The pleura is a thin membrane that surrounds the lungs and lines the chest cavity. It plays an important role in enabling the lungs to expand and contract during breathing. Any inflammation or disease affecting this delicate membrane can lead to pleural diseases. This article explores some of the common pleural conditions, their causes and symptoms.
What are Pleural Effusions?
Pleural effusions refer to an abnormal buildup of fluid in the pleural space between the lungs and chest wall. This excess fluid puts pressure on the lungs and prevents them from expanding fully. Pleural effusions have various underlying causes but the most common ones are infections, circulatory disorders and cancers. Some key factors that can lead to pleural effusions are:
– Pneumonia or other lung infections – Bacterial, viral or fungal infections in the lungs or pleura often cause pleural effusions as white blood cells and fluids rush to the site of infection.
– Heart failure – When the heart is unable to pump blood efficiently, fluid leaks into the lungs and pleural space leading to pleural effusions.
– Liver disease – Conditions like cirrhosis that affect liver function can result in disruptions to fluid balance in the body and cause pleural effusions.
– Cancers – Lung cancer, breast cancer or lymphomas that have metastasized to the lungs or pleura are a significant cause of malignant or tumor-related pleural effusions.
The most common symptoms of pleural effusions include chest pain, shortness of breath, dry cough and difficulty taking deep breaths. The excess fluid needs to be drained to relieve symptoms.
Pneumothorax – Air in the Pleural Space
In a pneumothorax, air leaks into the pleural space causing the lung to collapse. This occurs when there is a tear or rupture in the pleura. Spontaneous pneumothoraces commonly occur in tall, thin young men who smoke. Other potential causes include blunt chest trauma, medical procedures involving the lung (biopsies), and underlying lung conditions like COPD or lung cysts.
Symptoms of pneumothorax include sudden onset sharp, stabbing chest pain, shortness of breath, anxiety, rapid breathing and heart rates. The affected side of the chest cannot fully expand on breathing in. Treatment aims to re-expand the lung by removing the air in the pleural space through a chest tube, needle or surgery depending on severity. Recurrence is prevented through procedures like pleurodesis or pleurectomy.
Mesothelioma – A Devastating Cancer
Mesothelioma is an aggressive form of cancer that develops from the mesothelial cells of the pleura or peritoneum. Exposure to asbestos is the main cause of mesothelioma, with risks persisting even decades after exposure. Men older than 65 years have a higher risk. Symptoms include chest wall pain, breathlessness, persistent cough and weight loss.
On diagnostic tests like CT scans, the pleura appears thickened and nodular with bilateral pleural effusions often present. Mesothelioma has very poor survival rates with median survival of only 9 to 14 months. Treatment consists of surgery, radiation therapy and chemotherapy but the cancer typically keeps recurring. New immunotherapies and targeted therapies are being studied to improve outcomes. Unfortunately, mesothelioma continues to be a devastating disease due to its late detection and chemo-resistant nature.
Other Less Common Pleural Diseases
In addition to the above discussed conditions, there are a few other rare pleural diseases that can arise:
– Empyema – A bacterial infection of pleural fluid causing pus accumulation which needs drainage.
– Hemothorax – Blood accumulation in the pleural space due to trauma, bleeding disorders or cancer.
– Pleurisy – General term for inflammation of the parietal pleura causing chest wall pain. Can result from infections, autoimmune diseases or unknown causes.
– Pulmonary Embolism – Blood clots that travel from the legs/veins and lodge in the lungs blocking arteries can lead to pleural effusions.
– Tubercular Pleurisy – Inflammation of the pleura from a Mycobacterium tuberculosis infection.
Managing Pleural Diseases
While some pleural conditions resolve on their own, many need medical treatment, monitoring or surgery. Diagnosis involves clinical exams, medical imaging and thoracentesis for fluid/biopsy analysis. Treatment aims to address the underlying cause, alleviate pleural fluid or air through drainage techniques and manage associated symptoms. Preventive measures for some diseases include smoking cessation and asbestos exposure avoidance. With early identification and personalized management, outcomes for many pleural disorders have significantly improved in recent years. However, more research is still needed, especially for aggressive diseases like mesothelioma.
In conclusion, this article discussed the anatomy and physiology of the pleura and highlighted some major pleural diseases, their characteristic features, causes, diagnosis and management approach. A better understanding of these conditions can aid early detection and guide treatment decisions for improved patient care and outcomes.
*Note:
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it
