How to Diagnose a Bilateral Plural Effusion With Progressive Dyspnea

Epusions that are free flowing typically accumulate in the most dependent part of the chest. Chest x-ray can also sometimes give you some clues as to the cause of the effusion. In this patient, it doesn't seem like there's any symptoms of infection and peers to have evidence of heart failure on exam. So I think it's reasonable to defer a diagnostic thorsentesis in this case and monitor the effusions for improvement with volume removal and treatment of our underlying etiology.