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Pleural effusion in haematological malignancies: an educational position statement
Olivia Walsh1,2, Arran Patel3, Najib Rahman1,2,4
1Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Breathe (Sheffield, England)
|February 19, 2026
Summary
Pleural effusion complicates hematologic malignancies in 20-48% of patients, posing diagnostic challenges. Understanding diverse causes is key for effective management and improving patient prognosis in these cancers.
Area of Science:
- Hematology
- Pulmonology
- Oncology
Background:
- Pleural effusion is a frequent complication in hematologic malignancies like lymphomas, leukaemias, and multiple myeloma.
- It affects an estimated 20-48% of patients, contributing 10-16% of all malignant pleural effusions.
- Diagnosis is challenging due to low yields from traditional methods like cytology and biopsy.
Purpose of the Study:
- To provide a comprehensive overview of pleural effusions in hematologic malignancies.
- To discuss prevalence, pathophysiology, diagnostic challenges, and management strategies.
- To offer evidence-based recommendations for clinical practice.
Main Methods:
- Literature review and synthesis of existing evidence.
- Analysis of prevalence data from case series.
- Discussion of pathophysiological mechanisms.
- Evaluation of diagnostic and management strategies.
Main Results:
- Pleural effusions occur in a significant proportion of patients with hematologic malignancies.
- Pathophysiology is diverse, including direct infiltration, obstruction, and treatment effects.
- Poor diagnostic yield of standard tests necessitates advanced approaches.
- Presence of effusion may indicate advanced disease and poorer prognosis.
Conclusions:
- Pleural effusions in hematologic malignancies present complex diagnostic and management issues.
- Understanding the varied aetiologies is crucial for effective patient care.
- Evidence-based recommendations are needed to guide clinical practice and improve outcomes.
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