ABSTRACT
Pleural effusions caused by heart failure 269 Incidence 269 Pathogenesis270 Imaging 270 Pleural fluid analysis 271 Treatment 271
Pleural effusions caused by pericardial diseases 272 Post-cardiac injury syndrome 272 Acute pericarditis 272 Constrictive pericarditis273
Pleural effusions caused by pulmonary embolism 273 Incidence 273 Pathogenesis 273
Clinical manifestations 273 Chest imaging 273 Pleural fluid findings 273 Diagnosis and treatment274
Pleural effusions caused by other vascular diseases 274 Superior vena cava syndrome274 Acute aortic dissection 274 Hemothorax 274
Future directions 276 References 276
Heart failure (HF), resulting from any structural or functional impairment of ventricular lling or ejection of blood,
is largely a clinical diagnosis based on history and a physical examination (Table 21.1).1 e cardinal manifestations of HF are dyspnea and fatigue, normally limiting exercise tolerance, as well as uid retention, which may lead to pulmonary and/or splanchnic congestion and/or peripheral edema. It is generally accepted that the physical examination ndings that point to HF as the most likely diagnosis are a third heart sound (likelihood ratio [LR] >8) and elevated
neck vein pressure (LR ~5). In contrast, B-type natriuretic peptide (BNP) or NT-pro-BNP levels of less than 100 and 300 pg/mL, respectively, are the strongest argument against the disease (LR ~0.1).2
