The differential diagnosis of pleural effusions

Authors: Miloslav Marel ;  Libor Fila ;  Michaela Červená
Authors‘ workplace: Pneumologická klinika 2. LF UK a FN v Motole, Praha
Published in: Vnitř Lék 2016; 62(7-8): 598-604
Category: Reviews


The problems of pleural effusions are connected with many areas of medicine. The problem affects approx. 0.5 % of the population every year. The paper summarizes pathophysiological data relating to the emergence of effusions, their epidemiology, description of particular types of effusions and possibilities of treatment. More attention is paid to the differential diagnosis and therapy for malign pleural effusions.

Key words:
diagnostics – exudate – treatment – pleura – transudate


1. Yamada S. Über die seröse Flüssigkeit in der Pleurahöhle der gesunden Menschen. Z Ges Exp Med 1933; 90(1): 342–348.

2. Light RW. Pleural Disease. 2nd ed. Lea and Febiger: Philadelphia 1990.

3. Marel M, Zrůstová M, Stasný B et al. Incidence of Pleural Effusions in Well-defined region: Epidemiological Study in Central Bohemia. Chest 1993; 104(5): 1486–1489.

4. Marel M, Stastny B, Melínová L et al. Diagnosis of Pleural Effusions – Experience with Clinical Studies 1986–1990. Chest 1995; 107(6): 1598–1603.

5. Marel M. Novinky v diferenciální diagnostice pleurálních výpotků. Zdrav Nov – příloha Lékařské listy – 2007; 56(2): 23–26.

6. Toušek M. Diferenciální diagnostika pleuritického syndromu. Státní zdravotnické nakladatelství: Praha 1962.

7. Light RW, Gary Lee YC. Textbook of Pleural Diseases. 2nd ed. Hodder: London 2008. ISBN 978–0340940174.

8. Porcel JM. Pearls and myths in pleural fluid analysis. Respirology 2011; 16(1): 44–52.

9. Rahman NM, Mishra EK, Davies HE et al. Clinically important factors influencing the diagnostic measurement of pleural fluid pH and glucose. Am J Respir Crit Care Med 2008; 178(5): 483–490.

10. Hooper C, Gary Lee YC, Maskell N. [BTS Pleural Guideline Group]. Investigation of a unilateral pleural effusion in adults: British Thoracic Society pleural disease guideline 2010. Thorax 2010; 65(Suppl 2): ii4-ii17.

11. Valdes L, San José E, Alvarez D et al. Diagnosis of tuberculous pleurisy using the biologic parameters adenosine deaminase, lysozyme and interferon gamma. Chest 1993; 103(2): 458–465.

12. Dheda K, van Zyl-Smit RN, Sechi LA et al. Utility of quantitative T-cell responses versus unstimulated interferon-g for the diagnosis of pleural tuberculosis. Eur Respir J 2009; 34(5): 1118–1126.

13. Bennedsen J, Thomsen VO, Pfyffer GE et al. Utility of PCR in diagnosing pulmonary tuberculosis. J Clin Microbiol 1996; 34(6): 1407–1411.

14. Rodriguez-Panadero F, Borderas Naranjo F, López Mejîas J. Pleural metastatic tumours and effusions. Frequency and pathogenic mechanisms in a post-mortem series. Eur Resp J 1989; 2(4): 366–369.

15. Davies HE, Sadler RS, Bielsa S et al. Clinical impact and reliability of pleural fluid mesothelin in undiagnosed pleural effusions. Am J Respir Crit Care Med 2009; 180(5): 437–444.

16. Matchaba PT, Volmink J. Steroids for treating tuberculous pleurisy. Cochrane Database Syst Rev 2000; 2: CD001876.

17. Roberts ME, Neville E, Berrisford RG et al. [BTS Pleural Disease Guideline Group]. Management of a malignant pleural effusion: British Thoracic Society pleural disease guideline 2010. Thorax 2010; 65(Suppl 2): ii32-ii40.

18. Jannsen JP, Collier G, Astoul P et al. Safety of talc poudrage in malignant pleural effusion. Lancet 2007; 369(9572): 1535–1539.

19. Lui MM, Thomas R, Lee YC. Complications of indwelling pleural catheter use and their management. BMJ Open Resp Res 2016; 3(1): e000123. Dostupné z DOI: <–000123>.

20. Davies EH, Davies RJ, Davies CW. [BTS Pleural Disease Guideline Group]. Management of pleural infection in adults: British Thoracic Society pleural disease guideline 2010. Thorax 2010; 65(Suppl 2): ii41-ii53.

Diabetology Endocrinology Internal medicine

Article was published in

Internal Medicine

Issue 7-8

2016 Issue 7-8

Most read in this issue

This topic is also in:

Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account