Pleural disease is a common clinical problem encountered in everyday practice. The investigation and management of pleural effusion has evolved considerably from inpatient admission and effusion drainage as the standard of care, with the focus of management shifting towards more complex diagnostic and therapeutic pathways aimed at expeditious and comprehensive management. This chapter focuses on the diagnostic pathways for patients presenting with pleural effusion and/or thickening. Whilst drainage of a symptomatic effusion remains at the centre of clinical care, a thorough and timely evaluation is required to inform appropriate management. With the rising incidence of malignant pleural disease and recent advances in diagnostic and therapeutic options, the need to obtain pleural biopsies is increasing to allow accurate pathological, immunological and molecular characterisation, with the aim of providing more individualised treatment. Performing procedures on an ambulatory basis combining diagnostic and therapeutic intent has become possible in the modern specialised pleural service and this is facilitated by the widespread use of point-of-care TUS by physicians.

Cite as: Hassan M, Munavvar M, Corcoran JP. Pleural interventions: less is more? In: Maskell NA, Laursen CB, Lee YCG, et al., eds. Pleural Disease (ERS Monograph). Sheffield, European Respiratory Society, 2020; pp. 90–104 [https://doi.org/10.1183/2312508X.10023319].