The pleura are anatomically and physiologically distinct structures. The pleural cavities are formed early during embryonic development from the intraembryonic coelom. Anatomically, the pleura are divided into two structures: the visceral and the parietal pleura. The visceral pleura lines the lungs and is intimately invested with the lung parenchyma. The parietal pleura lines the chest wall, diaphragm, mediastinum, and the superior portion of the lungs.
The pleura and pleural fluid production are tightly regulated anatomical and physiologic entities. The pleura function as serous membranes that line the lungs and chest wall by creating a sealed space between the lungs and atmosphere, allowing for the development of distinct intrathoracic pressures necessary for respiration and the production of pleural fluid. Pleural fluid serves as a lubricant as well as a mechanical coupler between the chest wall and the lungs during respiration. The pleural cavity is a potential space that exists until various pathologic processes interrupt the normal anatomy or physiology of the space, exposing the cavity. Air, excess pleural fluid, chyle, infections, and fibrous tissue are all potential pathologic entities that can disrupt the pleura and pleural space.
Patients presenting with pleural disorders often complain of a myriad of symptoms; however, most commonly patients will present with one or more of the following: dyspnea, chest pain, and cough. The history and physical examination help to differentiate the etiology of these symptoms. Questions that investigate the onset and duration of these symptoms, their character, and past medical and surgical history can all be illuminating. The physical examination is indispensable in investigating pleural diseases. Dullness or hyperresonance on percussion, decreased or increased tactile fremitus, breath sounds, and visual inspection of the chest wall and respiratory pattern can further refine the diagnosis.
Diagnosing pleural disorders often starts with a standard posteroanterior and lateral chest x-ray. The lungs, chest wall, and mediastinum are visualized, and if a pathologic process occurs, the pleural cavity is also visualized. More advanced visualization techniques such as a computed tomography (CT) scan and ultrasound may be necessary to further define the process. In some cases, invasive techniques (i.e., thoracentesis in pleural effusions) are required to finalize a diagnosis.
Benign pleural disorders are a diverse group of diseases that require complex management and often a combination of both medical and surgical approaches. For example, for pneumothoraces, conservative management involves evacuating the pleural space. If conservative management fails or there is worsening of the disease or recurrence, the patient proceeds to surgical therapy. Conservative management attempts to decrease the disruption within the pleural space and treat the underlying cause. Surgery is often reserved for refractory cases or patients with contraindications to conservative management.
Outcomes and prognosis
The term “benign” is misleading in describing nonmalignant pleural disorders. If left untreated or not properly treated, these diseases can lead to significant morbidity and even mortality. Some disease processes do recur and ultimately require more extensive surgical management or chronic conservative treatment. ...
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessSurgery Full Site: One-Year Subscription
Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.
Pay Per View: Timed Access to all of AccessSurgery
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.