ABSTRACT
The most common cause of pleural effusion in the industrialized countries of the world is heart disease. Classically, the fluid accumulates in both pleural spaces and the effusion is a transudate, but, as will be discussed in this chapter, there are important exceptions to these generalities that depend on the kind of heart disease that is present as well as on its treatment. Most patients with cardiogenic pleural effusions have congestive failure from some variety of left-sided heart disease; less commonly, pericardial disease and various types of cardiac injury may be associated with pleural effusion. Patients with heart disease may also develop pleural effusions of noncardiac origin, especially those caused by pulmonary emboli and bacterial pneumonia. The diagnosis of cardiac-related pleural effusions is typically straightforward, and treatment is focused on the underlying heart disease; there are, however, certain pitfalls that may worsen the patient’s clinical manifestations, confuse the attending physician, and delay the institution of appropriate therapy.
