pleural disease

Pleural diseases are conditions that affect the pleura, which is the membrane that lines the thoracic (chest) cavity and covers the lungs. The pleura plays a crucial role in facilitating breathing by cushioning the lungs and making it easier to expand and contract.

There are several types of pleural diseases, including:

• Pleurisy: an inflammation of the pleural lining, which can cause sharp chest pains that worsen when breathing or coughing [11][13]
• Pleural effusion: a buildup of fluid in the pleural space, which can be caused by excess fluid production or decreased absorption [4][7][9]
• Pneumothorax: a condition where air enters the pleural space and pushes against the lung, preventing it from expanding properly [3][14]
• Hemothorax: a collection of blood in the pleural space
• Pleural tumors: growths on the pleura that can be benign or malignant

Pleural diseases can have various causes, including infections (viral or bacterial), autoimmune diseases, lung conditions, and chest injuries. Some causes of chest pain are life-threatening, making it essential to seek medical attention promptly if symptoms persist or worsen over time [13].

The management of pleural disorders involves addressing the underlying cause and providing relief from symptoms. In some cases, this may involve surgical intervention, while in others, medication or other treatments may be more effective.

References:

• [3] Description of pleural effusion
• [4] Definition of pleural effusion
• [7] Explanation of pleural effusion
• [9] Information on pleural effusion
• [11] Cause of pleurisy
• [13] Symptoms and causes of pleurisy
• [14] Overview of pleural disorders

Pleurisy, which refers to inflammation of the pleura, can manifest in various ways depending on its underlying cause. Some common signs and symptoms include:

• Chest pain: This is often the most prominent symptom, described as sharp or stabbing, and worsens with deep breathing, coughing, or sneezing [3][7][13]. The pain may be localized to one area or radiate to the shoulder or back.
• Shortness of breath: Difficulty breathing can occur due to fluid accumulation in the pleural space (pleural effusion) or air entering the space (pneumothorax) [1][5][11].
• Cough: A dry cough is a common symptom, which may progress to a productive cough if an infection is present [7][14].
• Fever and chills: These symptoms can indicate an underlying infection or inflammatory process [6][10].

Additionally, certain conditions that cause pleural disease may have unique symptoms. For example:

• Pleural effusion may not initially produce symptoms but can lead to chest pain, difficulty breathing, and coughing as the fluid accumulates [12].
• Empyema, a condition where pus collects in the pleural space, can present with signs of inflammation, such as fever, chills, and increased white blood cell count [15].

It's essential to note that not all cases of pleurisy or pleural effusion will exhibit these symptoms. A proper diagnosis by a healthcare professional is necessary for an accurate assessment and treatment plan.

References:

[1] Context result 3 [2] Context result 7 [3] Context result 13 [4] Context result 14 [5] Context result 11 [6] Context result 6 [7] Context result 7 [8] Context result 13 [9] Context result 14 [10] Context result 10 [11] Context result 11 [12] Context result 12 [13] Context result 13 [14] Context result 14 [15] Context result 15

Diagnostic Tests for Pleural Disease

Pleural disease diagnostics involve a range of tests to diagnose and identify the underlying cause of pleurisy or other pleural disorders. The diagnostic approach can be tailored to individual patients, taking into account their specific symptoms, medical history, and test results.

Common Diagnostic Tests

• Pleural fluid testing: This involves removing a sample of pleural fluid for laboratory analysis. The fluid is examined for various parameters, including protein and lactate dehydrogenase (LDH) levels, Gram staining and culture, cytology, and other tests to identify the cause of the effusion [2][4].
• Imaging tests: Chest X-rays, computed tomography (CT) scans, and ultrasounds are used to visualize the pleural space and detect any abnormalities, such as fluid or air accumulation [7][10].
• Blood tests: These are performed to determine if there is an underlying illness that may be contributing to the pleural disorder [3][10].
• Endoscopies: In some cases, a healthcare provider may perform endoscopy procedures to examine the pleural space and collect tissue samples for further testing [11].

Additional Diagnostic Procedures

• Thoracentesis: This involves removing fluid from the pleural space using a needle or catheter. The procedure is often performed under local anesthesia [11].
• Pleural fluid analysis: This is considered the gold standard for diagnosis, and novel biomarkers such as suPAR and PAI-1 may aid in diagnosis and prognosis [12].

Other Tests

• Metagenomics: This involves analyzing the microbiome of the pleural space to identify potential infections or other causes of pleurisy [12].
• Chest surgery or trauma evaluation: In some cases, a healthcare provider may need to evaluate the patient's chest surgery or trauma history to determine if it is contributing to the pleural disorder [13].

References

[1] Diagnostics (Basel). 2020 Dec 4;10(12):1046. doi: 10.3390/diagnostics10121046. [2] Feb 28, 2022 — Pleural fluid testing involves removing a sample of this fluid so that it can be analyzed using one or more laboratory methods. [3] by JM PORCEL · 2006 · Cited by 409 — Other tests helpful for diagnosis include helical computed tomography and thoracoscopy. Pleural effusion develops when more fluid enters the ... [4] Dec 6, 2023 — A pleural fluid analysis is a group of tests that examine a sample of abnormal fluid that builds up in the space between your lungs and chest wall. [5] by A SAGUIL · 2014 · Cited by 116 — Routine testing includes protein and lactate dehydrogenase levels, Gram staining and culture, cytology (malignant effusions can be diagnosed by ... [6] Jun 26, 2024 — Pleural fluid analysis is the gold standard for diagnosis; novel biomarkers such as suPAR and PAI-1 hold promise in aiding diagnosis and prognosis in pleural infection. [7] Lung or pleural disease such as lung cancer, mesothelioma, tuberculosis or asbestosis. Chest surgery or trauma. A blood clot in your lung ... What tests will be done to diagnose pleurisy? Your healthcare provider uses tests to diagnose pleurisy and figure out the underlying cause. Possible tests include: [8] This review considers these various aspects of pleural disease. ... Barbieri CA. Diagnostic value of tests that discriminate between exudative and transudative pleural effusions. Chest 1997;111: ... [9] Whilst pleural patients are heterogeneous as a population and in the aetiology of the disease with which they present, we provide an overview of the typical diagnostic appro … Diagnostics (Basel) . 2020 Dec 4;10(12):1046. doi: 10.3390/diagnostics10121046. [10] Lung or pleural disease such as lung cancer, mesothelioma, tuberculosis or asbestosis. Chest surgery or trauma. A blood clot in your lung ... What tests will be done to diagnose pleurisy? Your healthcare provider uses tests to diagnose pleurisy and figure out the underlying cause. Possible tests include: [11] This review considers these various aspects of pleural disease. ... Barbieri CA. Diagnostic value of tests that discriminate between exudative and transudative pleural effusions. Chest 1997;111: ... [12] Lung or pleural disease such as lung cancer, mesothelioma, tuberculosis or asbestosis. Chest surgery or trauma. A blood clot in your lung ... What tests will be done to diagnose pleurisy? Your healthcare provider uses tests to diagnose pleurisy and figure out the underlying cause. Possible tests include: [13] Lung or pleural disease such as lung cancer, mesothelioma, tuberculosis or asbestosis. Chest surgery or trauma. A blood clot in your lung ... What tests will be done to diagnose pleurisy? Your healthcare provider uses tests to diagnose pleurisy and figure out the underlying cause. Possible tests include:

Treatment Options for Pleural Disease

Pleural disease, which includes conditions such as pleurisy and pleural effusion, can be treated with various medications depending on the underlying cause and severity of the condition.

• Steroids: Steroid medication is used to relieve pain and reduce inflammation or swelling associated with pleurisy. This treatment option is often prescribed for patients with inflammatory bowel disease, sickle cell disease, or those experiencing a blood clot in their lung (pulmonary embolism) [10].
• Anti-inflammatories: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others), are commonly used to treat the pain and inflammation associated with pleurisy. In some cases, steroid medication may also be prescribed [10].
• Diuretics: Diuretics are used to help manage pleural effusion caused by congestive heart failure or other medical conditions. These medications work by removing excess fluid from the body [2].
• Antibiotics: Antibiotics are prescribed if there is an infection causing the pleural disease. This treatment option is essential for patients with bacterial infections, such as tuberculosis or pneumonia [4].
• Doxycycline and bleomycin: These medications have been found to be effective in treating most patients with pleural effusion. They can be administered more easily through small-bore catheters, making them a convenient treatment option [7].

Other Treatment Options

In addition to medication, other treatment options for pleural disease include:

• Pleurodesis: This procedure involves injecting an irritating substance (such as talc or doxycycline) into the pleural space through a chest tube. The goal of this treatment is to prevent further fluid accumulation in the pleural space [6].
• Tunneled pleural catheter: A tunneled pleural catheter can be used to drain excess fluid from the pleural space, providing relief for patients with malignant pleural effusion [13].

References

[1] Antunes G, Ali NJ, BTS Pleural Disease Guideline Group. Management of a malignant pleural effusion: British Thoracic Society Pleural Disease Guideline. (Context 1)

[2] Providers choose pleural effusion treatment based on the underlying condition and whether the effusion is making it hard for you to breathe. Medicines Providers use diuretics and other heart failure medications to treat pleural effusion from congestive heart failure or other medical conditions. (Context 2)

[3] Treatment is based on the nature of the effusion and underlying condition. (Context 15)

[4] Treatment includes non-steroidal anti-inflammatory drugs (NSAIDS) and opioids if pain is severe. There is no reduction in level of inflammatory pleural symphysis development with the use of NSAIDS, as had previously been thought. (Context 12)

[5] Kheir F, Shawwa K, Alokla K, Omballi M, Alraiyes AH. Tunneled pleural catheter for the treatment of malignant pleural effusion: a systematic review and meta-analysis. Am J Ther 2016;23(6):e1300-e1306. (Context 13)

[6] Pleurodesis is a procedure that involves injecting an irritating substance into the pleural space through a chest tube. The goal of this treatment is to prevent further fluid accumulation in the pleural space. (Context 6)

[7] Doxycycline and bleomycin have been found to be effective in treating most patients with pleural effusion. They can be administered more easily through small-bore catheters, making them a convenient treatment option. (Context 7)

[8] Lung or pleural disease such as lung cancer, mesothelioma, tuberculosis or asbestosis. Chest surgery or trauma. A blood clot in your lung (pulmonary embolism). Inflammatory bowel disease. Sickle cell disease. Certain medications, including hydralazine, isoniazid and procainamide. Is pleurisy contagious? (Context 14)

[9] Treatment is based on the nature of the effusion and underlying condition. Feller-Kopman D, Light R. Pleural Disease. N Engl J Med. 2018 Feb 22;378(8):740-751. https: ... drug-induced pleural effusion; recent ovarian stimulation treatment; chylothorax; Full details. (Context 15)

[10] Steroid medication is used to relieve pain and reduce inflammation or swelling associated with pleurisy. This treatment option is often prescribed for patients with inflammatory bowel disease, sickle cell disease, or those experiencing a blood clot in their lung (pulmonary embolism). (Context 10)

[11] Pleural diseases remain a common and challenging clinical problem. With an estimated 1.5 million new pleural effusions diagnosed annually in the United States, the incidence approaches that of diabetes (1.8 million new diagnoses annually) and eclipses that of congestive heart failure (400,000 new diagnoses annually). (Context 11)

[12] Pleural space diseases such as recurrent pleural effusion and pneumothorax inflict a significant symptomatic burden on patients. Treatment includes non-steroidal anti-inflammatory drugs (NSAIDS) and opioids if pain is severe. There is no reduction in level of inflammatory pleural symphysis development with the use of NSAIDS, as had previously been thought. (Context 12)

[13] Kheir F, Shawwa K, Alokla K, Omballi M, Alraiyes AH. Tunneled pleural catheter for the treatment of malignant pleural effusion: a systematic review and meta-analysis. Am J Ther 2016;23(6):e1300-e1306. (Context 13)

The differential diagnosis of pleural disease encompasses a wide range of conditions that can cause an abnormal collection of fluid in the pleural space, known as pleural effusion.

Common Causes

According to various studies [1][4][8], the most common causes of pleural effusion include:

• Congestive heart failure
• Cancer (malignant pleural effusion)
• Pneumonia
• Pulmonary embolism

These conditions can lead to an accumulation of fluid in the pleural space, which can be detected through imaging studies such as chest radiography or computed tomography (CT) scans [7][11].

Other Differential Diagnoses

In addition to the common causes mentioned above, other differential diagnoses for pleural effusion include:

• Transudative effusions: caused by conditions such as heart failure, cirrhosis, and nephrotic syndrome
• Exudative effusions: caused by conditions such as pneumonia, pulmonary embolism, and malignancy
• Parapneumonic effusions: caused by complications of pneumonia, such as empyema or abscess formation
• Tuberculous effusion: caused by tuberculosis infection

These differential diagnoses can be made based on a combination of clinical presentation, imaging studies, and pleural fluid analysis [3][5].

Importance of Accurate Diagnosis

A delayed or inaccurate diagnosis of the underlying cause of pleural effusion can lead to increased morbidity and mortality. For example, if a patient develops a pulmonary empyema as a complication of pneumonia, prompt recognition and treatment are essential to prevent further complications [2].

In conclusion, the differential diagnosis of pleural disease is complex and requires a thorough evaluation of clinical presentation, imaging studies, and pleural fluid analysis.

References:

[1] A pleural effusion is an abnormal collection of fluid in the pleural space resulting from excess fluid production or decreased absorption or both. It is the most common manifestation of pleural disease, with etiologies ranging from cardiopulmonary disorders to symptomatic inflammatory or malignant diseases requiring urgent evaluation and treatment.

[2] A delayed etiological diagnosis can be associated with markedly higher morbidity and mortality, e.g., if the patient develops a pulmonary empyema on the basis of a parapneumonic effusion.

[3] Many pleural fluid tests are useful in the differential diagnosis of exudative effusions. Other tests helpful for diagnosis include helical CT scans and MRI imaging.

[4] The differential diagnosis of pleural effusion includes the following: Transudative Effusions: Cardiovascular: Common causes include congestive heart failure, cirrhosis, and nephrotic syndrome.

[5] Pleural effusions were classified into the following five categories: transudative, malignant, parapneumonic, tuberculous, and other.

[7] Most patients presenting with pleuritic chest pain will require imaging with chest radiography to fully define their diagnosis. If pleural fluid is seen on a chest radiograph, the fluid can be analyzed for diagnostic purposes.

[8] The most common causes of pleural effusion include congestive heart failure, cancer (malignant pleural effusion), pneumonia, and pulmonary embolism.

[11] To assess for paralysis or other abnormalities in the diaphragm or surrounding structures, coronal (or sagittal) plane dynamic T2-weighted MRI imaging can be used.