Because the treatment of pleural effusion varies based on the cause it is important to have a good differential diagnosis. This would drive the diagnostic approach and ultimately the diagnostic study of choice based on the presentation. After determining whether the effusion is unilateral or bilateral through chest x-ray, the likely cause should be considered. If the diagnosis is clearly pointing towards nephrotic syndrome or congestive heart failure, then these patients do not necessarily need to have a thoracentesis performed and should be treated. However, a thoracentesis becomes the diagnostic study of choice in the following circumstances:
an unclear cause
patient experiencing pleuritic chest pain
patient experiencing symptoms out of proportion to the size of the effusion
no response to treatment
The use of thoracentesis becomes urgent if the patient is decompensating or the pleural effusion is considerably large.
Pleural effusion diagnostic study of choice
Pulmonary edema other diagnostic studies
Hemoptysis diagnostic study of choice
Aspiration pneumonia other diagnostic studies
Aspiration pneumonia diagnostic study of choice
Pulmonary edema diagnostic study of choice
Pleural effusion differential diagnosis
Pneumothorax diagnostic study of choice