Diagnosing and managing suspected malignant pleural effusions.

Malignant pleural effusions are both a diagnostic and therapeutic challenge for clinicians. A reasonable approach used at our institution for diagnosing malignant effusions is presented. The presence of a malignant effusion generally portends a worse outcome, and thus preserving quality of life is of utmost importance in its management. Clinicians must balance the morbidity of aggressive diagnostic and therapeutic maneuvers with the putative benefits derived from them. Broadly speaking, asymptomatic, small malignant pleural effusions should be managed conservatively, reserving largevolume throacentesis, tube or thoracoscopic pleurodesis, indwelling TPC, and pleurectomy for symptomatic patients and for those whose life expectancy is sufficiently long to glean benefit from these interventions.