The presentation of pleural effusion differs according to size of the effusion, the rate of fluid accumulation, comorbidities, and underlying respiratory reserve.
Symptoms:
- may be asymptomatic
- dyspnoea - dependent on size of effusion
- dull chest pain
- cough (non productive)
Signs:
- there may be a displacement of the trachea and the lung apex away from the effusion if it is very large
- there is reduced movement of the affected side
- the site of the pleural effusion is dull to percussion; classical stony dullness is not a constant sign
- there is reduced vocal fremitus over a pleural effusion
- breath sounds are reduced or absent over a pleural effusion
- towards the upper part of an effusion there may be signs of consolidation i.e. bronchial breathing and bleating vocal resonance - aegophony
- the presence of Grocco's triangle is considered to be pathognomonic
Reference:
- Roberts ME, Rahman NM, Maskell NA, et al. British Thoracic Society guideline for pleural disease. Thorax. 2023 Jul;78(suppl 3):s1-42.