Epidemiology
About 1.5 million people develop a pleural effusion in the US each year. The leading cause of pleural effusion in the US is congestive heart failure (CHF), with an estimated annual incidence of 500,000. Pneumonia is second, with an incidence of 300,000.[4] Approximately 40% of the hospitalized patients with pneumonia have an associated parapneumonic effusion.[4] Malignancy is the third leading cause overall, with an estimated incidence of 200,000;[4] however, it is the second most common cause of effusion in patients >50 years of age.[5] Pulmonary embolus, viral disease, coronary artery bypass surgery, and cirrhosis are also common causes of effusion. Small pleural effusions are present in up to 40% of patients with pulmonary embolism. Of all patients with cirrhosis, 5% have an associated pleural effusion.[6]
Tuberculosis is an important cause of pleural effusion in the developing world and should also be considered in high-incidence areas, in travelers returning from endemic areas, and in immunocompromised people.
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