Letter to the Editor

Distribution of Pleural Effusion in Congestive Heart Failure

Authors: José M. Porcel, MD, Manuel Vives, MD

Abstract

To the Editor:The recent article by Woodring questioned the classic statement of predominantly right-sided pleural effusions in patients with congestive heart failure (CHF), on the basis of a study of 120 patients whose cardiac pleural effusions were equally distributed between the right and the left hemithorax.1 More importantly, the author also concluded that left-sided effusion is not an atypical finding in CHF and is not, in and of itself, an indication for further clinical or imaging workup to find alternative causes. This latter point seems to contradict Light's recommendations2 and consensus guidelines,3 and may possibly influence practice trends. Therefore, we present our own experience with the radiographic distribution of cardiac pleural effusions in the largest clinical series to our knowledge.

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References

1.Woodring JH. Distribution of pleural effusion in congestive heart failure: what is atypical? South Med J2005;98:518–523.
 
2.Light RW. Pleural effusion. N Engl J Med 2002;346:1971–1977.
 
3.Maskell NA, Butland RJ, Pleural Diseases Group, Standards of Care Committee, British Thoracic Society. BTS guidelines for the investigation of a unilateral pleural effusion in adults. Thorax 2003;58 (Suppl 2):ii8–17.
 
4.Peterman TA, Brothers SK. Pleural effusions in congestive heart failure and in pericardial disease. N Engl J Med 1983;309:313.
 
5.Weiss JM, Spodick DH. Laterality of pleural effusions in chronic heart failure. Am J Cardiol1984;53:951.
 
6.Kataoka H. Pericardial and pleural effusions in decompensated chronic heart failure. Am Heart J2000;139:918–923.