for review, 15 (16 percent) had no cough, shortness of breath or chest pain, and 79 (84 percent) had symptoms. Effusions without symptoms were more often free-flowing (11 of 15, versus 30 of 79) and small (10 of 15, versus 15 of 79). Cancer, congestive heart failure, pneumonia-related and postoperative effusions accounted for 70 percent of symptomatic and 79 percent of asymptomatic effusions. No benign asbestos effusions were diagnosed in this series. Asbestos appeared only in the literature review. There the authors, citing other studies, listed benign asbestos effusion among the causes most often found without symptoms. The authors concluded that asymptomatic effusion occurred in 16 percent of their thoracentesis patients and had causes similar to those of symptomatic effusion.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective chart review combined with a review of the English-language medical literature from 1975 to 1988
• Who was studied: Patients who underwent thoracentesis at the University of Massachusetts Medical Center between July 1, 1986 and June 30, 1987. 115 charts were reviewed and 4 were excluded. A further 17 were excluded because the charts did not record whether symptoms were present or absent. That left 94 patients: 79 with symptomatic and 15 with asymptomatic pleural effusion.
• Exposure: The chart review compared pleural effusions with and without symptoms (cough, dyspnea, chest pain). It did not measure asbestos exposure. Asbestos enters only through the literature review, as benign asbestos effusion, and no such effusions were diagnosed among the study's own patients.
• Main results:
  • Of the 94 patients with pleural effusion suitable for review, 15 (16 percent) were asymptomatic and 79 (84 percent) were symptomatic.
  • The 15 asymptomatic effusions were split evenly: 5 (33.3%) transudates, 5 (33.3%) exudates and 5 (33.3%) indeterminate. Of the 79 symptomatic effusions, 18 (23%) were transudates, 44 (56%) exudates and 17 (21%) indeterminate. The greater share of exudates in the symptomatic group was not statistically significant (p greater than 0.1).
  • Compared with symptomatic effusions, asymptomatic effusions were more often free-flowing (11 of 15, 73%, versus 30 of 79, 38%) and small (10 of 15, 67%, versus 15 of 79, 19%).
  • Malignancy, congestive heart failure, parapneumonic and postoperative effusions together accounted for 70 percent of symptomatic and 79 percent of asymptomatic effusions. Malignancy was the most common diagnosis in both groups: 25 of 79 (32%) symptomatic and 4 of 15 (26%) asymptomatic.
  • In the literature review (not this study's patients), postpartum, postoperative and benign asbestos effusions were the causes most commonly found without symptoms. Table 4 gives an estimated 66 percent asymptomatic for benign asbestos effusion, citing references 7 and 12.
  • Describing an earlier study by Epler et al of 1,135 asbestos-exposed workers (not this study's data), the authors reported that 34 of 54 effusions (63 percent) were judged benign asbestos effusion, and two thirds of these were asymptomatic.
• The authors' conclusion: The authors concluded that asymptomatic pleural effusion made up 16 percent of their thoracentesis series. Its spectrum of causes was similar to that of symptomatic effusion. They also concluded that the literature showed asbestos exposure, recent childbirth, tuberculosis and uremia as other conditions commonly associated with asymptomatic effusion.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Thoracentesis, Exudate, Pleural Biopsy, Bronchoscopy.

Related studies

• Chronic empyema: importance of preventing complications in the management of pleural effusions — V. Molander, M. Diakopoulou, et al. (2013)
• Etiology of pleural effusions: analysis of more than 3,000 consecutive thoracenteses — J.M. Porcel, A. Esquerda, et al. (2014)
• Calretinin. A selective marker of normal and neoplastic mesothelial cells in serous effusions — M.C. Barberis, M. Faleri, et al. (1997)
• Benign asbestos pleural effusion: diagnosis and course — B.W. Robinson, A.W. Musk (1981)
• Evaluation of pleural CYFRA 21-1 and carcinoembryonic antigen in the diagnosis of malignant pleural effusions — G. Salama, M. Miédougé, et al. (1998)
• The role of liquid-based cytology and ancillary techniques in pleural and pericardic effusions: an institutional experience — E.D. Rossi, T. Bizzarro, et al. (2015)

Browse more research in Chest, or return to medical research.