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.