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Thoracic Surgery

Diseases & Conditions

Pleural Diseases

Types of pleural diseases include pleural effusion, pleurisy, hemothorax, and plueroal tumors. The pleura is a large sheet of tissue that contains a small amount of fluid that lines the thoracic (chest) cavity and covers the  lungs.  


Symptoms of pleural diseases vary based on the kind and severity. Typically, pleural effusion causes no symptoms.

Symptoms of pleurisy (an infection of the pleural cavity) may include:

  • Shortness of breath
  • A cough
  • Fever and chills
  • Rapid, shallow breathing
  • Unexplained weight loss
  • A sore throat followed by joint swelling and soreness

Symptoms of hemothorax (the presence of blood in the pleural cavity) may include:

  • Chest pain
  • Shortness of breath
  • Respiratory failure
  • A rapid heart rate
  • Anxiety
  • Restlessness

Symptoms of pleural tumors may include:

  • Shortness of breath
  • Chest pain
  • General discomfort
  • Cough
  • Unexplained weight loss


Causes of pleurisy include:

  • Viral, bacterial, and fungal infections
  • Lung cancer
  • Other lung diseases, such as sarcoidosis, asbestosis, lymphangioleiomyomatosis and mesothelioma
  • Pulmonary embolism
  • Familial Mediterranean fever
  • Parasites
  • Heart surgery
  • Chest injury or trauma
  • Reaction to certain medications

Causes of pleural effusion include:

  • Congestive heart failure
  • Lung cancer
  • Pneumonia
  • Tuberculosis, asbestosis, sarcoidosis, and reactions to medications

Causes of pneumothorax may include:

  • A bulla, which is a large distended air space
  • Lung diseases such as chronic obstructive pulmonary disease (COPD)
  • Tuberculosis
  • Surgery
  • Trauma

Causes of hemothorax include:

  • Chest trauma
  • Lung and pleural cancer
  • Chest or heart surgery

For some pleural tumors, the cause is unknown. Known causes of pleural tumors may include cancer that has spread to the pleural space.


In addition to taking a detailed medical history and performing a physical examination, the surgeon may order tests to detect pleural diseases, including:

  • Arterial blood gas analysis 
  • Biopsy 
  • Blood test
  • Chest X-rays 
  • Computed tomography (CT) scans
  • Magnetic resonance imaging (MRI)
  • Positron emission tomography (PET) scans Patients with diabetes should talk with their physician about diet guidelines for the hours leading up to the scan
  • Stress test
  • Thoracentesis
  • Ultrasound


Depending on the pleural condition and its cause, treatment may include:

  • Medications to relieve pleurisy symptoms, such as acetaminophen (Tylenol), ibuprofen (Motrin), and codeine cough suppressants
  • Surgery or minimally invasive tumor removal
  • Tumor ablation, a minimally invasive technique in which radiofrequency, cold or heat energy can be used to destroy cancer cells
  • Chemotherapy
  • Radiation therapy
  • Pleurodesis, in which a chemical is injected that seals the pleural space, eliminating the chance for fluid buildup
  • Thoracostomy, in which the physician inserts a chest tube through the chest wall. After injecting a local anesthetic into the chest wall where the fluid is located, the physician will insert a plastic tube into the chest between two ribs. The physician will then connect the tube to a suction device, which will help to remove the fluid.
  • PleurX catheter, which is a thin, flexible tube that the surgeon will place in the pleural space to drain the fluid accumulation associated with pleural effusion
  • Thoracentesis, which is the removal of pleural fluid with a needle or a catheter that the surgeon inserts through the ribs in the back of the chest into the chest wall
  • Bullectomy, which is the removal of a bulla


Call: 617.638.5600
Fax: 617.638.7382

Boston Medical Center
Center for Thoracic Surgery
Moakley Building
830 Harrison Avenue, 3rd Floor
Boston, MA 02118

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Fax: 617.638.7382

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