Pleural Disease

Pleural Disease

Pleural disease affects the thin layers of tissue surrounding the lungs and can result from a wide range of conditions, including infection, inflammation, autoimmune disorders, tuberculosis, trauma, and cancer. Common pleural disorders include pleurisy, pleural effusion, empyema, tuberculosis-related pleural disease, and pleural malignancies such as lymphoma and mesothelioma.

Symptoms may include chest pain, shortness of breath, difficulty breathing when lying flat, or labored breathing. Some patients may find they need to sit upright or stand in order to breathe more comfortably. Because these symptoms can have many causes, accurate diagnosis is essential to determine the appropriate treatment.

At the Institute for Thoracic Surgery in Miami, Florida, Mark R. Dylewski, M.D., provides specialized evaluation and surgical treatment for complex pleural disorders. Treatment is individualized according to the underlying cause, extent of disease, and overall health of each patient.

If you are experiencing persistent chest pain, shortness of breath, or difficulty breathing, contact the Institute for Thoracic Surgery to discuss your symptoms and treatment options.

Pleural Disease

Pleural disease encompasses a broad range of conditions affecting the pleura, the thin layers of tissue that surround the lungs and line the inside of the chest cavity. These conditions may be benign, inflammatory, infectious, traumatic, or malignant. When the pleura becomes inflamed, thickened, scarred, infected, or filled with abnormal fluid or air, patients may develop chest pain, shortness of breath, cough, or difficulty breathing.

What Causes Pleural Disease?

Pleural disease has many possible causes. Benign and inflammatory conditions include pleurisy, autoimmune disorders, pleural thickening, and other inflammatory processes. Infectious diseases may result from bacterial pneumonia, tuberculosis, fungal infections, or other organisms and can lead to complicated pleural effusions or empyema, a collection of infected fluid or pus within the pleural space.

Pleural disease can also result from trauma or medical procedures, including bleeding into the pleural space (hemothorax) or air entering the pleural cavity (pneumothorax). In other patients, pleural abnormalities are associated with malignancy, including malignant pleural mesothelioma, lymphoma, metastatic cancer, or cancer-related pleural effusion.

Symptoms and Evaluation

Symptoms vary according to the underlying cause and extent of disease. Common symptoms include chest pain that may worsen with deep breathing or coughing, shortness of breath, persistent cough, fever or chills, fatigue, and a sensation of pressure or heaviness in the chest. Some patients have few symptoms, and pleural abnormalities may be discovered incidentally on imaging.

Evaluation begins with a detailed medical history and physical examination and commonly includes chest X-ray, computed tomography (CT), and ultrasound. When fluid is present, thoracentesis may be performed to remove fluid for laboratory, microbiologic, and cytologic analysis while also relieving symptoms. Depending on the findings, additional evaluation may include bronchoscopy, image-guided or thoracoscopic pleural biopsy, and specialized testing to determine whether infection, inflammation, or malignancy is responsible.

Treatment of Pleural Disease

Treatment depends on the underlying diagnosis rather than the pleural abnormality alone. Small or uncomplicated effusions may sometimes be managed by treating the underlying condition. Antibiotics are used when bacterial infection is responsible, while tuberculosis and other specific infections require appropriate antimicrobial therapy.

When a pleural effusion causes significant symptoms, thoracentesis can remove fluid and improve breathing. Recurrent effusions may require an indwelling pleural catheter or pleurodesis, particularly when associated with malignancy.

Pleural infections such as empyema generally require antibiotics together with effective drainage. When infection persists despite medical treatment and drainage, surgery may be necessary to remove infected material and allow the lung to fully re-expand.

Surgical Treatment

When surgery is indicated, the appropriate procedure depends on the underlying disease, the condition of the lung and pleura, and the patient's overall health. Video-assisted thoracoscopic surgery (VATS) is commonly used for diagnosis and treatment through small incisions. Depending on the condition, thoracoscopic surgery may be used to drain an infected pleural collection, remove diseased or abnormal tissue, obtain a definitive biopsy, treat a persistent air leak, or perform decortication to remove a restrictive layer of scar tissue surrounding the lung.

Robotic-assisted thoracic surgery may also be appropriate for selected patients and can provide enhanced visualization and precise instrument control through minimally invasive access. More extensive pleural disease, complex infection, advanced malignancy, or involvement of surrounding structures may require a larger open operation. For malignant pleural disease, treatment may involve surgery in combination with systemic therapy and/or radiation, depending on the diagnosis and stage.

At the Institute for Thoracic Surgery in Miami, Florida, Mark R. Dylewski, M.D., provides specialized evaluation and surgical treatment for a wide range of pleural disorders. The objective is to identify the underlying cause and develop an individualized treatment strategy using the least invasive approach capable of safely and effectively addressing the disease.