Pleural Effusion in an Asymptomatic Patient: RESULTS

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Retrospective Chart Review

One hundred fifteen charts were reviewed. Of these, four were excluded from analysis; three repre­sented procedures to drain large pneumothoraces, while one chart lacked essential information. There were 79 patients with SPE and 15 patients with APE. Another 17 patients fell into the third group and were excluded from further analysis. Thus, of the 94 patients with PE that were suitable for review, 79 (84 percent) were SPE and 15 (16 percent) were APE.

The percentage of transudates and exudates in each group is shown in Table 1. The APE group was evenly divided between transudates, exudates, and indeter­minate effusions. The SPE group showed a greater percentage of exudates than transudates, although the difference was not statistically significant (p>0.1). The chest radiographic features of the APE group are shown in Table 2. Compared to SPE, APEs were more frequently free-flowing and of smaller size. Apcalis Oral Jelly

Table 1—Comparison of Types of Effusion

	Symptomatic No (%)	Asymptomatic No (%)
	n = 79	n= 15
Transudate	18 (23)	5 (33.3)
Exudate	44 (56)	5 (33.3)
Indeterminate	17 (21)	5 (33.3)

The diagnoses associated with SPE and APE are shown in Table 3. In both groups, the three most common diagnoses were malignancy, congestive heart failure, and parapneumonic effusion, accounting for more than 61 percent of the effusions in both groups. If postoperative surgery-related effusions are in­cluded, 70 percent of the SPE and 79 percent of the APE were accounted for. Postoperative effusions were more commonly symptomatic, but made up a larger percentage of the APE group. Other causes of APE included liver disease, gastric ulcer and drug-induced lupus.

Table 2—Radiographic Features of Symptomatic and Asymptomatic Pleural Effusions

	Symptomatic No (%)	Asymptomatic No (%)
	n = 79	n = 15
Bilateral	38 (48)	8 (53)
Free flowing	30 (38)	11 (73)
Loculated	9(11)	0(0)
Small	15 (19)	10 (67)
Medium	12 (15)	4 (27)
Large	23 (29)	1 (6)

Review of the Literature

Major causes of APE identified by our literature search are shown in Table 4. While postpartum, postoperative and benign asbestos effusion were most commonly encountered as asymptomatic, it was clear from our review that most causes of SPE can also cause APE in unusual situations. Of the articles used to describe these frequencies, three were prospec­tive and five retrospective. None dealt specifi­cally with APE.
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Table 3—Diagnoses of Pleural Effusions

	Symptomatic	Asymptomatic
Diagnoses	No (%)	No (%)
	n = 79	n= 15
Malignancy	25 (32)	4 (26)
Congestive heart failure	13 (16)	3 (20)
Parapneumonic	11 (14)	3 (20)
Postoperative	6(8)	2 (13)
Trauma/hemothorax	8(10)	0(0)
Empyema	7(9)	0 (0)
Liver disease/ascites	3(4)	1 (7)
Uremia	3(4)	0(0)
Drug induced lupus	1 (1)	1 (7)
Gastric ulcer	0(0)	1 (7)
Infectious endocarditis	1 (1)	0(0)
CAPD related	1 (1)	0(0)
CAPD, continuous ambulatory peritoneal dialysis.

Table 4—The Most Common Causes of Asymptomatic Pleural Effusions

	Estimated Frequency (%)	References
Postpartum	frequent	6
Postoperative (abdominal)	frequent	8
Benign asbestos effusion	66	7,12
Uremia	29	11
Malignancy	23	9
Tuberculosis	6	10