History

Symptoms due to effusion: Dyspnoea, chest pain that may be pleuritic, cough, shoulder pain, lethargy

Symptoms depending on the underlying cause: Weight loss, haemoptysis, fever, night sweats, swollen legs/abdomen

The following points should be specifically covered when taking a history from a patient with a pleural effusion:

• History of heart, liver or renal disease
• History of malignancy (however remote)
• History of chest disease, especially recent pneumonia
• History of pancreatic disease
• History of connective disease such as rheumatoid arthritis
• Previous cardiac surgery
• Smoking history
• Occupational history, especially any previous asbestos exposure
• Previous tuberberculosis exposure and HIV status
• Risk factors for venous thrombo-embolism
• Recent trauma, especially if anticoagulated (suggesting haemothorax)
• Accurate drug history

An accurate drug history is important, as certain drugs are known to sometimes cause pleural effusions. Some of the more common include:

• Phenytoin
• Methotrexate
• Amiodarone
• Nitrofurantoin
• Beta-blockers

Further information may be found here.

Equally, a recent reduction in diuretics may precipitate fluid accumulation that leads to an effusion.