Pleural effusion causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Prince Tano Djan, MBChB [2]


Common causes of transudative pleural effusion include;[1][2][3][4][5] left ventricular failure, Nephrotic syndrome, and cirrhosis, while common causes of exudative pleural effusions[6] are bacterial pneumonia, cancer (with lung cancer, breast cancer, and lymphoma causing approximately 75% of all malignant pleural effusions), viral infection, and pulmonary embolism. Pulmonary embolism may lead to formation of either transudate or exudate however, an exudate is commonly observed.

Causes of transudates

Most common causes

Most common causes of transudative pleural effusion include:[1][2][3][4][5][7][8][9]

Less common causes

Rare causes

Causes of exudates

Common causes

Most common causes of exudative pleural effusion include:[6]

Less common causes

Rare causes

Commonly asymptomatic patients presenting with a pleural effusion
Typically symptomatic patients presenting with a pleural effusion

Causes by Organ System

Cardiovascular Central venous stenosis, congestive heart failure, constrictive pericarditis, Dressler's syndrome, pulmonary embolus, pulmonary hypertension, pulmonary infarction, restrictive cardiomyopathy, superior vena cava syndrome, Uhl anomaly, Wegener's granulomatosis, Churg-Strauss syndrome
Chemical / poisoning No underlying causes
Dermatologic Jaffe-Campanacci syndrome, yellow nail syndrome
Drug Side Effect Bromocriptine, Bosutinib, cabergoline, dasatinib, everolimus, ethanolamine oleate, Hydroxocobalamin, lisuride, Meropenem, Oprelvekin, pergolide, Pertuzumab, piribedil, pramipexole, ropinirole, Sargramostim, minoxidil, sirolimus
Ear Nose Throat No underlying causes
Endocrine Myxedema
Environmental No underlying causes
Gastroenterologic Cirrhosis of liver, esophageal perforation, hepatic failure, pancreatitis, protein losing enteropathy, Whipple's disease, abdominal abscess
Genetic No underlying causes
Hematologic Diffuse large B-cell lymphoma, EBV associated lymphoproliferative syndrome, lymphoma, non-Hodgkin lymphoma, lymphangiomyomatosis
Iatrogenic Abdominal surgery, CABG, central venous catheter, endoscopic variceal sclerotherapy, liver transplantation, lung transplantation, post open heart surgery, radiotherapy
Infectious Disease Abdominal abscess, actinomycosis, anthrax, asbestosis, aspergillosis, atypical mycobacteria, blastomycosis, coccidioidomycosis, empyema, Francisella tularensis , hydatid disease, paragonimiasis, pneumonia, scrub typhus, subphrenic abscess, tuberculosis, Whipple's disease
Musculoskeletal / Ortho Diaphragmatic hernia, Gorham's disease, Rheumatoid arthritis
Neurologic Jaffe-Campanacci syndrome, Neurofibromatosis
Nutritional / Metabolic Malnutrition
Obstetric/Gynecologic Fetal indomethacin syndrome,[12] ovarian hyperstimulation syndrome
Oncologic Adenocarcinoma of lung, breast cancer, diffuse large B-cell lymphoma, EBV associated lymphoproliferative syndrome, Kaposi sarcoma, lung cancer, lymphoma, malignancy, Meigs' syndrome, mesothelioma, non-Hodgkin lymphoma, neurofibromatosis, bronchial neoplasm, bronchogenic carcinoma, lung cancer
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary bronchial neoplasm, bronchogenic carcinoma, chylothorax, extensive atelectasis, extramedullary haemopoiesis, haemothorax, lung cancer, lupus pleuritis, lymphangiomyomatosis, pleurisy, pleuritis, pulmonary edema, recurrent polyserositis, urinothorax, yellow nail syndrome , empyema, pneumonia, tuberculosis, Adenocarcinoma of lung, Lung cancer, Meigs' syndrome, Mesothelioma, Jaffe-Campanacci syndrome
Renal / Electrolyte Chronic renal failure, nephrotic syndrome
Rheum / Immune / Allergy Churg-Strauss syndrome, sarcoidosis, Sjogren's syndrome, systemic lupus erythematosus, Dressler's syndrome, rheumatoid arthritis, lupus pleuritis
Sexual Jaffe-Campanacci syndrome
Trauma Chest trauma
Urologic No underlying causes
Dental No underlying causes
Miscellaneous Hypoproteinemia, radiation

Causes in Alphabetical Order


  1. 1.0 1.1 Chawla RK, Madan A, Chawla A, Arora HN, Chawla K (2015). "Bilateral Pleural Effusion: A Rare Case Report.". Indian J Chest Dis Allied Sci 57 (4): 243-5. PMID 27164734.
  2. 2.0 2.1 Gilbert CR, Yarmus LB, Feller-Kopman DJ, Lee HJ, Gorden JA (2016). "The Undefined Value of Pleural Interventions in Advanced Heart Failure and Recurrent Pleural Effusions.". Ann Am Thorac Soc 13 (3): 447-8. doi:10.1513/AnnalsATS.201512-825LE. PMID 26963358.
  3. 3.0 3.1 Riccio E, Argentino G, Pisani A, Memoli B (2013). "Pleural effusion in peritoneal dialysis: overload or leakage?". Clin Exp Nephrol 17 (6): 907. doi:10.1007/s10157-013-0794-8. PMID 23494296.
  4. 4.0 4.1 Shah S, Robson N, Sajid S (2015). "Pleuro-Peritoneal Fistula – An Important Condition to Consider in Patients using Peritoneal Dialysis.". Acute Med 14 (2): 69-71. PMID 26305084.
  5. 5.0 5.1 Asim M, Hamid EM (2013). "Pleuroperitoneal leak in a peritoneal dialysis patient.". BMJ Case Rep 2013. doi:10.1136/bcr-2013-200130. PMID 23853026.
  6. 6.0 6.1 Lee J, Lim JK, Lee SY, Yoo SS, Lee SY, Cha SI et al. (2016). "Neutrophilic Loculated Tuberculous Pleural Effusion: Incidence, Characteristics and Differentiation From Complicated Parapneumonic Effusion.". Am J Med Sci 351 (2): 153-9. doi:10.1016/j.amjms.2015.11.010. PMID 26897270.
  7. Butani L, Polinsky MS, Kaiser BA, Baluarte HJ (1998). "Pleural effusion complicating acute peritoneal dialysis in hemolytic uremic syndrome.". Pediatr Nephrol 12 (9): 772-4. PMID 9874325.
  8. Hanna J, Truemper E, Burton E (1997). "Superior vena cava thrombosis and chylothorax: relationship in pediatric nephrotic syndrome.". Pediatr Nephrol 11 (1): 20-2. PMID 9035166.
  9. Jenkins PG, Shelp WD (1974). "Recurrent pleural transudate in the nephrotic syndrome. A new approach to treatment.". JAMA 230 (4): 587-8. PMID 4479274.
  10. Wang Z, Xia G, Lan L, Liu F, Wang Y, Liu B et al. (2016). "Pleural Effusion in Multiple Myeloma.". Intern Med 55 (4): 339-45. doi:10.2169/internalmedicine.55.4733. PMID 26875957.
  11. Light, Richard J. (2007). Pleural diseases. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-6957-4. 
  12. 12.0 12.1 Murray HG, Stone PR, Strand L, Flower J (1993). "Fetal pleural effusion following maternal indomethacin therapy.". Br J Obstet Gynaecol 100 (3): 277-9. PMID 8476835.
  13. Bartlett RP, Greipp PR, Tefferi A, Cupps RE, Mullan BP, Trastek VF (1995). "Extramedullary hematopoiesis manifesting as a symptomatic pleural effusion.". Mayo Clin Proc 70 (12): 1161-4. doi:10.1016/S0025-6196(11)63442-3. PMID 7490917.