10th January 2024

Presentation

Pleural effusion presentation can be variable due to several changeable factors (size of effusion, how quickly the effusion accumulated, its underlying cause), but the overwhelmingly common symptom is “shortness of breath.” A detailed history of the shortness of breath should be undertaken to determine character, speed of onset, duration and how limiting the symptomology is on activities of daily living. Given there is a significant range of pathologies that pleural effusions can be associated with, there is also variety in the associated symptoms.

Important associated symptoms to consider would include presence of –

• Constitutional symptoms (fever, night sweats, weight loss),
• Cough and sputum production
• Recent travel history
• Past medical history (including specifically if any current or previous cancer diagnosis),
• Occupational history
• Smoking history.

Signs

On clinical examination, reduced chest expansion may be noted, either unilaterally or bilaterally, dependent on the underlying effusion aetiology. The typical finding described is “stony” dull percussion over the area of the pleural effusion with associated reduced breath sounds. Bronchial breathing can also be present just superior to the uppermost point of the effusion. In massive pleural effusion tracheal deviation away from the side of effusion can also be seen.

In addition to the effusion itself, clinical examination can give clues to the underlying aetiology:

Table 1: Clinical features with their associated underlying aetiology. 

Table 1: Table adapted from – 

Bhatnagar R, Maskell N. The modern diagnosis and management of pleural effusions. BMJ. 2015;351(September).

Saguil A, Wyrick K, Hallgren J. Diagnostic approach to pleural effusion. Am Fam Physician. 2014;90(2):99–104.