The pleura is the membrane that lines the thoracic (chest) cavity and covers the lungs. It is like a large sheet of tissue that wraps around the outside of the lungs and lines the inside of the chest cavity. 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
- Pneumothorax - the presence of air or gas in the pleural cavity
- Hemothorax - the presence of blood in the pleural cavity
- Pleural tumors
What are the Symptoms of Pleural Diseases?
Symptoms of pleurisy may include:
- Shortness of breath
- A cough
- Fever and chills
- Rapid, shallow breathing
- Unexplained weight loss
- Sore throat that is followed by joint swelling and soreness
Pleural Effusion
- Typically, pleural effusion causes no symptoms.
Symptoms of pneumothorax include:
- Sudden sharp pain that worsens with deep breathing
- Shortness of breath
- Chest tightness
- Fatigue
- Fast heart rate
- Bluish skin color (called cyanosis)
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
Causes of Pleural Diseases
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 (trauma)
- Reaction to certain medications
Causes of pleural effusion include:
- Congestive heart failure
- Lung cancer
- Pneumonia
- Tuberculosis, asbestosis, sarcoidosis, and reactions to medications
- Bulla, which is a large distended air space
- Lung diseases such as chronic obstructive pulmonary disease
- Tuberculosis
- Surgery
- Trauma
- Chest trauma
- Lung and pleural cancer
- Chest or heart surgery
Causes of hemothorax include:
For some pleural tumors, the cause is unknown. Known causes of pleural tumors may include cancer that has spread to the pleural space.
Diagnosis
In addition to taking a detailed medical history and performing a physical examination, the patient’s 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
Any suspicious mass of tissue or tumor is subject to a biopsy, or removal of cells from the mass. This is the only technique that can confirm the presence of cancer cells. The doctor will use a general or local anesthetic depending on the location of the mass, and then remove a sample of tissue to send to the lab. The sample is sent to a pathologist, a physician who is an expert at identifying diseased cells in tissue samples. Very often, a few stiches are used to help the area heal, and tenderness is felt for a short period of time.
Blood Tests
A common tool for disease screening, blood tests provide information about many substances in the body, such as blood cells, hormones, minerals, and proteins.
Chest X-ray
Chest x-rays provide an image of the heart, lungs, airways, blood vessels and bones in the spine and chest area. They can be used to look for broken bones, diseases like pneumonia, abnormalities, or cancer.
Computed Tomography (CT) Scan
CT scans use x-ray equipment and computer processing to produce 2-dimensional images of the body. The patient lies on a table and passes through a machine that looks like a large, squared-off donut. Doctors order CT scans when they want to see a two-dimensional image of the body to look for tumors and examine lymph nodes and bone abnormalities. If contrast dye is used to improve the computer image, the patient may need to avoid eating or drinking for 4 to 6 hours before the test. Patients should tell their provider before the test if they have any allergies or kidney problems.
Magnetic Resonance Imaging (MRI)
This test 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. MRI is a more detailed tool than x-ray and ultrasound and for certain organs or areas of the body, it provides better images than CT. MRI may not be recommended if you have a pacemaker or other metal implant.
Positron Emission Tomography (PET) scan
A PET scan is used to detect cellular reactions to sugar. Abnormal cells tend to react and "light up" on the scan, thus 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 will lie on a table while a scanner follows the radiotracer and sends three-dimensional images to a computer screen. Patients are generally asked to wear comfortable clothing and refrain from eating for 4 hours before the scan. Tell your doctor if you are pregnant or breastfeeding. Patients with diabetes should discuss diet guidelines with their physician for the hours leading up to the scan.
Stress Test
A stress test is used to gain more 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 as well as plan treatment.
Thoracentesis
A procedure to remove excess fluid in the space between the lungs and chest wall.
Ultrasound
Diagnostic ultrasound, also called sonography or diagnostic medical sonography, is an imaging method that uses high-frequency sound waves to produce images of structures within the body. The images can provide valuable information for diagnosing and treating a variety of diseases and conditions. Most ultrasound examinations are done using a sonar device outside the body, though some ultrasound examinations involve placing a device inside the body.
Treatment
After a careful evaluation, the medical team will recommend the treatment that is appropriate to each patient’s particular circumstances. Depending on the pleural condition and its cause, treatment may include:
Bullectomy
Bullectomy is the surgical removal of a bulla, which is an air pocket in the lung that is greater than one centimeter in diameter (across). Bullae tend to occur as a result of lung tissue destruction and diseases such as cancer and emphysema. Their presence in the lung takes up space, causes pressure and blocks your breathing.
Chemotherapy
Chemotherapy is a medication or combination of medications used to treat cancer. Chemotherapy can be given orally (as a pill) or injected intravenously (IV). When chemotherapy drugs enter the bloodstream, it destroys cancer cells. Chemotherapy is particularly useful for cancers that have metastasized, or spread. Chemotherapy attacks all quickly-dividing cells, regardless of whether they are cancerous which can cause a number of side effects, including hair loss, mouth sores, loss of appetite, nausea and vomiting, diarrhea, and low blood counts. Low blood counts can increase a patient’s risk of infection, bruising or bleeding, fatigue, and shortness of breath. The side effects of chemotherapy are generally temporary and often go away once treatment is completed. Chemotherapy regimens vary from patient to patient. They are generally repeated several times in cycles, with three to four weeks separating each cycle to allow damaged normal cells time to recover. After the first two or three sessions of chemotherapy, patients may have a CT or PET scan to see if the drug(s) is effective. If the drug(s) is not working, it may be switched out for a new drug(s).
Minimally Invasive Tumor Removal
Video-Assisted Thorascopic Surgery (VATS) is a minimally invasive alternative to open chest surgery that involves less pain and recovery time. After giving you a sedative, the physician will make tiny incisions in your chest and then insert a fiber-optic camera called a thorascope as well as surgical instruments. As the physician moves the thorascope around, images that provide important information are projected on a video monitor. VATS is not appropriate for all patients; you should have a thorough discussion with your provider before making a decision. It is often not recommended in people who have had chest surgery in the past, because remaining scar tissue can make accessing the chest cavity more challenging and thus riskier.
Pleurodesis or Pleural Effusion
Pleurodesis is a therapy that we offer for lung cancer patients to remove excess fluid—called pleural effusion—from the space between the lungs and chest wall that line the lungs (pleura). This fluid prevents the lungs from fully expanding as you breathe, causing shortness of breath. Pleural effusion is usually diagnosed by means of a chest x-ray, and a sample of the fluid may be taken to confirm its cause. There are a few ways to perform pleurodesis. One such way is video-assisted thoracoscopy, a new, less invasive method that we offer at BMC. Using a thoracoscope, a small, thin instrument with a light and lens, your surgeon will locate the area to be treated, drain your lung fluid, and then insert a talcum powder or antibiotic solution. This solution will circulate in the space between the pleura lining the chest wall and the lungs, causing some minor irritation and inflammation, which then causes the tissues to stick together, eliminating the space. Further fluid buildup is thereby prevented, allowing you to breathe easier. If the procedure is not successful, it may be repeated. Pleurodesis does not treat lung cancer, but it can be a very helpful tool in reducing symptoms.
PleurX Catheter
The PleurX catheter is a thin, flexible tube that is placed in the pleural space to drain the fluid buildup associated with pleural effusion. Traditionally, treatment for chronic pleural effusion has required patients to remain in the hospital. The PleurX catheter allows you to manage your pleural effusion at home. The device consists of a catheter that is placed in the pleural space through a small incision. The catheter is connected to a vacuum bottle. When you open a valve at the end of the catheter, fluid drains into the vacuum bottle.
Radiation Therapy
Radiation uses special equipment to deliver high-energy particles, such as x-rays, gamma rays, electron beams or protons, to kill or damage cancer cells. Radiation (also called radiotherapy, irradiation, or x-ray therapy) can be delivered internally through seed implantation or externally using linear accelerators (called external beam radiotherapy, or EBRT). Radiation may be used as a solitary treatment to cure the tumor or in combination with surgery and/or chemotherapy. The equipment used to deliver the radiation therapy is called a linear accelerator. The linear accelerator has a moveable arm, which enables the radiation to be focused on the part of your body where the cancer is located. Developments in EBRT equipment have enabled physicians to offer conformal radiation. With conformal radiation, computer software uses imaging scans to map the cancer three-dimensionally. The radiation beams are then shaped to conform, or match, the shape of the tumor.
Radiation works by breaking a portion of the DNA of a cancer cell, which prevents it from dividing and growing. Radiation therapy can be systemic, meaning it moves throughout your bloodstream. Systemic therapies are usually given as an injection into a blood vessel or are taken as a pill. Systemic treatments expose your entire body to cancer-fighting medication. Radiation therapy is typically given as a "local" treatment however, meaning it affects only the part of the body that needs therapy.
Thoracentesis
The removal of pleural fluid with a needle or catheter that your surgeon inserts through your ribs in the back of your chest into your chest wall.
Thoracostomy
During thoracostomy, the physician will inject a local anesthetic into the chest wall where the fluid is located and place 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
Tumor Ablation
Tumor ablation is an image-guided, minimally invasive treatment used to destroy cancer cells. In tumor ablation, a physician inserts a specially equipped needle (probe) into the tumor or tumors guided by computed tomography (CT). Once the probe is in place, energy is transmitted through it and into the tumor.