Original Article

Distribution of Pleural Effusion in Congestive Heart Failure: What Is Atypical?

Authors: John H. Woodring, MD

Abstract

Objectives: This study was performed to determine the distribution of pleural effusion between the right and left hemithorax in patients with uncomplicated congestive heart failure, and to determine whether left-sided pleural effusion actually constitutes an atypical distribution in congestive heart failure.


Methods: The study group consisted of 120 consecutive patients with both clinical and radiographic evidence of uncomplicated congestive heart failure, and whose chest radiographs at the time of presentation also showed evidence of pleural effusion. The presence or absence of pleural effusion in the right and left hemithorax was recorded for each case, as was the size of each pleural effusion, and the distribution of pleural effusion in these 120 patients was entered into a 2 × 2 table and analyzed by χ2 analysis.


Results: There were 207 total pleural effusions, with 105 on the right and 102 on the left. Isolated right-sided pleural effusions occurred in 18 patients, there were bilateral pleural effusions larger on the right than the left in 25, there were bilateral pleural effusions of roughly equal size on each side in 36, there were bilateral pleural effusions larger on the left side than the right in 26, and there were isolated left-sided pleural effusions in 15. The difference was not statistically significant (χ2 = 0.316; P ≤ 1.0).


Conclusions: Left-sided pleural effusion is not an atypical finding in congestive heart failure and is not, in and of itself, an indication for further clinical or imaging evaluation.


Key Points


* A review of the chest radiographs of 120 consecutive patients with clinical and radiographic evidence of uncomplicated congestive heart failure, who also had radiographic evidence of pleural effusion, revealed a total of 207 pleural effusions, with 105 right-sided and 102 left-sided pleural effusions.


* The difference in the distribution of pleural effusion between the right and left hemithorax was not statistically significant (χ2 = 0.316; P ≤ 1.0).


* Left-sided pleural effusion is not an atypical finding in congestive heart failure and is not, in and of itself, an indication for further clinical or imaging evaluation.

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References

1. Felson, B. Chest Roentgenology. Philadelphia, W B Saunders Co, 1973, p 359.
 
2. O'Rourke RA, Shaver JA, Silverman ME. The history, physical examination, and cardiac auscultation, in Fuster V, Alexander RW, O'Rourke RA, et al (eds): Hurst's The Heart. New York, McGraw-Hill, 2001, ed 10, Vol 1 p 234.
 
3. Meszaros WT. Cardiac Roentgenology Plain Films and Angiocardiographic Findings. Springfield, Charles C. Thomas, 1969, p 105.
 
4. Harle TS. Congestive heart failure, in Freundlich IM, Bragg DG (eds): A Radiologic Approach to Diseases of the Chest. Baltimore, Williams & Wilkins, 1997, ed 2, p 352.
 
5. Müller NL, Fraser RS, Colman NC, et al. Radiologic Diagnosis of Diseases of the Chest.Philadelphia, WB Saunders Co, 2001, pp 653–654.
 
6. Fraser RS, Müller NL, Colman N, et al. Fraser and Paré's Diagnosis of Diseases of the Chest.Philadelphia, WB Saunders Co, 1999, ed 4, Vol 4, pp 653–654.
 
7. Chakko S. Pleural effusion in congestive heart failure. Chest 1990;98:151–152.
 
8. Johnson JL. Pleural effusions in cardiovascular disease: pearls for correlating the evidence with the cause. Postgrad Med 2000;107:95–101.
 
9. Felz MW, Neely J. Beware the left-sided effusion. J Fam Pract 1997;45:519–522.
 
10. Weiss JM, Spodick DH. Laterality of pleural effusions in chronic congestive heart failure. Am J Cardiol 1984;53:951.
 
11. White PD, August S, Michie CR. Hydrothorax in congestive heart failure. Am J Med Sci1947;214:243–247.
 
12. McPeak EM, Levine SA. The preponderance of right hydrothorax in congestive heart failure. Ann Intern Med 1946;25:916–927.
 
13. Race GA, Scheifley CH, Edwards JE. Hydrothorax in congestive heart failure. Am J Med1957;22:83–89.
 
14. Fleischner FG. Atypical arrangement of free pleural effusion. Radiol Clin North Am 1963;1:347–362.
 
15. Rudikoff JC. Early detection of pleural fluid. Chest 1980;77:109–111.
 
16. Vix VA. Roentgenographic recognition of pleural effusion. JAMA 1974;229:695–698.
 
17. Collins JD, Burwell D, Furmanski S, et al. Minimal detectable pleural effusions a roentgen pathology model. Radiology 1972;105:51–51.
 
18. Raasch BN, Carsky EW, Lane EJ, et al. Pleural effusion: explanation of some typical appearances.AJR 1982;139:899–904.
 
19. Onadeko BO. The radiologic patterns of pleural effusions in Nigerians. Niger Med J 1979;9:687–691.
 
20. Roper WH, Waring JJ. Primary serofibrinous pleural effusion in military personnel. Am Rev Respir Dis 1955;71:616–634.
 
21. Woodring JH. Recognition of pleural effusions on supine radiographs: how much fluid is required?AJR 1984;142:59–64.
 
22. Peterman TA, Brothers SK. Pleural effusions in congestive heart failure and in pericardial disease. N Engl J Med 1983;309:313.
 
23. Kalomenidis I, Rodriguez M, Barnette R, et al. Patient with bilateral pleural effusion: are the findings the same in each fluid. Chest 2003;124:167–176.