Pleural Injuries: Causes and Management

What Is a Pleural Injury?

Pleural injury refers to damage or trauma occurring in the pleura, which is a double-layered membrane that surrounds the lungs and lines the chest cavity. The pleura has two layers: the visceral pleura, covering the lungs, and the parietal pleura, lining the chest wall.

When the pleural layers are damaged, it can result in inflammation known as pleurisy, the accumulation of fluid between the pleural layers called pleural effusion, or pneumothorax, which causes lung collapse. Various factors, such as trauma, infections, or underlying lung diseases, can cause pleural injuries.

What Are the Causes of Pleural Injury?

Pleural injuries can arise from various factors:

• Trauma: Direct chest injuries, such as fractures from accidents or falls, can damage the pleural layers.

• Infections: Lung infections like pneumonia or pleuritis can trigger pleural issues.

• Lung Diseases: Underlying lung conditions like chronic obstructive pulmonary disease (COPD), tuberculosis, or lung cancer can result in pleural problems.

• Pleural Effusion: Accumulation of excess fluid in the pleural space due to conditions like heart failure, liver disease, kidney disease, or infections can eventually lead to pleural injuries.

• Pneumothorax: This occurs when air leaks into the pleural space, causing the lung to collapse. Trauma, underlying lung conditions, or spontaneous causes can result in pneumothorax.

• Pleural Tumors: Tumors originating in the pleura (mesothelioma) or spreading from nearby organs can cause pleural injuries.

• Radiation Therapy: Treatment for lung cancer or other chest-related cancers using radiation can lead to pleural damage.

• Blood Clots: The formation of blood clots in the pulmonary arteries can cause pulmonary embolism, leading to pleural infarction or injuries.

• Medications: Certain drugs like Methotrexate or Nitrofurantoin can also lead to pleural injuries.

What Are the Symptoms of Pleural Injuries?

Pleural disorders can have different symptoms, although some individuals may experience no symptoms at all. The signs and complications associated with these disorders can vary significantly, depending on the specific condition and its severity.

Common symptoms of pleural disorders include:

• Sharp or Stabbing Chest Pain: This pain intensifies during deep breathing, coughing, or sneezing, indicating irritation or inflammation in the pleura.

• Persistent Cough: A chronic cough is a prevalent symptom, often accompanied by discomfort in the chest area.

• Shortness of Breath: Breathing difficulties, especially during physical activities or even at rest, can indicate pleural issues affecting lung function.

• Slow Weight Gain in Children: Children with pleural disorders may exhibit slow weight gain, falling significantly below their ideal or average weight for their age group.

• Fever: In some cases, pleural disorders can lead to fever, indicating an underlying infection or inflammation.

• Fatigue: Generalized weakness and tiredness can result from the strain on the respiratory system caused by pleural disorders.

• Cyanosis (Bluish Skin): Insufficient oxygen levels due to compromised lung function can cause the skin to appear bluish, especially in the lips, fingers, or toes.

• Anxiety: The distressing nature of breathing difficulties and chest pain can lead to feelings of anxiety and restlessness.

• Rapid Heart Rate: Increased heart rate, known as tachycardia, can occur as the heart tries to compensate for reduced oxygen levels in the bloodstream.

How to Diagnose the Pleural Injuries?

The assessments help in diagnosing pleural disorders while excluding other potential causes of chest pain.

Medical History:

To diagnose a pleural disorder, the healthcare provider will inquire about personal and family health history. They will specifically focus on the description of chest pain, including details such as:

• Sensation: What the pain feels like?

• Location: Where is it located and whether it radiates to the arms, jaw, or shoulders?

• Onset: When it started and if it comes and goes?

• Triggers: What makes it better or worse?

This information helps to know whether the pain is related to issues with the heart, chest muscles, lungs, or digestive system.

Physical Examination:

During the physical exam, the health care provider will measure vital signs by checking the person's blood pressure, heart rate, and temperature. They palpate, feeling the chest, belly, and pulse. They listen carefully, auscultating the heart and lungs, paying attention to any abnormal sounds. Additionally, they use a probe on the individual's finger or forehead to assess oxygen levels in their blood.

Specifically for Pleural Disorders:

• Pleurisy: An inflamed pleura may produce a rough, scratchy sound (pleural friction rub) during breathing.

• Pleural Effusion: Fluid buildup might dull the sound during chest tapping.

• Pneumothorax: Unusual echoes may be detected during chest tapping.

Diagnostic Tests:

• Biopsies will be taken to take Pleura samples to check for signs of disease.

• Blood tests help reveal illnesses increasing pleurisy or other pleural disorders risk.

• Lung Imaging techniques like magnetic resonance imaging (MRI) or X-rays to detect fluid, air, or other abnormalities in the pleural space, ruling out conditions like pneumonia, fractured ribs, or lung tumors.

• Endoscopy examination for disease signs, guide biopsies, or removal of pleural fluid.

• Thoracentesis is a procedure to extract pleural fluid for testing and evaluating it for infection, cancer, or other conditions causing fluid or blood accumulation.

• Ultrasounds help to search for fluid, air, or abnormalities in the chest.

How to Treat the Pleural Injuries?

Pleural injuries are treated depending on the type of injury and how severe it is. Some disorders go away on their own, while others need medical help. Management of pleural injuries includes the following.

Medicines:

• Antibiotics, antifungals, or antiparasitic medicines to treat infections in the pleural space or lungs.

• Corticosteroids help reduce inflammation but can have side effects with long-term use.

• Low-dose morphine helps with long-term shortness of breath but has a risk of addiction.

• Ibuprofen to reduce pain and inflammation.

Procedures:

• Chest Tubes: Drain fluid, blood, or air from the pleural space.

• Heimlich Valves: Prevent fluid and air from entering the chest while allowing the body to breathe normally.

• Indwelling Pleural Catheters (IPC): Thin tubes are left in place to drain fluid regularly.

• Medicine Injections: Break up material that cannot be removed with a needle.

• One-Way Endobronchial Valve: Allows air to exit the pleural space but not re-enter.

• Pleurodesis: Helps close the pleural space by making the layers stick together, preventing fluid buildup.

• Surgery: Surgery might be needed to remove stubborn fluid, pus, or blood clots. Surgery can also involve removing part of the pleura ribs or performing pleurodesis.

• Thoracentesis: Removes air, blood, or fluid from the pleural space using a needle, guided by ultrasound to minimize complications.

Conclusion

Pleural injuries can result from various factors, such as trauma, infections, or pre-existing lung conditions. Typical symptoms include cough, shortness of breath, and chest pain. It is crucial for these symptoms to be accurately diagnosed and managed promptly. The appropriate approach depends on the underlying cause and the severity of the patient's condition. Without proper treatment, complications like partial or complete lung collapse, accumulation of pus in the pleural space, or even life-threatening situations can arise. Seeking timely medical attention is vital to prevent these potential complications.