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Pleural Diseases: Pleurisy, Pleural Effusion, Hemothorax | Diseases and Conditions - Thoracic Surgery | BMC

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Thoracic Surgery
Diseases & Conditions
Pleural Diseases
Boston Medical Center's Division of Thoracic Surgery treats a broad range of conditions, including
pleural diseases. We combine medical excellence, technologically advanced facilities and equipment,
and a patient-centered approach to provide fast, accurate diagnoses and effective treatments.
What are Pleural Diseases?
The pleura is the membrane that lines your thoracic (chest) cavity and covers your lungs. It is a large
sheet of tissue that wraps around the outside of your lungs and lines the inside of your chest cavity.
There is a small space between the layers of the pleura, which contains a small amount of fluid that
serves as a lubricant for the two layers of the pleura. There are several types of pleural diseases,
including:
Pleurisy, an infection of the pleural cavity
Pleural effusion, the buildup of pleural fluid in the pleural cavity
Hemothorax, the presence of blood in the pleural cavity
Pleural tumors
Symptoms
Causes
Diagnostic Procedures
Treatment
What are the Symptoms?
Symptoms of pleural diseases vary based on the kind and severity. Typically, pleural effusion causes
no symptoms.
Symptoms of pleurisy may include:
Shortness of breath
A cough
Fever and chills
Rapid, shallow breathing
Unexplained weight loss
A sore throat that is followed by joint swelling and soreness

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Pleural Diseases: Pleurisy, Pleural Effusion, Hemothorax | Diseases and Conditions - Thoracic Surgery | BMC
A sore throat that is followed by joint swelling and soreness

Symptoms of hemothorax may include:

Chest pain
Shortness of breath
Respiratory failure
A rapid heart rate
Anxiety
Restlessness
Symptoms of pleural tumors may include:
Shortness of breath
Chest pain
General discomfort
Cough
Unexplained weight loss
What Causes Pleural Diseases?
Causes of pleurisy include:
Viral, bacterial and fungal infections
Lung cancer
Other lung diseases, such as carcoidosis, asbestosis, lymphangioleiomyomatosis and
mesothelioma
Pulmonary embolism
Familial Mediterranean fever
Parasites
Heart surgery
Chest injury, or trauma
Reaction to certain medications
Causes of pleural effusion include:
Congestive heart failure
Lung cancer
Pneumonia
Tuberculosis, asbestosis, sarcoidosis and reactions to medications
Causes of pneumothorax may include:
A bulla, which is a large distended air space
Lung diseases such as chronic obstructive pulmonary disease(COPD)
Tuberculosis
Surgery
Trauma
Causes of hemothorax include:
Chest trauma
Lung and pleural cancer
Chest or heart surgery
For some pleural tumors, the cause is unknown. Known causes of pleural tumors may include cancer
that has spread to the pleural space.
How are Pleural Diseases Diagnosed?

In addition to taking a detailed medical history and performing a physical examination, your surgeon
may order tests to detect pleural diseases, including:
Arterial blood gas analysis to measure how well your lungs transfer oxygen from the blood and
how well the lungs remove carbon dioxide
Biopsy is one way to obtain a sample of tissue, which is then examined under a microscope in
a laboratory. Your doctor will apply a numbing agent and will insert a needle between your ribs
and into the chest, guided by a CT scan or an X-ray.
Blood test
Chest X-rays provide an image of the heart, lungs, airways, blood vessels and bones in the
spine and chest area.
Computed tomography (CT) scans, which use X-rays to create two-dimensional images of the

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Pleural Diseases: Pleurisy, Pleural Effusion, Hemothorax | Diseases and Conditions - Thoracic Surgery | BMC
body, including lymph nodes. If contrast dye is used to improve the computer image, you may
need to avoid eating or drinking for four to six hours before the test. Be sure to tell your doctor
before the test if you have any allergies or if you have kidney problems.
Magnetic resonance imaging (MRI), which is a painless, radiation-free test that uses a
magnetic field, radiofrequency pulses and a computer to produce detailed images of body
structures in multiple places. You may be asked to drink a contrast solution for better imaging,
and you will most likely lie on a moving table as pictures are taken.
Positron emission tomography (PET) scans are used to detect cellular reactions to sugar.
Abnormal cells tend to react and "light up" on the scan, helping physicians diagnose a variety of
conditions. For the PET scan, a harmless chemical, called a radiotracer, is injected into your
blood stream. Once it has had time to move through your body, you lie on a table while a
scanner follows the radiotracer and sends three-dimensional images to a computer screen.
Patients are usually asked to wear comfortable clothing and not to eat for four hours before the
scan. Tell your doctor if you are pregnant or breastfeeding. Patients with diabetes should talk
with their physician about diet guidelines for the hours leading up to the scan
Stress test, which is used to gain information about how your heart functions during exercise.
Your physician will monitor your heartbeat and blood flow as you walk on a treadmill, and will
then be able to diagnose any problems and plan treatment.
Thoracentesis
Ultrasound

How are Pleural Diseases Treated?

After a careful evaluation of your condition, we will recommend the treatment that is appropriate to your
particular circumstances. Depending on the pleural condition and its cause, treatment may include:
Medications to relieve pleurisy symptoms, such as acetaminophen (Tylenol), ibuprofen
(Motrin), and codeine cough suppressants
Surgery or minimally invasive tumor removal
Tumor ablation, a minimally invasive technique in which radiofrequency, cold or heat energy
can be used to destroy cancer cells
Chemotherapy, or the use of medications injected into the bloodstream to kill cancer cells
Radiation therapy, or the use of high-energy X-rays and other sources of radiation to kill cancer
cells
Pleurodesis, in which a chemical is injected that seals the pleural space, eliminating the
chance for fluid buildup
Thoracostomy, in which your physician inserts a chest tube through your chest wall. After
injecting a local anesthetic into your chest wall where the fluid is located, your physician will
insert a plastic tube into your chest between two ribs. Your physician will then connect the tube
to a suction device, which will help to remove the fluid.
PleurX catheter, which is a thin, flexible tube that your surgeon will place in the pleural space to
drain the fluid accumulation associated with pleural effusion
Thoracentesis, which is the removal of pleural fluid with a needle or a catheter that your
surgeon inserts through your ribs in the back of your chest into your chest wall
Bullectomy, which is the removal of a bulla
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Fax: 617.638.7382

Boston Medical Center

Center for Thoracic Surgery
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830 Harrison Avenue, 3rd Floor
Boston, MA 02118

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