Chylothorax Drug hypersensitivity Nitrofurantoin Methysergide Miscellaneous diseases Asbestos exposure Pulmonary and lymph node myomatosis Uremia Postmyocardial infarction syndrome Trapped lung Congenital abnormalities of the lymphatics Postradiation therapy Drug reactions Reprinted from Light RW Pleural effusions Med Clin North Am 1977;61:1339–1352 Copyright © 1977 Elsevier With permission See text for transudate/exudate criteria Triage Patients with pleuritis often present with chest pain that may be severe Depending on the amount of pleural fluid, hypoxemia and significant respiratory distress may be present Promptly addressing pain and respiratory compromise is a priority Initial Assessment/H&P The hallmarks of pleural disease are chest pain, shortness of breath, fever, and in many cases an abnormal CXR Pain with respirations, or pleuritic chest pain, is the most characteristic symptom with pleural inflammation, and may be localized Most patients also describe some degree of dyspnea Additional symptoms vary depending on the primary cause In “dry” pleurisy, which is usually caused by a minor pulmonary infection, the patient is often febrile with an irritating, nonproductive cough With oncologic etiologies, weight loss, night sweats, and fatigue may be present On examination, the chest wall over the involved area may be tender, and a coarse vibration may sometimes be appreciated on palpation A pleural friction rub is most apt to be heard when pleural inflammation is associated with little or no effusion The sound has been described as low pitched, sometimes with a grating or squeaking quality It has also been described as a “purring” noise It is usually loudest on inspiration, but often it may also be audible during expiration