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We need to know why some pleural effusions tend to occur independent of hydrostatic forces We aim to describe the association between the presence and size of pleural effusion and central hemodynamics, including pulmonary capillary wedge pressure (pcwp) in an advanced heart failure population. The most common cause of pleural effusion was heart failure, which accounted for 37.4% of cases
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The second most common cause was parapneumonic effusion (19.5%) and the third was malignant pleural involvement (15.4%). This further promotes pleural fluid accumulation, often resulting in bilateral effusions. Pleural effusions are commonly seen in patients with congestive heart failure
They are usually bilateral or right sided and are rarely left sided
An important step in the evaluation of any pleural effusion is the classification of the fluid into a transudate or an exudate. Patients with pe also had significantly lower cardiac index and output, but no differences in mean pulmonary artery pressure, right ventricular diastolic pressure (rvdp) and pulmonary artery occlusion pressure 6 the authors conclude that pe in these patients is associated with right hf. Pleural effusions are common in patients with congestive heart failure
This process is felt to be due to left ventricular (lv) dysfunction leading to elevated pulmonary venous and left atrial pressures. In patients with chf, increased pressure within the pulmonary circulation often leads to fluid leakage into the pleural space This occurs because the failing heart cannot adequately handle the blood volume returning from the lungs, causing a backup that elevates pulmonary venous pressure. There have been several discussions on the sidedness of pleural effusion in heart failure
One view is that the larger surface area of right lung permits more transudation into the right pleural cavity.
Elevated pressures in the superior and inferior vena cava can increase hydrostatic pressure in pleural capillaries
