The pleura is a thin, double-layered membrane that surrounds each lung and lines the chest cavity. It exists in two layers - the visceral pleura which wraps directly around each lung, and the parietal pleura which lines the inner chest wall. These two layers come together at the lung edges. The pleura helps reduce friction as the lungs expand and contract during breathing by acting as a lubricated surface. Any damage, infection or inflammation of this membrane can result in pleural enffusion.
Pleural Effusion
One of the most common pleural diseases is pleural effusion, which occurs when excessive fluid collects in the pleural space between the two pleural layers. This happens when there is an imbalance between the amount of fluid produced by the lungs or chest vs the amount drained by the lymphatic system. Fluid buildup puts pressure on the lungs and hampers their ability to fully expand during breathing. Some common causes of pleural effusions include congestive heart failure, pneumonia, cancer metastasis and cirrhosis of the liver. Patients experience symptoms like chest pain, cough, shortness of breath and fatigue. Diagnosis involves a physical exam, chest x-ray and thoracentesis procedure where a needle is used to draw out fluid for analysis. Treatment targets the underlying cause and may involve medications, drainage procedures or surgery.
Pleurisy
Inflammation of the pleura membrane is known as pleurisy. It commonly results from viral or bacterial infections like pneumonia, tuberculosis or diseases like lupus. Patients experience chest pain that worsens with breathing or coughing. The pain is sharp and localized to one spot. A physical exam and listening to the lungs with a stethoscope can reveal rub-like sounds as the inflamed layers rub against each other during breathing. Diagnosis is confirmed with imaging tests and blood work. Mild cases are treated with pain relievers while severe cases involving infections need antibiotics. Removing any fluid buildup via thoracentesis also helps relieve pain and pressure.
Pneumothorax
A pneumothorax occurs when air leaks into the pleural space between the two pleural layers, causing the lung to collapse. It can happen spontaneously due to underlying lung conditions or as a result of trauma to the chest. Smoking increases risk of spontaneous pneumothorax as does having tall, thin body type. Symptoms include sudden onset sharp chest pain that gets worse with breathing, shortness of breath, rapid breathing rate and pale blue skin color. A chest x-ray confirms diagnosis by showing the collapsed lung. Treatment depends on severity - mild cases may only need rest, oxygen and pain meds while more serious ones require a chest tube to drain air or surgery to repair any ruptures in the lung lining. Recurrent pneumothorax becomes a chronic condition needing preventive strategies.
Mesothelioma
This rare type of cancer develops from mesothelial cells that make up the pleura membrane. While its exact cause is unknown, significant risk is associated with exposure to asbestos fibers either through occupational activities or environmental sources. Several decades often pass between asbestos exposure and tumor development. Mesothelioma commonly presents with nonspecific symptoms like chest pain, shortness of breath, weight loss and fatigue. Diagnosis involves medical history, physical exam, chest imaging and biopsy. Due to its aggressive nature and late detection, prognosis is often poor. Treatment combines surgery, radiation and chemotherapy to extend survival, though curing mesothelioma remains challenging.
Benign Pleural Tumors
Benign growths called pleural tumors can also arise from the pleura, though much less common than cancer. Examples include pleural lipomas that form from fatty tissue in the chest lining and fibrous pleural tumors composed of fibrous or scar-like cells. They are usually small, slow-growing masses that do not spread to other areas. People may incidentally notice the tumors on imaging tests performed for other reasons. Symptoms if any result from the tumor compressing surrounding tissues. Surgical removal is generally curative for symptomatic benign pleural growths. Regular follow-up is advised after surgery to check for recurrence.
In summary, the pleura is a protective membrane around the lungs vulnerable to diseases and disorders that impact breathing. Common conditions causing pleural disease range from infections to fluid/air buildup and even tumors. While mild cases heal with conservative measures, serious pathologies often require invasive management. A prompt diagnosis is key to effective treatment and relief from respiratory distress associated with these conditions affecting the delicate lining around the lungs.
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