Pleural Diseases
The pleura (ploor´-uh) is the membrane that lines your chest (thoracic) cavity and covers your lungs. The layers of your pleura contain a small amount of fluid that acts as a lubricant as you breathe in and out. The space between the layers is called the pleural cavity.

Pleural effusion, which is excess fluid in the pleural cavity, is one of the most common problems seen by primary care physicians.

Some estimates report an incidence of one million cases of pleural effusion in the United States each year. 

Causes of Pleural Diseases
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Causes of Pleural Diseases

The causes of pleural disease depend upon what type of disease you have. 

  • Pleural effusion is excess fluid in the pleural cavity. The most common cause is congestive heart failure. Other causes include lung cancer, pneumonia, tuberculosis, liver disease, pulmonary embolism, lupus, and reaction to certain medications. 

  • Pleurisy is pain associated with inflammation of the pleural cavity. The most common cause is a viral infection, such as influenza. Other causes include bacterial and fungal infections, lung cancer, other diseases such as rheumatoid arthritis and mesothelioma, and reaction to certain medications. 

  • Pneumothorax is a buildup of air or gas in the pleural cavity around the lung that causes the lung to collapse. Chronic obstructive pulmonary disease, tuberculosis, and trauma are the most common causes. 

  • Hemothorax is a buildup of blood in the pleural cavity. Chest trauma is the most common cause, but lung and pleural cancer and chest or heart surgery can also cause a hemothorax. 
  • Pleural tumors are cancerous tissues in the pleural cavity. Sometimes, the cause is unknown. Other times, pleural tumors are cancers that have spread from other areas of the body. 
Symptoms of Pleural Diseases
Shortness of breath
Feeling that you cannot get enough air
Chest pain
Pain in your chest that is often worse with deep breathing, coughing, or laughing
Unexplained weight loss
Losing weight without trying
Fatigue
Feeling tired easily
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Symptoms of Pleural Diseases

Symptoms of pleural disease also depend upon what type of disease you have. 

  • Pleural effusion generally causes no symptoms and, by itself, is not serious.
  • Symptoms of pleurisy may include a sharp pain when breathing, shortness of breath, a cough, fever and chills, rapid breathing, unexplained weight loss, and sore throat followed by joint swelling and soreness.
  • Pneumothorax can cause a sharp pain that gets worse when you breathe deeply, chest tightness, fatigue, a fast heart rate, and a bluish skin color (cyanosis).
  • Symptoms of hemothorax may include chest pain, shortness of breath, respiratory failure, a fast heart rate, anxiety, and restlessness.
  • Pleural tumors are cancerous tissues in the pleural cavity and may cause shortness of breath, chest pain, general discomfort, cough, and unexplained weight loss.

If you have questions about your specific pleural disease, you can print these sample questions to use as a basis for discussion with your doctor. 

Pleural diseases include pleural effusion, pleurisy, pneumothorax, hemothorax, and pleural tumors.
Diagnosis and Treatment Options
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Diagnosis and Treatment Options

CT scan showing giant compressive malignant fibrous tumor of the pleura
CT scan showing giant compressive malignant fibrous tumor of the pleura

After taking a detailed medical history and performing a physical examination, your doctor may order any of the following: chest radiography (X-ray), computed tomography (CT scan), blood tests, etc.

For more information on these tests, visit our common diagnostic tests page. 
 
Your treatment will vary depending on the type of pleural disease you have. If you require surgery, you will need to consult with a cardiothoracic surgeon to determine your treatment options. 

Below are examples of treatment options for pleural diseases. Talk to your doctor about the treatment that is right for you.

Video-Assisted Thorascopic Surgery (VATS)

A minimally invasive alternative to open chest surgery that involves less pain and recovery time. After you receive a sedative, your surgeon will make tiny incisions in your chest and then insert a fiber-optic camera called a thorascope. Images from the thorascope will give the surgeon important information that will help guide the appropriate treatment.

A minimally invasive alternative to open chest surgery that involves less pain and recovery time. After you receive a sedative, your surgeon will make tiny incisions in your chest and then insert a fiber-optic camera called a thorascope. Images from the thorascope will give the surgeon important information that will help guide the appropriate treatment.

Thoracentesis

Using a needle or catheter that your surgeon inserts through your ribs in the back of your chest into your chest wall, the excess pleural fluid will be removed.

Using a needle or catheter that your surgeon inserts through your ribs in the back of your chest into your chest wall, the excess pleural fluid will be removed.

Pleurodesis

A procedure in which your surgeon will inject a chemical agent into your pleural space. The chemical will irritate the pleural layers and eliminate the chance for fluid buildup.

A procedure in which your surgeon will inject a chemical agent into your pleural space. The chemical will irritate the pleural layers and eliminate the chance for fluid buildup.

Treatment for mechanical problems (fluid, air, or blood) focuses mainly on removing the fluid, air, or blood from the pleural space, relieving the symptoms, and treating the underlying condition.
Recovery
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Recovery

Your recovery time will vary depending on the type of pleural disease you have and how it was treated.

Reviewed by: Robbin G. Cohen, MD, with assistance from John Hallsten and Travis Schwartz
August 2016 

Previously reviewed by: Rishindra Reddy, MD, and Jules Lin, MD 
 

Questions for Your Doctor
What type of pleural disease do I have?
Will my condition ever get better without treatment? Can it get worse?
What are my treatment options?
Will I need surgery?
What are the potential side effects of this treatment?
How often do you do the procedure that you’ve recommended for me?
What is the success rate for that specific procedure?
Will this treatment cure my disease or only manage my symptoms?
When should I seek medical attention if I am experiencing symptoms following surgery?
Will I have any restrictions after treatment? (activity, driving, etc)
Will I have to be out of work? If so, for how long?
Will I have to change my diet and/or lifestyle after treatment?
Will I have to take any long-term medications?
How likely is it that I will need additional treatment later?
If I want a second opinion, how would I get one?
The Society of Thoracic Surgeons

The STS mission is to advance cardiothoracic surgeons’ delivery of the highest quality patient care through collaboration, education, research, and advocacy.