Feature Article

Pleural effusion: recognition, triage and treatment

Ken K.P. Chan, Carmen P.S. Tan, Y.C. Gary Lee




Pleural effusion has many possible causes, some of which are life-threatening and require urgent treatment, but is often not recognised because of its nonspecific presentation. Three cases illustrate the steps in recognising and triaging patients with pleural effusion.

Key Points

  • Pleural effusion can be a complication of a range of acute and chronic lung and extrapulmonary diseases, some of which are life-threatening and require urgent treatment.
  • Patients with pleural effusion often present first to their GP with nonspecific respiratory symptoms.
  • GPs should be vigilant and have a low threshold for excluding or confirming the diagnosis of pleural effusion, for example by ordering a chest x-ray.
  • Triage of patients with pleural effusion for urgent, semi-urgent or elective referral is based on clinical parameters (e.g. presence of infective symptoms, recent trauma or bleeding risk, effusion size and suspicion of pulmonary embolism or malignancy).
  • Patients with suspected empyema, haemothorax, pulmonary embolism-related pleural effusion or massive pleural effusion require urgent referral to a centre with pleural specialist support.