Diseases of Pleura - Types, Symptoms, and Management

Introduction

The pleura is a thin and expansive type of mesothelial tissue. The pleura consists of the following:

1. An outer parietal layer that lines the inner surface of the thoracic cavity (chest).

2. An inner visceral layer that lines the surface of the lungs.

3. Both layers are separated by a space termed the pleural space or pleural cavity that is filled with pleural fluid. The pleural fluid enables the smooth gliding of the pleural layers past each other while breathing.

Symptoms are usually common for most pleural diseases. Depending on the type of the disease condition as well as the severity, the treatment measures vary. Neglecting to seek treatment can result in severe complications such as complete lung collapse, sepsis, or even shock.

What Are the Types of Pleural Diseases?

There are several types of pleural diseases, and some common examples are as follows:

1. Pleurisy - Inflammation of the pleura (inner or outer layer) is termed pleurisy or pleuritis. Inflammation can affect the smooth gliding of the pleural layers and consequently affect the smooth breathing process. Pleurisy is most commonly caused by viral infections.

2. Pleural Effusion - Pleural effusion is characterized by excessive build-up of fluid within the pleural space. The leading cause of pleural effusion is congestive heart failure.

3. Pneumothorax - Pneumothorax is a condition when the air enters the pleural space, causing part or complete lung to collapse. Pneumothorax most frequently occurs as a result of chronic obstructive pulmonary disease (COPD).

4. Hemothorax - Hemothorax is a condition where blood accumulates in the pleural space. An injury to the chest or lungs is the most common cause of hemothorax.

5. Empyema - Empyema is a condition where a collection of pus is present in the pleural space. Empyema most frequently occurs as a result of pneumonia.

6. Pleural Tumor - Pleural tumors may arise from the pleura or spread into the pleura from tumors of the surrounding organs. Pleural tumors can be of different types, such as:

   1. Malignant tumors originate from the pleura itself, such as mesothelioma.

   2. A tumor may spread to the pleura from other sites in the body, such as breast cancer.

   3. Benign tumors can also arise from the pleura, such as pleural lipoma.

What Are the Causes of Pleural Diseases?

There are various causes of pleural diseases. Depending on the type of the disease condition, the specific cause may vary. Some of the factors that commonly cause pleural diseases are as follows:

• Infections.

  • Viral.

  • Bacterial.

  • Fungal.

• Injury to the Chest.

• Diseases Involving the Lungs.

  • Pneumonia.

  • Chronic obstructive pulmonary disease (COPD).

  • Tuberculosis.

  • Blebs- Small air blisters can develop on the surface of the lungs. In some cases, these blebs can rupture and cause leakage of air into the pleural space.

  • Cancer.

• Medical Conditions.

  • Congestive heart failure.

  • Liver cirrhosis.

  • Kidney failure.

  • Autoimmune diseases (a condition where healthy cells and tissues in the body are mistakenly attacked by the immune system, leading to inflammation, pain, and other symptoms).

• Complications following a heart or lung surgery.

• Prolonged use of certain medications (for example, Nitrofurantoin).

• Asbestos Exposure- Working with asbestos or living with individuals who work with asbestos may increase the risk of exposure to stray fibers of asbestos, which triggers the cells and cause mesothelioma (pleural tumor).

What Are the Signs and Symptoms of Pleural Diseases?

The signs and symptoms of pleural diseases can vary depending on the specific condition. However, some common signs and symptoms include the following:

• Pain or discomfort in the chest that intensifies while breathing, coughing, or sneezing.

• Shortness of breath.

• Difficulty in breathing- which eases when one is in an upright position (orthopnea).

• Dry cough.

• Fever and chills- in case of the presence of infections or pneumonia.

• Increase in heart rate.

• Restlessness and anxiety - in case of hemothorax.

• Fatigue or weakness.

• Unexplained weight loss - especially in the case of pleural tumors.

• Bluish discoloration of the skin (cyanosis) - in severe cases of pneumothorax.

However, some individuals with pleural diseases may not experience any symptoms initially. Routine check-ups and diagnostic tests may be necessary for early diagnosis of pleural diseases.

How to Diagnose Pleural Diseases?

The specific diagnostic approach will depend on the type and severity of the suspected pleural disease. Some common diagnostic methods used to evaluate pleural diseases are as follows:

• Medical History: History regarding symptoms, medical history, and history of any exposure to asbestos or other environmental toxins is noted by the doctor.

• Physical Examination: Listening to the chest with a stethoscope to check for abnormal sounds. For example, a dull sound is present in the case of pleural effusions when the chest is auscultated.

• Imaging Tests: Imaging tests can help visualize the pleura and identify any abnormalities. Imaging test includes:

  • Chest X-ray.

  • Magnetic resonance imaging (MRI) scan.

  • Ultrasound scan.

  • Computerized tomography (CT) scan.

  • Electrocardiogram- to confirm chest pain is not due to a heart condition.

• Thoracentesis: This is a procedure where, through the chest wall, a needle is inserted into the pleural space to remove a sample of the pleural fluid for testing.

• Biopsy: If a tumor or abnormality is detected, a tissue sample is excised for examination under a microscope.

• Pulmonary Function Tests: These tests can assess lung function and may be used to evaluate certain pleural diseases, such as mesothelioma.

How to Treat Pleural Diseases?

Depending on the general health of the individual, the cause and severity of the pleural disorder, and the presence of other factors or disease conditions, appropriate treatment measures are advised.

• Medications: Medications are prescribed to help individuals relieve symptoms and treat the primary cause of pleural disease.

  • Infections are treated with appropriate drugs such as antibacterial, antiviral, or antifungal drugs.

  • Corticosteroids (Prednisone) are used to reduce inflammations.

  • Non-steroidal anti-inflammatory drugs (NSAIDs- Ibuprofen) are used to treat pain and inflammation.

• Drainage: Appropriate measures for drainage of fluid, blood, air, or pus from the pleural space can be done depending on the severity of the condition as well as the overall health of the individual.

  • Chest Tubes: In hospitalized individuals, chest tubes are placed for several days for drain fluid, blood, or pus from the pleural space.

  • Thoracentesis: This is a procedure where, through the chest wall, a needle is inserted into the pleural space in order to remove the excessive build-up of fluid, blood, or air. Ultrasound scans may be used to guide the needle efficiently.

  • Indwelling Pleural Catheters (IPC): This is a procedure where a thin tube is temporarily left inside the individual to help drain fluid multiple times within a week.

• Valve Placement: Two types of valves can be used to manage pleural diseases.

  • Heimlich Valve: Heimlich valve is a one-way valve that prevents fluid and air from entering the chest when one inhales. A Heimlich valve can be attached to a chest tube or IPC, enabling one to go home while waiting for lung re-expansion.

  • One-way Endobronchial Valve: The valve is surgically implanted in the bronchial tube to enable air to leave the pleural space. The one-way endobronchial valve also prevents the air from re-entering the pleural space.

• Pleurodesis: Pleurodesis is a procedure where a chemical or medication is inserted into the pleural space (after the removal of pleural fluid) to create inflammation and adhesion between the two pleural layers in order to prevent further fluid buildup.

• Surgery: Surgical removal of the affected part or the entire lung may be required, depending on the severity of the disease. Additionally, surgery may be required to repair the pleural membrane or to eliminate fluid or blood clots that cannot be removed by thoracentesis.

Conclusion

Early detection and timely treatment are crucial in managing pleural diseases and preventing potential complications. The risk of developing pleural diseases is higher in individuals over 55 years, those with a family history of pneumothorax, smokers, and individuals with certain medical conditions. Prolonged use of specific medications like blood thinners and cancer drugs can also increase the risk. Individuals are advised to consult at the earliest if they begin to experience symptoms of pleural diseases.