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Pleural Cavity Disease

Introduction

Pleural cavity diseases affect the thin membrane, called the pleura that wraps around the lung and lines the inside of the chest wall. Between the layers of tissue is a very thin space called the pleural space. Normally this space is filled with a small amount of fluid—about 4 teaspoons full. The fluid helps the two layers of the pleura glide smoothly past each other as you breathe in and out.

The pleura can become irritated, inflamed (pleurisy) and infected (pleuritis). Extra fluid (pleural effusion), air (pneumothorax), or blood (hemothorax) can accumulate between them, causing part of the lung to collapse.The pleura can become irritated, inflamed (pleurisy) and infected (pleuritis). Extra fluid (pleural effusion), air (pneumothorax), or blood (hemothorax) can accumulate between them, causing part of the lung to collapse.

Causes And Symptoms Of Pleural Cavity Diseases

1. Pneumothorax

Air or gas can build up in the pleural space. When this happens, it’s called a pneumothorax. A lung disease or acute lung injury can cause a pneumothorax.

Causes of Pneumothorax

Some lung procedures also can cause pneumothorax. Examples include lung surgery, drainage of fluid with a needle, bronchoscopy and mechanical ventilation.

Sometimes, the cause of a pneumothorax is not known. This is called spontaneous pneumothorax. Smoking increases the risk of spontaneous pneumothorax. Having a family history of the condition also increases the risk.

Lung diseases that can cause pneumothorax are chronic obstructive pulmonary disease (COPD), tuberculosis and lymphangioleiomyomatosis.

The symptoms of pneumothorax include:

  • Sudden, sharp chest pain that gets worse when you breathe in deeply or cough
  • Shortness of breath
  • Chest tightness
  • Fatigue (tiredness) that comes on easily
  • A rapid heart rate
  • A bluish tint to the skin (caused by lack of oxygen)

Other symptoms of pneumothorax include flaring of the nostrils, anxiety, stress and hypotension (low blood pressure).

2. Pleural Effusion

In some cases of pleurisy, excess fluid builds up in the pleural space. This is called pleural effusion. A lot of extra fluid can push the pleura against your lung until the lung, or part of it, collapses. This can make it hard for you to breathe.

Sometimes the extra fluid gets infected and turns into an abscess. When this happens, it is called an empyema.

Causes of Pleural Effusion

These include chest infection or pneumonia, tuberculosis, lung cancer and lymphangioleiomyomatosis (LAM).

Heart failure, kidney and liver failure are also known causes.

Asbestosis and reactions to some medicines can also lead to pleural effusion.

Symptoms of Pleural Effusion

This disorder may cause breathlessness or chest discomfort. However, some have no symptoms.

3. Haemothorax

Blood also can build up in the pleural space. This condition is called haemothorax.

Causes of haemothorax

An injury to your chest, chest or heart surgery or lung or pleural cancer can cause a haemothorax.

Symptoms of haemothorax

The symptoms of a haemothorax often are similar to those of a pneumothorax. They include:

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

4. Pleurisy

Pleurisy is a condition in which the pleura is inflamed.

Causes of Pleurisy

Many conditions can cause pleurisy. Viral infections are likely the most common cause. Other causes of pleurisy include:

  • Bacterial infections (such as pneumonia and tuberculosis) and infections from fungi or parasites
  • Pulmonary embolism (a sudden blockage in a lung artery, usually caused by a blood clot)
  • Autoimmune disorders, such as lupus and rheumatoid arthritis
  • Cancer, such as lung cancer, lymphoma and mesothelioma
  • Chest and heart surgery especially coronary artery bypass grafting
  • Lung diseases, such as  lymphangioleiomyomatosis (LAM) or asbestosis
  • Inflammatory bowel disease
  • Familial Mediterranean fever (an inherited condition that often causes fever and swelling in the abdomen or lungs)

Sometimes the cause of pleurisy isn’t known.

Symptoms of Pleurisy

The main symptom of pleurisy is sharp or stabbing chest pain. The pain gets worse when you breathe in deeply, cough or sneeze.

The pain may stay in one place or spread to your shoulders or back. Sometimes the pain becomes a fairly constant dull ache.

Depending on the cause of the pleurisy, you may have other symptoms such as:

  • Shortness of breath or rapid, shallow breathing
  • Coughing
  • Fever and chills
  • Unexplained weight loss

Treatment

Pleural disorders and pleurisy are treated with procedures, medicines and other methods. The goals of treatment include:

  • Relieving symptoms
  • Removing the fluid, air or blood from the pleural space (if a large amount is present)
  • Treating the underlying condition

Relieving Symptoms

To relieve pleurisy symptoms, your doctor may recommend:

  • Paracetamol or anti-inflammatory medicines (such as ibuprofen) to control pain.
  • Codeine-based cough syrups to control coughing
  • Lying on your painful side. This might make you more comfortable.
  • Breathing deeply and coughing to clear mucus as the pain eases. Otherwise, you may develop pneumonia
  • Getting plenty of rest.

Removing Fluid, Air or Blood From the Pleural Space

Your doctor may recommend removing fluid, air or blood from your pleural space to prevent a lung collapse.

The procedures used to drain fluid, air or blood from the pleural space are similar.

  • During thoracocentesis, your doctor will insert a thin needle or plastic tube into the pleural space. An attached syringe will draw fluid out of your chest. This procedure can remove more than 6 cups of fluid at a time.
  • If your doctor needs to remove a lot of fluid, he or she may use a chest tube. Your doctor will inject a painkiller into the area of your chest wall where the fluid is. He or she will then insert a plastic tube into your chest between two ribs. The tube will be connected to a container that suctions out the fluid. Your doctor will use a chest x ray to check the tube’s position.
  • Your doctor also can use a chest tube to drain blood and air from the pleural space. This process can take several days. The tube will be left in place and you’ll likely stay in the hospital during this time.

Sometimes the fluid in the pleural space contains thick pus or blood clot. It may form a hard skin or peel, which makes the fluid harder to drain. To help break up the pus or blood clot, your doctor may use a chest tube to deliver medicine called fibrinolytics to the pleural space. If the fluid still won’t drain, you may need surgery.

If you have a small, persistent air leak into the pleural space, your doctor may attach a one-way valve to the chest tube. The valve allows air to exit the pleural space, but not to reenter. Using this type of valve may allow you to continue your treatment at home.

Treat the Underlying Condition

The fluid sample that was removed during thoracocentesis will be checked under a microscope. This can tell your doctor what’s causing the fluid buildup, and he or she can decide the best way to treat it.

If the fluid is infected, treatment will involve antibiotics and drainage. If you have tuberculosis or a fungal infection, treatment will involve long-term use of antibiotics or antifungal medicines.

If tumours in the pleura are causing fluid buildup, the fluid may quickly build up again after it’s drained. Sometimes antitumor medicines will prevent further fluid buildup. If they don’t, your doctor may seal the pleural space. Sealing the pleural space is called pleurodesis.

For this procedure, your doctor will drain all of the fluid out of your chest through a chest tube. Then he or she will push a substance through the chest tube into the pleural space. The substance will irritate the surface of the pleura. This will cause the two layers of the pleura to stick together preventing more fluid from building up.

Chemotherapy or radiation treatment may also be used to reduce the size of the tumours.

If heart failure is causing fluid buildup, treatment usually includes diuretics (medicines that help reduce fluid buildup) and other medicines.

Prevention

Pleural cavity diseases and pleurisy can be prevented by avoiding the factors that are known to cause them. The role of smoking cessation should be emphasised.

References

  1. Mediline plus
  2. Pubmed
  3. National Heart, Lung and Blood Institute

 

Last reviewed : 16 January 2015
Writer : Dr. Norhaya bt. mohd Razali
Accreditor : Dr. Jamalul Azizi b. Abdul Rahman