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Thoracic Surgery

Diseases & Conditions

Pleural Diseases

Boston Medical Center's Division of Thoracic Surgery treats a broad range of conditions, including pleural diseases. We combine medical excellence, technologically advanced facilities and equipment, and a patient-centered approach to provide fast, accurate diagnoses and effective treatments.

What are Pleural Diseases?

The pleura is the membrane that lines your thoracic (chest) cavity and covers your lungs. It is a large sheet of tissue that wraps around the outside of your lungs and lines the inside of your chest cavity. There is a small space between the layers of the pleura, which contains a small amount of fluid that serves as a lubricant for the two layers of the pleura. There are several types of pleural diseases, including:

  • Pleurisy, an infection of the pleural cavity
  • Pleural effusion, the buildup of pleural fluid in the pleural cavity
  • Hemothorax, the presence of blood in the pleural cavity
  • Pleural tumors

Diagnostic Procedures

What are the Symptoms?

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

Symptoms of pleurisy may include:

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

Symptoms of hemothorax 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

What Causes Pleural Diseases?

Causes of pleurisy include:

  • Viral, bacterial and fungal infections
  • Lung cancer
  • Other lung diseases, such as carcoidosis, 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.

How are Pleural Diseases Diagnosed?

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

  • Arterial blood gas analysis to measure how well your lungs transfer oxygen from the blood and how well the lungs remove carbon dioxide
  • Biopsy is one way to obtain a sample of tissue, which is then examined under a microscope in a laboratory. Your doctor will apply a numbing agent and will insert a needle between your ribs and into the chest, guided by a CT scan or an X-ray.
  • Blood test
  • • Chest X-rays provide an image of the heart, lungs, airways, blood vessels and bones in the spine and chest area.
  • Computed tomography (CT) scans, which use X-rays to create two-dimensional images of the body, including lymph nodes. If contrast dye is used to improve the computer image, you may need to avoid eating or drinking for four to six hours before the test. Be sure to tell your doctor before the test if you have any allergies or if you have kidney problems.
  • Magnetic resonance imaging (MRI), which is a painless, radiation-free test that uses a magnetic field, radiofrequency pulses and a computer to produce detailed images of body structures in multiple places. You may be asked to drink a contrast solution for better imaging, and you will most likely lie on a moving table as pictures are taken. 
  • • Positron emission tomography (PET) scans are used to detect cellular reactions to sugar. Abnormal cells tend to react and "light up" on the scan, helping physicians diagnose a variety of conditions. For the PET scan, a harmless chemical, called a radiotracer, is injected into your blood stream. Once it has had time to move through your body, you lie on a table while a scanner follows the radiotracer and sends three-dimensional images to a computer screen. Patients are usually asked to wear comfortable clothing and not to eat for four hours before the scan. Tell your doctor if you are pregnant or breastfeeding. Patients with diabetes should talk with their physician about diet guidelines for the hours leading up to the scan
  • Stress test, which is used to gain information about how your heart functions during exercise. Your physician will monitor your heartbeat and blood flow as you walk on a treadmill, and will then be able to diagnose any problems and plan treatment.
  • Thoracentesis
  • Ultrasound

How are Pleural Diseases Treated?

After a careful evaluation of your condition, we will recommend the treatment that is appropriate to your particular circumstances. 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, or the use of medications injected into the bloodstream to kill cancer cells
  • Radiation therapy, or the use of high-energy X-rays and other sources of radiation to kill cancer cells
  • Pleurodesis, in which a chemical is injected that seals the pleural space, eliminating the chance for fluid buildup
  • Thoracostomy, in which your physician inserts a chest tube through your chest wall. After injecting a local anesthetic into your chest wall where the fluid is located, your physician will insert a plastic tube into your chest between two ribs. Your 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 your 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 your surgeon inserts through your ribs in the back of your chest into your chest wall
  • Bullectomy, which is the removal of a bulla

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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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Boston, MA 02118
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