Transudative effusions, typically secondary to cardiac, renal or hepatic dysfunction, are often characterised as benign pleural effusions. This reflects their supposed indolent disease course, that should improve with the correct pharmacology. This view has been challenged with several studies demonstrating that patients with refractory transudates have a poor prognosis, often worse than exudates. This supports the idea that these patients should be managed in a symptom-based approach, whilst minimising hospital length of stay. Accordingly, there has been increased interest into best management strategies of these effusions, with new studies examining novel management techniques. This chapter will outline the pathogenesis, diagnosis and management of the transudative NMPE.

Cite as: Walker S, Shojaee S. Nonmalignant pleural effusions: are they as benign as we think? In: Maskell NA, Laursen CB, Lee YCG, et al., eds. Pleural Disease (ERS Monograph). Sheffield, European Respiratory Society, 2020; pp. 218–231 [https://doi.org/10.1183/2312508X.10024119].