Pleural Effusion: Or something else? Differential Diagnosis

Respiratory System (J00-J99)

  • Hematothorax – accumulation of blood in the pleural space.
  • Chylothorax – accumulation of lymphatic fluid in the pleural space.
  • Pleural empyema – accumulation of pus in the pleural space; Note: risk of esophageal perforation (esophageal perforation; rare).
  • Pleurisy (pleurisy) – e.g. with pneumococci, streptococci.
  • Pneumonia (pneumonia)
  • Pseudochylothorax – accumulation of lymph-like fluid in the pleural space.

Blood, hematopoietic organs – immune system (D50-D90).

Endocrine, nutritional and metabolic diseases (E00-E90).

  • Hypoalbuminemia – decreased occurrence of albumin (protein) in the blood.
  • Myxedema – pasty (puffy; bloated) skin that shows nonpushable, doughy edema (swelling) that is not positional; facial and peripheral; occurring primarily on the lower legs; in the setting of hypothyroidism (hypothyroidism)
  • Ovarian hyperstimulation syndrome (OHSS) – may occur in rare cases during ovulation induction in the setting of artificial insemination. The clinical picture varies greatly depending on the severity; OHSS is caused by the supply of gonadotropins (hormones), which stimulate follicle maturation (egg maturation), respectively, to induce ovulation (ovulation).

Skin and subcutaneous (L00-L99).

  • Yellow-nail syndrome (YNS) – syndrome of unknown etiology, in which, as a result of nail dystrophy (growth disorders the nails), the nails thicken and turn yellowish, and furthermore a pleural effusion and lymphedema develop. In addition, dilated (expanded) bronchi and recurrent (recurrent) sinusitis (sinusitis) may occur.

Cardiovascular system (I00-I99)

  • Acute pericarditis (inflammation of the pericardium).
  • Dressler syndrome (synonyms: postmyocardial infarction syndrome, postcardiotomy syndrome) – pericarditis (inflammation of the pericardium) and/or pleurisy (inflammation of the pleura) occurring several weeks (1-6 weeks) after a myocardial infarction (heart attack) or injury to the myocardium (heart muscle) as a late immunologic reaction at the pericardium (heart sac) after formation of heart muscle antibodies (HMA).
  • Heart failure (cardiac insufficiency)
    • Right heart failure (right heart weakness) – inability of the right heart to pump blood sufficiently through the circulatory system.
    • Left heart failure (left heart weakness) – pleural effusion occurs on the floor of the left heart failure; pleura visceralis is the place of origin of the effusion in this case
  • Pulmonary embolism – occlusion of vessels supplying the lungs by an embolus (blood clot); about 20-55% of patients with pulmonary embolism have a pleural effusion
  • Obstruction of the superior vena cava (superior vena cava), unspecified.
  • Pulmonary hypertension (PH: pressure increase in the pulmonary arterial system) – prevalence (disease frequency) of pleural effusion is about 20%, occur more on the right side.

Infectious and parasitic diseases (A00-B99).

  • Bacterial infections, unspecified
  • Mycoses (fungal infections), unspecified
  • Parasitoses – infections with parasites -, unspecified.
  • Tuberculosis (consumption)
  • Viral infections, unspecified

Liver, gallbladder and bile ducts – Pancreas (pancreas) (K70-K77; K80-K87).

Mouth, esophagus (food pipe), stomach, and intestines (K00-K67; K90-K93).

  • Acute peritonitis (inflammation of the peritoneum).
  • Intraabdominal abscesses – encapsulated collections of pus in the abdomen.
  • Esophageal perforation – perforation of the esophagus.
  • Diaphragmatic hernia – soft tissue hernia in the area of the diaphragm.

Musculoskeletal system and connective tissue (M00-M99).

  • Eosinophilic granulomatosis with polyangiitis (EGPA), formerly Churg-Strauss syndrome (CSS) – granulomatous (roughly: “granule-forming”) inflammation of small to medium-sized blood vessels in which the affected tissue is infiltrated (“walked through”) by eosinophilic granulocytes (inflammatory cells).
  • Granulomatosis with polyangiitis (GPA), formerly Wegener’s granulomatosis – necrotizing (tissue dying) vasculitis (vascular inflammation) of the small to medium-sized vessels (small-vessel vasculitides), which is associated with granuloma formation (nodule formation) in the upper respiratory tract (nose, sinuses, middle ear, oropharynx) as well as the lower respiratory tract (lungs)
  • Rheumatoid arthritis
  • Systemic lupus erythematosus (SLE) – systemic disease affecting the skin and connective tissue of the vessels, leading to vascular inflammation (vasculitides) of numerous organs such as the heart, kidneys, or brain; prevalence (disease frequency) of pleural effusion is high at 30-50% (polyserositis)
  • Sjögren’s syndrome (group of sicca syndromes) – autoimmune disease from the group of collagenoses, which leads to a chronic inflammatory disease of the exocrine glands, most commonly the salivary and lacrimal glands; typical sequelae or complications of sicca syndrome are:
    • Keratoconjunctivitis sicca (dry eye syndrome) due to lack of wetting of the cornea and conjunctiva with tear fluid.
    • Increased susceptibility to caries due to xerostomia (dry mouth) due to reduced salivary secretion.
    • Rhinitis sicca (dry nasal mucous membranes), hoarseness and chronic cough irritation and impaired sexual function due to disruption of mucous gland production of the respiratory tract and genital organs.

Neoplasms – tumor diseases (C00-D48).

  • Bronchial carcinoma (lung cancer)
  • Gastrointestinal malignancies (malignant gastrointestinal tumors) (approximately 5% of all cases of malignant pleural effusion)
  • Immunoblastic lymphadenopathy – malignant (malignant) disease of blood cells belonging to the non-Hodgkin’s lymphomas.
  • Leukemia, unspecified
  • Lymphoma (approximately 10% of all cases of malignant pleural effusion).
  • Mammary carcinoma (breast cancer) (about 25% of all cases of malignant pleural effusion).
  • Meigs syndrome – simultaneous occurrence of fibroma of the ovary (ovary), ascites (abdominal fluid) and pleural effusion.
  • Unspecified metastatic neoplasia – malignant neoplasm associated with the formation of daughter tumors.
  • Pleural mesothelioma – a malignant tumor of the pleura arising from the mesothelial cells (celomic epithelium). [Initial description involved disease initiation from inhaled asbestos dust.]
  • Pleuritis carcinomatosa – inflammation of the pleura (pleura) associated with metastasis to the pleura.
  • Ovarian cancer (ovarian cancer) (about 5% of all cases of malignant pleural effusion).

Genitourinary system (kidneys, urinary tract – sex organs) (N00-N99).

  • Nephrotic syndrome – collective term for symptoms occurring in various diseases of the glomerulus (renal corpuscles); symptoms include proteinuria (increased excretion of protein in the urine) with protein loss of more than 1 g/m²/body surface/d; hypoproteinemia, peripheral edema due to hypalbuminemia of < 2.5 g/dl in serum, hyperlipoproteinemia (dyslipidemia).
  • Renal insufficiency (kidney weakness).

Injuries, poisoning, and other consequences of external causes (S00-T98).

  • Injuries of the thorax (chest), unspecified.

Other

  • Endoscopic esophageal variceal sclerotherapy – sclerotherapy of varicose veins of the esophagus by endoscope.
  • Peritoneal dialysiskidney replacement procedure that uses the peritoneum as a dialysis membrane.
  • Condition after abdominal surgery – procedures in the abdominal cavity.
  • Condition after bypass surgery in the heart
  • Condition after liver transplantation (LTx)
  • Condition after radiotherapy

Medication

  • Amiodarone (antiarrhythmic drug)
  • Beta blocker
  • Bromocriptine (dopamine D2 agonist; inhibition of prolactin secretion).
  • Clozapine (neuroleptic).
  • Dantrolene (hydantoin derivative from the muscle relaxant group) – used in malignant hyperthermia
  • Interleukin-2 (IL 2)
  • Methotrexate (MTX)
  • Methysergide (ergotamine derivative; drug from the group of serotonin antagonists) – used as a migraine medication.
  • Monoclonal antibodiespertuzumab, trastuzumab.
  • Nitrofurantoin (antibiotic)
  • Phenytoin (antiepileptic)
  • Procarbazine (nonclassical alkylane with high antineoplastic activity; cytostatic).

Environmental exposures – intoxications (poisonings).

  • Exposure to asbestos (asbestosis)