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Pleural Diseases

Pleural Diseases

Pleural (Pulmonary Membrane) Diseases:

Pleura is a membrane comprising of two leaf-like structures coating the inner surface of thoracic wall and covering both lungs. Between these two leaves is a small space, appropriately called the pleural space, which contains a minimal amount of fluid. Thanks to this fluid between the two layers, lungs are able to easily carry out respiratory motion inside the rib cage.

Various diseases afflict pleural tissue, just like other tissues around the body. Pleural effusion, emphysema, chylothorax, pneumothorax, hemithorax and pleural tumors can be listed among these. 

Pleural effusion: Caused as a result of fluid accumulating in the pleural space, pleural effusion may also stem from benign conditions like lung infections, tuberculosis and pulmonary embolism or lung cancer and tumoral formations in pleura or other organs. It may result in pain in the chest and sides or trigger other complaints like coughing by compressing lungs.

Pleural effusion may transition from being of ordinary nature to infective, in which state it might contain microbes. This is called empyema. In addition to complaints normally expected from pleural effusion, empyema introduces other symptoms to progress of disease, including febrility, malaise and overall unwell condition. Some rare cases may present accumulation of lymph fluid, which is rich in fat content. This is called chylothorax. Surgeries associated with the rib cage and tumoral formations also pose the risk of causing chylothorax. 

Pneumothorax: Air accumulated in the pleural space causes this condition, which may develop secondary to spontaneous air leaks from weak spots in the lungs, COPD or trauma. The tension and stimulation it creates on the pleura likely leads to dyspnea due to compression of the lungs or chest pain that invokes a stinging sensation. Urgent intervention may be required in cases where accumulation cannot be contained anymore or the patient exhibits signs of respiratory insufficiency. 

Hemothorax: This condition is characterized with accumulation of blood in the pleural space. Although it is mostly associated with trauma, it could also be caused by tumoral formations. Depending on the amount of blood, dyspnea and pain in the sides may be observed. Some cases may be as severe as to require surgical intervention. 

Pleural tumors: Spontaneously developing malignant tumors of pleural tissue are called mesothelioma. As a consequence of exposure to asbestos, these tumors show symptoms such as side pain, weight loss and dyspnea. Lung cancer and tumors afflicting other organs may also cause metastatic foci to emerge in the pleura. It is possible to incidentally detect benign tumors of pleural tissue as well. 

Diagnosis and treatment of pleural diseases: Upon hearing the patient’s detailed history, thorough examinations and investigations like blood tests, radiological procedures like chest x-ray, computerized tomography and ultrasound scans, and molecular imaging techniques like PET/CT provide useful diagnostic information. Interventional procedures like needle biopsy and thoracentesis as well as more advanced procedures like video-thoracoscopic surgery are also employed for diagnostic purposes.

Treatment approaches include first-instance drug therapies and surgical interventions of small scale, including thoracentesis and chest intubation. Furthermore video-thoracoscopic or robotic surgeries and open surgeries, if necessary, are also practiced for the purpose of treating pleural diseases.  

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