{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T23:33:31Z","timestamp":1791502411352,"version":"4.3.4"},"reference-count":47,"publisher":"Elsevier BV","issue":"6","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","journal.chestnet.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["CHEST"],"published-print":{"date-parts":[[2026,6]]},"DOI":"10.1016\/j.chest.2025.11.022","type":"journal-article","created":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T07:42:13Z","timestamp":1764142933000},"page":"1764-1774","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":3,"title":["Clinical Approach to a Pleural Effusion"],"prefix":"10.1016","volume":"169","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6064-0956","authenticated-orcid":false,"given":"Amit","family":"Chopra","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kurt","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc A.","family":"Judson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Feller-Kopman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"2","key":"10.1016\/j.chest.2025.11.022_bib1","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/j.chest.2025.02.003","article-title":"The impact of clinically significant pleural effusion on survival of US veterans with cancer, congestive heart failure, and pneumonia: the Veterans Administration Lung Effusion Study","volume":"168","author":"Chopra","year":"2025","journal-title":"Chest"},{"issue":"4","key":"10.1016\/j.chest.2025.11.022_bib2","doi-asserted-by":"crossref","first-page":"1534","DOI":"10.1016\/j.chest.2021.05.026","article-title":"Epidemiology of adult pleural disease in the United States","volume":"160","author":"Mummadi","year":"2021","journal-title":"Chest"},{"issue":"3","key":"10.1016\/j.chest.2025.11.022_bib3","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1016\/j.chest.2025.06.001","article-title":"Pleural fluid analysis: maximizing diagnostic yield in the pleural effusion evaluation","volume":"168","author":"Chopra","year":"2025","journal-title":"Chest"},{"issue":"11","key":"10.1016\/j.chest.2025.11.022_bib4","doi-asserted-by":"crossref","first-page":"1847","DOI":"10.1111\/j.1532-5415.2007.01392.x","article-title":"A comparative study of community- and nursing home-acquired empyema thoracis","volume":"55","author":"El Solh","year":"2007","journal-title":"J Am Geriatr Soc"},{"issue":"6","key":"10.1016\/j.chest.2025.11.022_bib5","doi-asserted-by":"crossref","first-page":"541","DOI":"10.4103\/lungindia.lungindia_144_23","article-title":"Catamenial haemothorax: a rare cause of pleural effusion","volume":"40","author":"Chetambath","year":"2023","journal-title":"Lung India"},{"issue":"10","key":"10.1016\/j.chest.2025.11.022_bib6","doi-asserted-by":"crossref","first-page":"2425","DOI":"10.1183\/09031936.97.10102425","article-title":"Pleural effusion as a presenting symptom of ovarian hyperstimulation syndrome","volume":"10","author":"Man","year":"1997","journal-title":"Eur Respir J"},{"issue":"4","key":"10.1016\/j.chest.2025.11.022_bib7","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1378\/chest.117.4.1031","article-title":"Pleural effusion and pneumothorax in hospitalized patients with HIV infection: the pulmonary complications, ICU support, and prognostic factors of hospitalized patients with HIV (PIP) study","volume":"117","author":"Afessa","year":"2000","journal-title":"Chest"},{"issue":"2","key":"10.1016\/j.chest.2025.11.022_bib8","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1136\/sti.76.2.122","article-title":"Pleural effusions in patients with AIDS","volume":"76","author":"Miller","year":"2000","journal-title":"Sex Transm Infect"},{"issue":"2","key":"10.1016\/j.chest.2025.11.022_bib9","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1378\/chest.104.2.655a","article-title":"Causes of pleural effusion in 75 HIV-infected patients","volume":"104","author":"Cadranel","year":"1993","journal-title":"Chest"},{"issue":"3","key":"10.1016\/j.chest.2025.11.022_bib10","doi-asserted-by":"crossref","first-page":"722","DOI":"10.3390\/cancers14030722","article-title":"Primary effusion lymphoma: a clinicopathologic perspective","volume":"14","author":"Gathers","year":"2022","journal-title":"Cancers (Basel)"},{"issue":"6","key":"10.1016\/j.chest.2025.11.022_bib11","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1055\/s-2001-18802","article-title":"Pleural effusions following cardiac injury and coronary artery bypass graft surgery","volume":"22","author":"Light","year":"2001","journal-title":"Semin Respir Crit Care Med"},{"issue":"12 Pt 1","key":"10.1016\/j.chest.2025.11.022_bib12","doi-asserted-by":"crossref","first-page":"1567","DOI":"10.1164\/rccm.200203-184OC","article-title":"Prevalence and clinical course of pleural effusions at 30 days after coronary artery and cardiac surgery","volume":"166","author":"Light","year":"2002","journal-title":"Am J Respir Crit Care Med"},{"issue":"2","key":"10.1016\/j.chest.2025.11.022_bib13","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.21037\/jtd-20-2082","article-title":"Pleural effusion post coronary artery bypass surgery: associations and complications","volume":"13","author":"Brookes","year":"2021","journal-title":"J Thorac Dis"},{"issue":"4","key":"10.1016\/j.chest.2025.11.022_bib14","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1097\/MCP.0000000000000383","article-title":"Pleural effusions in acute idiopathic pericarditis and postcardiac injury syndrome","volume":"23","author":"Porcel","year":"2017","journal-title":"Curr Opin Pulm Med"},{"key":"10.1016\/j.chest.2025.11.022_bib15","article-title":"Post-cardiac injury syndrome: an evidence-based approach to diagnosis and treatment","volume":"12","author":"Malik","year":"2021","journal-title":"Am Heart J Plus"},{"issue":"1","key":"10.1016\/j.chest.2025.11.022_bib16","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/S0272-5231(03)00125-4","article-title":"Drug-induced pleural disease","volume":"25","author":"Huggins","year":"2004","journal-title":"Clin Chest Med"},{"issue":"4","key":"10.1016\/j.chest.2025.11.022_bib17","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.00279-2020","article-title":"Pulmonary complications of Bcr-Abl tyrosine kinase inhibitors","volume":"56","author":"Weatherald","year":"2020","journal-title":"Eur Respir J"},{"issue":"1","key":"10.1016\/j.chest.2025.11.022_bib18","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1378\/chest.101.1.268","article-title":"Drug-induced lupus pleuritis mimicking pleural space infection","volume":"101","author":"Smith","year":"1992","journal-title":"Chest"},{"key":"10.1016\/j.chest.2025.11.022_bib19","doi-asserted-by":"crossref","DOI":"10.12659\/AJCR.933396","article-title":"Chronic pleuritis and recurrent pleural effusion after atezolizumab for small cell lung cancer","volume":"22","author":"Lin","year":"2021","journal-title":"Am J Case Rep"},{"issue":"5","key":"10.1016\/j.chest.2025.11.022_bib20","article-title":"Progressive pleural effusion as an immune-related adverse event in NSCLC: a case report","volume":"2","author":"Shen","year":"2021","journal-title":"JTO Clin Res Rep"},{"issue":"57","key":"10.1016\/j.chest.2025.11.022_bib21","doi-asserted-by":"crossref","first-page":"97623","DOI":"10.18632\/oncotarget.18824","article-title":"Thoracic radiation-induced pleural effusion and risk factors in patients with lung cancer","volume":"8","author":"Zhao","year":"2017","journal-title":"Oncotarget"},{"issue":"2","key":"10.1016\/j.chest.2025.11.022_bib22","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.radonc.2010.08.010","article-title":"Late radiation-induced heart disease after radiotherapy: clinical importance, radiobiological mechanisms and strategies of prevention","volume":"100","author":"Andratschke","year":"2011","journal-title":"Radiother Oncol"},{"key":"10.1016\/j.chest.2025.11.022_bib23","doi-asserted-by":"crossref","DOI":"10.1155\/2015\/416179","article-title":"Clinical investigation of benign asbestos pleural effusion","volume":"2015","author":"Fujimoto","year":"2015","journal-title":"Pulm Med"},{"issue":"12","key":"10.1016\/j.chest.2025.11.022_bib24","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1002\/jhm.2434","article-title":"Ultrasound in the diagnosis and management of pleural effusions","volume":"10","author":"Soni","year":"2015","journal-title":"J Hosp Med"},{"issue":"2","key":"10.1016\/j.chest.2025.11.022_bib25","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1378\/chest.08-0137","article-title":"Yellow nail syndrome: analysis of 41 consecutive patients","volume":"134","author":"Maldonado","year":"2008","journal-title":"Chest"},{"issue":"1","key":"10.1016\/j.chest.2025.11.022_bib26","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1148\/109.1.33","article-title":"Roentgen visualization of minute pleural effusion: an experimental study to determine the minimum amount of pleural fluid visible on a radiograph","volume":"109","author":"Moskowitz","year":"1973","journal-title":"Radiology"},{"issue":"1","key":"10.1016\/j.chest.2025.11.022_bib27","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1378\/chest.109.1.158","article-title":"The etiology of pleural effusions in an area with high incidence of tuberculosis","volume":"109","author":"Valdes","year":"1996","journal-title":"Chest"},{"issue":"6","key":"10.1016\/j.chest.2025.11.022_bib28","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1016\/j.chest.2022.06.012","article-title":"Multidisciplinary management of chylothorax","volume":"162","author":"Agrawal","year":"2022","journal-title":"Chest"},{"issue":"3","key":"10.1016\/j.chest.2025.11.022_bib29","first-page":"458","article-title":"Massive pleural effusion: malignant and nonmalignant causes in 46 patients","volume":"105","author":"Maher","year":"1972","journal-title":"Am Rev Respir Dis"},{"issue":"2","key":"10.1016\/j.chest.2025.11.022_bib30","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1111\/resp.13199","article-title":"Unexpandable lung from pleural disease","volume":"23","author":"Huggins","year":"2018","journal-title":"Respirology"},{"issue":"3","key":"10.1016\/j.chest.2025.11.022_bib31","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1016\/j.chest.2023.04.049","article-title":"Pressure-dependent pneumothorax and air leak: physiology and clinical implications","volume":"164","author":"Chopra","year":"2023","journal-title":"Chest"},{"issue":"3","key":"10.1016\/j.chest.2025.11.022_bib32","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1016\/j.jtho.2022.11.018","article-title":"Considerations for imaging of malignant pleural mesothelioma: a consensus statement from the International Mesothelioma Interest Group","volume":"18","author":"Katz","year":"2023","journal-title":"J Thorac Oncol"},{"issue":"2","key":"10.1016\/j.chest.2025.11.022_bib34","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1016\/j.chest.2020.02.051","article-title":"Diagnostic accuracy of thoracic ultrasonography to differentiate transudative from exudative pleural effusion","volume":"158","author":"Shkolnik","year":"2020","journal-title":"Chest"},{"key":"10.1016\/j.chest.2025.11.022_bib33","doi-asserted-by":"crossref","DOI":"10.1016\/j.rmed.2025.108295","article-title":"Role of ultrasound in differentiating simple parapneumonic from complicated parapneumonic pleural effusion","volume":"247","author":"Halasa","year":"2025","journal-title":"Respir Med"},{"issue":"1","key":"10.1016\/j.chest.2025.11.022_bib35","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1136\/thoraxjnl-2016-208904","article-title":"The accuracy of pleural ultrasonography in diagnosing complicated parapneumonic pleural effusions","volume":"72","author":"Svigals","year":"2017","journal-title":"Thorax"},{"issue":"2","key":"10.1016\/j.chest.2025.11.022_bib36","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1136\/thx.2008.100545","article-title":"Thoracic ultrasound in the diagnosis of malignant pleural effusion","volume":"64","author":"Qureshi","year":"2009","journal-title":"Thorax"},{"issue":"3","key":"10.1016\/j.chest.2025.11.022_bib37","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1111\/j.1440-1843.2004.00599.x","article-title":"Radiology in pleural disease: state of the art","volume":"9","author":"Evans","year":"2004","journal-title":"Respirology"},{"issue":"2","key":"10.1016\/j.chest.2025.11.022_bib38","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1111\/resp.13395","article-title":"Bacteriology and clinical outcomes of patients with culture-positive pleural infection in Western Australia: a 6-year analysis","volume":"24","author":"Brims","year":"2019","journal-title":"Respirology"},{"issue":"3","key":"10.1016\/j.chest.2025.11.022_bib39","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1148\/radiology.148.3.6878700","article-title":"Hyperdensity of recent hemorrhage at body computed tomography: incidence and morphologic variation","volume":"148","author":"Wolverson","year":"1983","journal-title":"Radiology"},{"issue":"3","key":"10.1016\/j.chest.2025.11.022_bib40","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/j.clinimag.2014.01.004","article-title":"Pseudo-hemothorax at computed tomography due to residual contrast media","volume":"38","author":"Romero","year":"2014","journal-title":"Clin Imaging"},{"issue":"1","key":"10.1016\/j.chest.2025.11.022_bib41","doi-asserted-by":"crossref","first-page":"163","DOI":"10.2214\/ajr.141.1.163","article-title":"Differentiating lung abscess and empyema: radiography and computed tomography","volume":"141","author":"Stark","year":"1983","journal-title":"AJR Am J Roentgenol"},{"issue":"1","key":"10.1016\/j.chest.2025.11.022_bib42","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1148\/radiol.2431041658","article-title":"The split pleura sign","volume":"243","author":"Kraus","year":"2007","journal-title":"Radiology"},{"issue":"3","key":"10.1016\/j.chest.2025.11.022_bib43","doi-asserted-by":"crossref","first-page":"487","DOI":"10.2214\/ajr.154.3.2106209","article-title":"CT in differential diagnosis of diffuse pleural disease","volume":"154","author":"Leung","year":"1990","journal-title":"AJR Am J Roentgenol"},{"issue":"2","key":"10.1016\/j.chest.2025.11.022_bib44","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1378\/chest.14-0820","article-title":"Accuracy of fluorodeoxyglucose-PET imaging for differentiating benign from malignant pleural effusions: a meta-analysis","volume":"147","author":"Porcel","year":"2015","journal-title":"Chest"},{"issue":"6","key":"10.1016\/j.chest.2025.11.022_bib45","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1053\/j.semnuclmed.2022.07.005","article-title":"FDG PET\/CT for staging and restaging malignant mesothelioma","volume":"52","author":"Lopci","year":"2022","journal-title":"Semin Nucl Med"},{"issue":"4","key":"10.1016\/j.chest.2025.11.022_bib46","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1016\/j.chest.2018.02.031","article-title":"A pilot feasibility study in establishing the role of ultrasound-guided pleural biopsies in pleural infection (The AUDIO Study)","volume":"154","author":"Psallidas","year":"2018","journal-title":"Chest"},{"issue":"8","key":"10.1016\/j.chest.2025.11.022_bib47","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0134376","article-title":"Diagnostic accuracy of natriuretic peptides for heart failure in patients with pleural effusion: a systematic review and updated meta-analysis","volume":"10","author":"Han","year":"2015","journal-title":"PLoS One"}],"container-title":["CHEST"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0012369225058027?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0012369225058027?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T15:25:40Z","timestamp":1781018740000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0012369225058027"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":47,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["S0012369225058027"],"URL":"https:\/\/doi.org\/10.1016\/j.chest.2025.11.022","relation":{},"ISSN":["0012-3692"],"issn-type":[{"value":"0012-3692","type":"print"}],"subject":[],"published":{"date-parts":[[2026,6]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Clinical Approach to a Pleural Effusion","name":"articletitle","label":"Article Title"},{"value":"CHEST","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.chest.2025.11.022","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 American College of Chest Physicians. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}]}}