The modern diagnosis and management of pleural effusions.

tant in terms of further investigations and long term outcome. The American Thoracic Society guidelines on the management of malignant pleural effusion, published in 2000, estimated the incidence in the US to be between 80 000 and 160 000 new cases each year. Despite the seemingly clear distinction between exudates and transudates, the clinical reality of determining the cause of a pleural effusion is often much more nuanced. Patients may present at different times along their disease course, with varying symptoms, and their condition may even have more than one contributory factor. Careful consideration of the whole patient story is vital to ensure timely and appropriate management.