The pleura is a thin membrane that surrounds the lungs and lines the chest cavity. It produces a fluid that lubricates the lungs to enable smooth expansion and contraction during breathing. Any inflammation or infection of the pleura is known as a pleural disease. Some common pleural diseases include pleurisy, pneumothorax, and pleural effusion. In this article, we will look at these conditions in more detail.
Pleurisy
Pleurisy, also known as pleuritis, is inflammation of the pleura. It causes sharp chest pain that worsens with breathing or coughing. The most common causes of pleurisy are viral or bacterial infections such as pneumonia, tuberculosis, or viruses like influenza. The inflammation can be due to other conditions as well, including blood clots, autoimmune diseases, and some cancers. Symptoms include chest pain, fever, cough, and difficulty breathing. A chest x-ray or CT scan may show pleural thickening or fluid buildup. Treatment focuses on treating the underlying cause with antibiotics or other medications. Applying a warm compress to the chest can help relieve pain.
Pneumothorax
A pneumothorax occurs when air leaks into the pleural space between the lungs and chest wall, causing the lung to collapse. It can be spontaneous without an obvious cause or traumatic due to an injury. Risk factors for spontaneous pneumothorax include smoking cigarettes, being tall and thin, or having underlying lung conditions. Symptoms include shortness of breath, chest pain that worsens with breathing or coughing, and feelings of tightness in the chest. Diagnosis is made through a chest x-ray which reveals the air in the pleural space. Small pneumothoraxes may heal on their own but larger ones require a chest tube to be inserted to drain the air and re-expand the lung. Surgery to prevent recurrences may be needed for repeated cases.
Pleural Effusion
A pleural effusion refers to an abnormal buildup of fluid in the pleural space between the lungs and chest wall. It can develop due to inflammation of the pleura from infections, cancer, congestive heart failure, or injuries. Symptoms include chest pain, cough, and breathlessness. The diagnosis is confirmed through a physical exam, chest x-ray, or ultrasound of the chest. A thoracentesis procedure uses a long needle to drain fluid from the pleural space for analysis. Depending on the cause, treatment may involve antibiotics, diuretics, chemotherapy, or sometimes surgery. Recurrences are managed with repeat thoracenteses or the placement of a chest tube.
Tuberculosis Pleural Effusion
TB is a common cause of pleural effusions worldwide. Mycobacterium tuberculosis bacteria infect the pleura, causing an immune-mediated reaction that leads to the buildup of fluid. Patients experience symptoms like chest pain, fever, night sweats, and weight loss. Diagnosis relies on microscopic examination of pleural fluid or culturing fluid, which takes 6-8 weeks to confirm. While awaiting test results, antituberculosis treatment is often empirically initiated based on clinical suspicion. Full treatment involves a 6-9 month course of multiple antibiotics. Draining the pleural fluid alone is usually not curative unless combined with antitubercular therapy.
Post-inflammatory Pleural Thickening
Significant pleurisy or pleural effusions from infections, cancers or autoimmune disorders can lead to fibrosis or scarring of the pleura called pleural thickening. As the inflamed pleura heals, excess fibrous tissue forms, making the pleural layers thicker than normal. This restricts normal lung expansion and makes the lungs stiff. Common symptoms are shortness of breath and chest pain. Chest x-rays usually confirm the diagnosis by revealing increased opacities along the chest wall. Treatment focuses on managing the underlying cause. Physiotherapy may help improve lung function. Surgery called pleurectomy can remove thickened pleura but lung re-expansion is not always possible.
Malignant Pleural Effusions
Cancer that spreads (metastasizes) to the pleura is a common cause of recurrent pleural effusions. Lung cancer, breast cancer and lymphomas frequently metastasize to the pleura. Patients experience breathlessness, chest discomfort and coughing up blood in some cases. Diagnosis involves cytological examination of pleural fluid for malignant cells. Treatment options depend on tumor type and stage. Thoracentesis may provide temporary relief but effusions often reoccur. Instilling anti-cancer drugs or talc into the pleural space during pleurodesis tries to permanently seal the space and prevent reaccumulation of fluid. Some patients require a Pleuroperitoneal shunt for long-term drainage. For selected cancers, radiation or chemotherapy also helps.
Conclusion
In summary, the pleura can be affected by various inflammatory diseases and injuries that cause accumulation of fluid, scarring or tumors in the pleural space. While some conditions are self-limiting, others require prolonged medical treatment and management of underlying causes. Drainage of pleural fluid and management of related symptoms improve quality of life in patients with pleural diseases.
*Note:
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it
