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Semin Respir Crit Care Med 2010; 31(6): 689-697
DOI: 10.1055/s-0030-1269828
© Thieme Medical Publishers

Pleural Effusions from Congestive Heart Failure

José M. Porcel1
  • 1Pleural Diseases Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, Lleida, Spain
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Publication History

Publication Date:
06 January 2011 (online)

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ABSTRACT

In heart failure (HF), pleural effusion results from increased interstitial fluid in the lung due to elevated pulmonary capillary pressure. Rarely, pleural effusions may occur in association with isolated right HF. HF-associated effusions are typically bilateral, but if unilateral, they are more commonly seen on the right side. The fluid typically meets the biochemical characteristics of a transudate, although in 25% of the cases it may fall into the exudative range. Testing for natriuretic peptides, such as NT-proBNP, significantly aids in diagnosing or excluding HF in patients with pleural effusion of unknown origin. The measurement of pleural fluid NT-proBNP is the best way to identify pleural effusions that meet the exudative criteria of Light but are due to HF. However, if natriuretic peptide assays are not available, calculation of the serum to pleural fluid albumin gradient represents a good substitute for making this distinction. Loop diuretics are the mainstay of therapy, although a therapeutic thoracentesis for very large effusions may occasionally be required.

KEYWORDS

Pleural effusion - heart failure - natriuretic peptides - transudate - exudate

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José M PorcelM.D. 

Department of Internal Medicine, Arnau de Vilanova University Hospital

Avda Alcalde Rovira Roure 80, 25196 Lleida, Spain

Email: jporcelp@yahoo.es

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