2449 Bioscientia Medicina: Journal Of Biomedicine & Translational Research 1. Introduction Malignant pleural effusion (MPE is defined as an effusion that occurs in association with malignancy as evidenced by the finding of malignant cells on pleural fluid cytology or pleural biopsy. In the United Kingdom, there are 40000 cases of MPE per year. It is estimated that 50% of them are metastatic. The most common etiology of MPE, about 80%, is lung cancer, breast cancer, lymphoma, ovarian cancer, and gastric cancer. This malignant pleural effusion is also a very difficult complication of advanced malignancy, with more than 150,000 cases per year in the United States. 1,2 Malignant pleural effusions may be spread from distant malignancies or maybe an early manifestation of an underlying intrathoracic or extrathoracic malignancy. Many experts classify the causes of MPE into primary malignancies in the lung, breast, ovary, mesothelioma, and other causes. Metastatic adenocarcinoma is the histopathological type of tumor that most often causes MPE. 2 Malignant pleural effusion is a complex health problem for clinicians. The etiologic diagnosis is a major problem and difficult to determine given the many possible etiologies for the primary tumor of the MPE. The short median survival rate, the high recurrence rate of malignant pleural effusion, and very eISSN (Online): 2598-0580 Bioscientia Medicina: Journal of Biomedicine & Translational Research Diagnosis and Management of Malignant Pleural Effusion: A Narrative Literature Review Husnul Auliya 1* , Roza Kurniati 2 , Fauzar 2 1 Departement of Internal Medicine, Faculty of Medicine, Universitas Andalas, Padang, Indonesia 2 Division of Pulmonology, Departement of Internal Medicine, Faculty of Medicine, Universitas Andalas/Dr. M. Djamil General Hospital, Padang, Indonesia ARTICLE INFO Keywords: Malignant pleural effusion Exudate Pleurodesis *Corresponding author: Husnul Auliya E-mail address: auliyaauliya90@gmail.com All authors have reviewed and approved the final version of the manuscript. https://doi.org/10.37275/bsm.v6i12.624 A B S T R A C T Malignant pleural effusion (MPE) is defined as an effusion that occurs in association with malignancy, as evidenced by the finding of malignant cells on pleural fluid cytology or pleural biopsy. The pathophysiology of MPE is not yet clear, but several hypotheses have been developed to explain the mechanism of MPE. Accumulation of effusion in the pleural cavity occurs due to increased vascular permeability due to the inflammatory reaction caused by the infiltration of cancer cells in the parietal and/or visceral pleura. Other possible mechanisms are the direct invasion of the tumor adjacent to the pleura, obstruction of the lymph nodes, hematogenous spread, and primary pleural tumor. Pleural fluid from a malignant process is usually an exudate. To distinguish between exudate and transudate is to assess the protein and LDH levels of the pleural fluid. Hemorrhagic pleural fluid with a red blood cell count >100,000/mm3 suggests an MPE. Pleural fluid glucose levels at low < 60 mg/dl at about 15-20% MPE. The definitive diagnosis of MPE is by finding malignant cells in the pleural fluid (cytology) or pleural tissue (pathological histology). Management of malignant pleural effusions is principally palliative. Management that is often done in cases of MPE is therapeutic thoracentesis, pleurodesis, drainage with long-term indwelling catheter, manufacture of the pleuroperitoneal shunt, intrapleural therapy, and radiotherapy.