Significance of congestive heart failure as a cause of pleural effusion: Pilot data from a large multidisciplinary teaching hospital

Abstract

Background: Epidemiological data on the causes of pleural effusion (PE) are scarce. Data on the local prevalence of various causes of PE may play a crucial role in the management strategy of patients with PE. The aim of the study was to investigate the causes of PE and to assess 30-day mortality rate in unselected adult patients treated in a large, multidisciplinary hospital.

Methods: Retrospective analysis of medical records, including chest radiographs, of 2835 consecutive patients admitted to the hospital was performed. Radiograhic signs of PE were found in 195 of 1936 patients in whom chest radigraphs were available. These patients formed the study group.

Results: The leading causes of PE were as follows: congestive heart failure (CHF; 37.4%), pneumonia (19.5%), malignancy (15.4%), liver cirrhosis (4.2%) and pulmonary embolism. The cause of PE in 6.7% patients was not established. There was a significant predominance of small volume PE as compared to a moderate or large volume PEs (153, 28 and 14 patients, respectively). Almost 80% of patients with CHF presented with small volume PE, while almost 50% of patients with malignant PE demonstrated moderate or large volume PE. Thirty-day mortality rate ranged from 0% for tuberculous pleurisy to 40% for malignant PE (MPE).

Conclusions: Pleural effusion was found in 10.1% of patients treated in a large multidisciplinary hospital. CHF was the leading cause of PE. Although 30-day mortality in patients with CHF was rela-tively high, it was lower than that in parapneumonic PE and MPE.

Keywords: cancer; congestive heart failure; epidemiology; pleural effusion; pleuritic; pneumonia; tuberculosis.

Figure 1

Percentage of patients with various causes of pleural effusion in the investigated group.

Figure 2

Distribution of underlying causes of pleural fluid formation in patients with small (n = 158; A), moderate (n = 28; B) and large (n = 14; C) volume of pleural effusion; CHF — congestive heart failure; MPE — malignant pleural effusion; PPE — parapneumonic pleural effusion.

Figure 3

Differences between distribution of pleural fluid volume in patients with various causes of pleural effusion; CHF — congestive heart failure; MPE — malignant pleural effusion; PPE — parapneumonic pleural effusion.