Pleural Effusion and the Approach to Therapy: Simple Versus Complex Effusions

Treatment of a parapneumonic pleural effusion is largely dictated by effusion size and disease progression. Small and moderate effusions in stage 1 may be treated with antibiotics alone and supplemental thoracentesis if the patient develops respiratory distress. Large effusions may be addressed with chest tube insertion with or without fibrinolytics and/or video-assisted thoracoscopic surgery (VATS). Choosing between these 2 interventions depends on the disease progression. Currently, further investigation is required to identify when the cutoff occurs for intervening with chest tube drainage or VATS.