Key Points

• Pleural effusions are common and have a broad differential, a thorough history and physical is required.
• Sampling fluid to determine a transudative or exudative process is an important step in defining etiology.
• The majority of effusions related to benign disease will resolve by treating the underlying disease and surgical intervention may not be warranted.
• The goal with exudative parapneumonic effusions is to identify and intervene in the early stages, prior to the development of an empyema.
• Symptom palliation is the treatment goal for the majority of malignant pleural effusions and this is most commonly accomplished with chemical pleurodesis or indwelling tunneled pleural catheters.