Resolution of Pleural Effusions

Abstract

P ulmonologists, internists, surgeons, and other medical specialists frequently encounter patients with pleural effusions. A plethora of articles have been written about the pathophysiology and pleural fluid (PF) characteristics that assist the physician in establishing a diagnosis and therapeutic plan for pleural diseases associated with effusions. In contrast, there is a paucity of information regarding the resolution time of a pleural effusion. The purpose of this review is to present the available published data regarding the time course of resolution for nonmalignant pleural effusions in the most commonly encountered pleural diseases (empyema, pus in the pleural space, was excluded). A MEDLINE search from 1966 to 1999 of the English-language literature was instituted, matching pleural effusion with each of the specific diseases most commonly associated with pleural effusions. The search included case reports and retrospective and prospective case series of pleural effusions that resolved spontaneously or with medical management, excluding pleural space manipulation. Of the 393 articles retrieved, only 110 specified a time course of resolution. With the available information, an estimated time course of resolution was determined for the specific pleural process (Table 1). This review should provide the physician with clinically useful information that should narrow the differential diagnosis and focus the diagnostic evaluation. Parapneumonic Pleural Effusions