49. Top Consults: Malignant Pleural Effusions

Malignant pleural effusions represent advanced-stage disease, with lung and breast cancers accounting for over half of all cases. Diagnosis relies on systematic pleural fluid analysis—specifically cytology, LDH, and cell counts—complemented by bedside ultrasound to detect diaphragmatic nodules or pleural thickening. When cytology remains inconclusive, pleuroscopy with pleural biopsy provides definitive tissue for diagnosis and molecular testing. Management strategies prioritize patient quality of life, necessitating an assessment of lung re-expansion and symptom relief following initial drainage. While traditional chemical pleurodesis remains an option, indwelling pleural catheters provide a minimally invasive, patient-centric alternative for recurrent effusions. Successful long-term management requires balancing these interventions with the patient's social support, life expectancy, and personal preferences, while remaining vigilant for complications like catheter-site infection or blockage.