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.