Pleural Disease Program

A pleural effusion is the buildup of fluid between the lungs and the lining of the chest cavity. (The pleura, thin membranes that line the lungs, normally have a small amount of fluid so that the lungs can expand and contract without friction. But sometimes too much fluid accumulates when the pleura becomes irritated, inflamed, or infected. Underlying diseases, such as congestive heart failure, pneumonia, kidney disease, cirrhosis, and cancer may also contribute to the abnormal collection of fluid. Pleural effusion can cause chest pain, shortness of breath, or make it difficult to breathe when lying down.

 

The most common methods to diagnose pleural effusions are chest X-ray, chest ultrasound, computed tomography (CT) of the chest, and thoracentesis.

 

Pleural effusions can be benign (not cancer) or malignant (cancer). We treat both types of pleural effusions.

An infection of the pleural space, also known as empyema, may develop as a complication of pneumonia. Although many people will develop a pleural effusion (see above) as a result of pneumonia, only some of them will also develop an infection. Your doctor will drain some of the fluid in the pleural effusion and culture it to see if infectious agents are present and require treatment.

A pleural mass or nodule is a solid lesion found in the pleural space. Pleural masses and nodules are also known as tumors, and are usually malignant. These nodules may be the result of cancer that has spread from elsewhere in the body (usually from the lungs). Treatment depends on the type of pleural mass or nodule.

A pleuroscopy is a medical procedure in which interventional pulmonologists examine the pleural space. To perform the procedure, they use a pleuroscope (a thin tube-like scope equipped with a camera) through a small incision in the chest wall. They are then able to see he pleural cavity.

To determine the cause of fluid accumulation, your doctor may recommend thoracentesis. This is a medical procedure to remove fluid from the pleural cavity. This will make it easier for you to breathe. It will also enable your doctor to analyze the fluid and determine the cause of the pleural effusion. To perform the procedure, the doctor numbs the side of your chest and inserts a thin needle into the pleural area to withdraw fluid. This is a common procedure that can be done with local anesthesia in an outpatient setting.

 

Thoracentesis is also used to remove fluid that comes back later. Or your doctor may recommend other treatments (see below).

A pleural biopsy involves taking a small sample of the membrane that surrounds your lungs (the pleura), in order to analyze the tissue. We offer a minimally invasive pleural biopsy, which uses a thin needle to reach the pleura. Your chest will be numbed with a local anesthetic during the procedure.

Whenever the cause of pleural effusion cannot be determined by the characteristics of the pleural fluid, we recommend medical or surgical thoracoscopy. Thoracoscopy is a minimally invasive procedure that allows the physician to visually inspect and obtain small biopsies of the pleural surface.

 

In many cases, treatment known as pleurodesis or "gluing of the pleural surface" is done after thoracoscopy. This procedure eliminates the pleural space, so that the lungs adhere to the chest wall. Afterwards, a chest tube or tunneled pleural catheter is left in place to finish draining the available air and fluid.

A PleurX catheter is a thin tube that enables you to drain pleural fluid at home. While you are sedated, a doctor will place the tip of the catheter inside the pleural space. Fluid will drain into a thin tube that is taped to your chest. The external portion of the catheter will be capped, so that fluid will drain only when you are ready.

 

A nurse will teach you how to care for your PleurX catheter. You will have to clean the catheter every day, drain the catheter as frequently as your doctor instructs, and change the dressing that holds the catheter in place at least once a week. Your nurse will provide handouts to help you remember how to care for your catheter.

Pleural decortication is a procedure to remove the surface layer or membrane covering the lung. This procedure may be performed when the pleural layer has grown thick and inflexible, restricting your lungs’ ability to expand so you can breathe.