In patients with pleural effusion, what is often recommended for severe cases?

In severe cases of pleural effusion, tube thoracostomy or surgical decortication is often recommended to effectively manage the condition. Pleural effusion involves the accumulation of fluid in the pleural space, which can lead to significant respiratory symptoms and impaired lung function.

When an effusion is large, particularly if it is causing respiratory distress or if there are signs of infection (such as paragon pneumonia or empyema), intervention is required to alleviate symptoms and prevent complications. Tube thoracostomy involves placing a tube into the pleural space to drain excess fluid, which can help restore normal breathing mechanics and improve oxygenation.

In cases where the effusion is complicated—such as with loculated fluid that does not respond to drainage through a tube—surgical decortication may be necessary. This procedure involves removing the thickened pleura to allow for better lung expansion and drainage, particularly when there is a risk of fibrosis or trapped lung.

While observation without intervention may be appropriate for small, asymptomatic effusions, and corticosteroids or oral antibiotics might be used in certain types of inflammatory or infectious conditions, these approaches do not address the immediate need for drainage in severe cases. Therefore, the most effective management strategy in this