Pleural effusions following cardiac injury and coronary artery bypass graft surgery

Abstract

This article discusses the pleural effusions that occur with the post-cardiac injury (Dressler's) syndrome (PCIS) and those that occur after coronary artery bypass graft (CABG) surgery. The PCIS can occur after any type of cardiac injury and is thought to be due to anti-myocardial antibodies. The primary symptoms are fever and chest pain, and pericarditis is frequently present. Pleural effusions are common with PCIS. The primary treatment for PCIS is a nonsteroidal anti-inflammatory agent or corticosteroids. Following CABG surgery, most patients will have a small unilateral left-sided pleural effusion, and approximately 10% of patients will have a larger effusion. These large effusions can be separated into early effusions occurring within the first 30 days of surgery that are bloody exudates with a high percentage of eosinophils, and late effusions occurring more than 30 days after surgery that are clear yellow lymphocytic exudates. The primary symptom of a patient with a pleural effusion post-CABG surgery is dyspnea; chest pain and fever are uncommon. Most patients with large pleural effusions postCABG surgery are managed successfully with one to three therapeutic thoracenteses.