What are the indications for referring a patient with a suspected malignant pleural effusion to secondary care?

Indications for referring a patient with suspected malignant pleural effusion to secondary care include:

• Presence of chest signs compatible with pleural disease in patients aged 40 and over, which suggests possible mesothelioma or lung cancer, warranting an urgent chest X-ray and consideration for referral ¹.
• Unexplained respiratory symptoms such as persistent or recurrent chest infection, unexplained chest pain, cough, or shortness of breath in patients aged 40 and over, especially if there is a history of smoking or asbestos exposure, should prompt urgent chest X-ray and referral if malignant pleural effusion is suspected ¹.
• Additional features such as weight loss, fatigue, appetite loss, or unexplained lymphadenopathy alongside respiratory symptoms increase suspicion of malignancy and support referral ¹.
• Patients with unexplained shortness of breath and chest signs consistent with pleural disease should be referred urgently to secondary care for further evaluation ¹.

In summary, any patient aged 40 or over presenting with pleural disease signs or unexplained respiratory symptoms suggestive of malignancy, especially with risk factors like smoking or asbestos exposure, should be referred urgently to secondary care for further investigation of suspected malignant pleural effusion ¹.