History

• Dyspnea from pleural effusions is related more to distortion of the diaphragm and chest wall during respiration than to hypoxemia. In many cases, drainage of pleural fluid alleviates symptoms despite limited improvement in gas exchange.

  • Dyspnea also can be caused by underlying intrinsic lung or heart disease, obstructing endobronchial lesions, or diaphragmatic paralysis, especially after coronary artery bypass surgery.

  • Drainage of pleural fluid might partially relieve symptoms but might allow the underlying disease to be recognized on repeat chest radiographs.

  • Displacement of the trachea and mediastinum towards the side of the effusion is an important clue to obstruction of a lobar bronchus by an endobronchial lesion, which can be due to malignancy or, less commonly, a nonmalignant cause such as a foreign body.

  
  

• Less common symptoms of pleural effusions include mild, nonproductive cough or chest pain.

• More severe

  cough or production of purulent or bloody sputum suggests an underlying pneumonia or endobronchial lesion.

• Constant chest wall pain might reflect chest wall invasion by bronchogenic

  carcinoma or malignant mesothelioma.

• Pleuritic chest pain suggests either pulmonary embolism or an inflammatory pleural process.

• Systemic toxicity evidenced by fever, weight loss, and inanition suggests empyema.