Malignant pleural effusion 

• About 40% of all pleural effusions are due to malignancy. 
• Presence of an effusion indicates incurable disease. 
• The presentation may be with dyspnoea, cough or chest discomfort, which can be dull or pleuritic in nature. Diagnosis and management of pleural effusion is discussed on page 494. 

Investigation:

• Pleural fluid aspiration & study:
  • blood-stained
  • exudative 
  • raised fluid to serum LDH ratio (> 0.6) 
  • raised fluid to serum protein ratio (>0.5). 
  • presence of malignant cells. 

Treatment:

• Palliation of symptoms 
• Aspiration  
• Systemic anti-cancer therapy 
• For recurrent pleural effusions 
  1. pleurodesis, [procedure performed to obliterate the pleural space to prevent recurrent pleural effusions, pneumothorax, or to treat a persistent pneumothorax]
  2. implanted drainage catheters, 
  3. pleurectomy 
  4. pleuroperitoneal shunt.