YIZHAK KUPFER, B.A.; SIDNEY TESSLER, M.D.
To the editor: The position paper on thoracentesis and pleural effusions (1), in the November issue, states that thoracentesis is indicated in all patients with pleural effusions of unknown cause except in a "patient presenting with clear clinical manifestations of recurrent left ventricular failure" in whom "a trial of diuresis might precede consideration of thoracentesis." We question the strength of the association between left ventricular failure alone and pleural effusions.
Most transudative effusions associated with congestive heart failure occur in patients with biventricular failure with consequent elevations of both the systemic and pulmonary venous pressures (2). Mellins and colleagues (3)
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KUPFER Y, TESSLER S. Congestive Heart Failure and Thoracentesis. Ann Intern Med. 1986;104:584–585. doi: 10.7326/0003-4819-104-4-584_2
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Published: Ann Intern Med. 1986;104(4):584-585.
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