Pleural disorders

Referrers should use this page when referring patients to public adult respiratory and sleep medicine outpatient services for pleural disorders.

Emergency referral
If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region.
Large symptomatic pleural effusion Symptomatic pleural effusion with hypoxia (SpO2<92%) and respiratory distress Acute pneumothorax Suspected empyema (new pleural effusion with clinical and biochemical features of infection and/or pneumonia)

Immediate referral
Immediately contact on-call registrar or service to arrange immediate respiratory assessment (seen within 7 days):
Large pleural effusion+/- suspected malignancy with no hypoxia or respiratory distress To contact the relevant service, see Clinician Assist WA: Acute Respiratory assessment (external site).

Immediate referral

Immediately contact on-call registrar or service to arrange immediate respiratory assessment (seen within 7 days):

Large pleural effusion+/- suspected malignancy with no hypoxia or respiratory distress

To contact the relevant service, see Clinician Assist WA: Acute Respiratory assessment (external site).

Clinical indications for outpatient referral
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
Symptoms as below in the context of a CT or CXR suggestive of a pleural disorder; Dyspnoea Chest pain Fevers Cough Weight loss

Clinical indications for outpatient referral

If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).

Symptoms as below in the context of a CT or CXR suggestive of a pleural disorder;

Mandatory information
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reason). This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.
History	Relevant history, onset, duration, and severity of symptoms Smoking/vaping status and history Current medication list Any known allergies Occupational history/asbestos exposure Exposure to TB Cardiac history History of previous malignancy
Examination	SpO2 on air
Investigations	CXR and/or CT thorax (if large effusion on CXR, CT chest not required)

Highly desirable
History	Nil
Examination	Nil
Investigations	FBC U&Es LFTs Coagulation study results Echocardiogram Other relevant imaging

Indicative clinical urgency category
Category 1 Appointment within 30 days	Pleural effusion
Category 2 Appointment within 90 days	Extensive pleural disease including: pleural thickening
Category 3 Appointment within 365 days	No defined category 3 criteria

Indicative clinical urgency category

Category 1

Appointment within 30 days

Category 2

Appointment within 90 days

Category 3

Appointment within 365 days

Exclusions
Significant asbestos exposure or asbestos related lung disease – see Asbestos Review Program – accepts state-wide referrals

Useful information
Nil

Useful information

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