Pleural Disease Care
Trusted care for diseases affecting the lining of the lungs
Respiratory Conditions Specialists
Beth Israel Deaconess Medical Center (BIDMC) provides highly specialized care for pleural diseases. These conditions affect the linings around the lungs. Our Pleural Disease Program is a specialized multidisciplinary service for evaluating and treating pleural disease.
Pleural Effusions
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 has a small amount of fluid. This fluid allows the lungs to expand and contract without friction. But sometimes, too much fluid accumulates when the pleura becomes irritated, inflamed or infected. This can cause chest pain, shortness of breath or make it difficult to breathe when lying down.
Certain health conditions can contribute to this unusual collection of fluid, including the following:
Infections of the Pleural Space
An infection of the pleural space (empyema) may develop as a complication of pneumonia. Although many people will develop a pleural effusion due to pneumonia, only some will also develop an infection.
If you have a pleural effusion, your doctor will drain some of the fluid in the pleural effusion. Then, they’ll culture it to see if infection is present. If so, you’ll receive treatment for the infection.
Pleural Masses or Nodules
A pleural mass or nodule is a solid lesion in the pleural space. Pleural masses and nodules are also known as tumors. They 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.
More About Pleural Disease Care
Our team uses the latest diagnostic tools to diagnose these complex conditions.
The most common methods used to diagnose pleural effusions are:
- Chest CT scan
- Chest ultrasound
- Chest X-Ray
Pleural effusions can be benign (noncancerous) or malignant (cancerous). We treat both types of pleural effusions.
Additional diagnostic tools include:
Pleuroscopy: A pleuroscopy is a medical procedure in which interventional pulmonologists examine the pleural space. To perform the procedure, they use a pleuroscope (thin, tube-like scope with a camera) through a small incision (cut) in the chest wall. They are then able to see the pleural cavity.
Thoracentesis: 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. Then, they insert a thin needle into the pleural area to withdraw fluid. This is a common procedure that uses local anesthesia (numbing only the affected area) in an outpatient setting. This means that you’ll go home following the procedure and won’t have to spend time in the hospital.
If the fluid returns after other treatments, your doctor may recommend thoracentesis. Alternately, your doctor may suggest one of the other treatment options below.
Minimally Invasive Pleural Biopsy: A pleural biopsy involves removing a small sample of the membrane that surrounds your lungs (pleura) to analyze the tissue. We offer a minimally invasive pleural biopsy. This procedure uses a thin needle to reach the pleura. Your doctor will apply local anesthetic to your chest during the procedure.
We offer the latest effective treatment options for pleural conditions.
Thoracoscopy and Minimally Invasive Pleurodesis
Sometimes, the care team cannot determine the cause of pleural effusion by closely examining the pleural fluid. In this case, we recommend medical or surgical thoracoscopy. Thoracoscopy is a minimally invasive procedure that allows the doctor to visually inspect and obtain small biopsies (tissue samples) of the pleural surface.
In many cases, the care team will perform pleurodesis (gluing of the pleural surface) after thoracoscopy. This procedure eliminates the pleural space, so that the lungs adhere to the chest wall. Afterwards, the doctor leaves a chest tube or tunneled pleural catheter in place to finish draining the available air and fluid.
PleurX Catheter
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 they tape to your chest. The doctor will cap the external portion of the catheter, 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.
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
Pleural decortication is a procedure to remove the surface layer or membrane covering the lung. Your care team may suggest this treatment if the pleural layer has grown thick and inflexible, restricting your lungs’ ability to expand so you can breathe.
