The chest (thoracic or pleural) cavity is a space that is enclosed by the spine, ribs, and sternum (breast bone) and is separated from the abdomen by the diaphragm. The chest cavity contains the heart, the thoracic aorta, lungs and esophagus (swallowing passage) among other important organs. The wall of the chest cavity is made up of the rib cage and diaphragm. The chest cavity is lined by a thin shiny membrane called the pleura, which covers the inside surface of the rib cage and spreads over the lungs as well. Normally, the pleura produces a small amount of fluid which serves as a lubricant to the lungs as they move back and forth against the chest wall during respiration.
A variety of conditions involve the pleura and pleural cavity, each with different causes, symptoms, and treatments.
Types of Pleural Diseases
Hemothorax: Accumulation of blood in the pleural cavity.
- Causes: Most chest trauma; other causes include lung/pleural cancer and chest/heart surgery
- Symptoms: Chest pain, shortness of breath, anxiety/restlessness, increased heart rate, respiratory failure if large
Pleural effusion: Accumulation of excess fluid in the pleural cavity; this accumulation pushes against the lung and prevents full expansion with breathing. This is one of the most common problems associated with the pleura.
- Causes: Congestive heart failure, lung cancer, pneumonia, tuberculosis, liver disease, pulmonary embolism, lupus, adverse reaction to specific medications
- Symptoms: May be asymptomatic (no symptoms), or produce shortness of breath and cough
Empyema: The accumulation of pus in the pleural cavity. This is a type of pleural effusion that is usually associated with pneumonia (an infection in the adjacent lung). The symptoms are those of the pneumonia (cough, fever) in addition to shortness of breath and impaired breathing.
Pleural tumors: Malignant tumors arising from the pleura (e.g. mesothelioma) or spreading to the pleura (metastatic) from another site, and benign tumors arising from the pleura.
- Symptoms: Shortness of breath, chest pain, cough, unexpected weight loss
Pleurisy: Inflammation of the pleura
- Causes: Infection of the respiratory system by a virus or bacteria, leak of air into pleural cavity from a punctured lung, chest injury, tuberculosis or other infection, tumor in the pleural cavity, rheumatoid arthritis, lupus, sickle cell crisis, pulmonary embolism, pancreatitis, complications from heart surgery
- Symptoms: Chest pain on taking a deep breath, shortness of breath, fever and/or chills, joint swelling and/or soreness, unexpected weight loss
Pneumothorax: Accumulation of air within the pleural cavity between the outside of the lung and the inside of the rib cage.
- Causes: Injury to the lung causing a leak of air, chronic obstructive pulmonary disease or other lung disease, tuberculosis, ruptured air blisters (blebs), mechanical ventilation
- Symptoms: Shortness of breath, rapid breathing, chest pain when taking a deep breath (pleurisy), cyanosis (bluish discoloration of the skin), respiratory distress if large
Diagnosis
Pleural disease may be suspected on the basis of a medical history and findings on a physical examination. It is confirmed with a chest x-ray, which shows the interior of the chest cavity, and a CT scan—a series of images of the inside of the body, taken from different angles and depths, to reveal a high level of detail. To ensure that the blood vessels and organs show up clearly in these scans, dye may be swallowed or injected into a vein during performance of the scan. Certain blood tests may also be useful in determining the cause and severity of the pleural disease.
Treatments
The treatment of pleural disease is dictated by the condition and may vary from placement of a chest tube to evacuate air, draining fluid with a needle (thoracentesis) or a chest tube, or opening the chest to remove the diseased pleura (decortication).
Abrading the pleural surface to achieve adherence of the lung to the chest wall may be required for recurrent pneumothorax.
In some cases of malignancy (mesothelioma), removal of all of the pleura as well as the underlying lung (extrapleural pnemonectomy) may be indicated.
Your physician will discuss with you the diagnosis and surgical and non-surgical options for treatment.
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