The pleura are twin layers of serous membranes surrounding the lungs and lining the chest cavity. Any disease affecting these membranes or the pleural space between them can be considered a pleural disease. Some of the most common pleural diseases include pleurisy, pneumonia, pneumothorax, pleural effusion, mesothelioma and tuberculosis. This article discusses several important pleural conditions, their causes, symptoms and treatment options.

Pleurisy

Pleurisy, also known as pleuritis, is inflammation of the pleural membranes. It usually occurs as a result of pneumonia or pulmonary embolism but can also be seen in rheumatic diseases. The most prominent symptoms are chest pain that worsens with breathing or coughing. Physical examination may reveal decreased breath sounds on the affected side. Pleurisy is generally not life-threatening and treatment focuses on addressing the underlying cause with antibiotics, anti-inflammatories or other medications depending on the condition. Pain control and rest are also important.

Pneumothorax

A pneumothorax is an abnormal collection of air in the pleural space between the lung and chest wall. There are two main types - spontaneous which occurs for no obvious reason, or traumatic from an injury. Risk factors include smoking, lung disease or previous thoracic surgeries. Symptoms include sharp chest pain, shortness of breath and a cough. A chest x-ray can diagnose it. Treatment ranges from simple observation for a minor pneumothorax to chest tube insertion for larger cases. Surgical procedures like pleurodesis or pleurectomy may be needed for recurrent pneumothoraces.

Pleural Effusion

A pleural effusion occurs when excessive fluid accumulates in the pleural space, preventing the lungs from fully expanding. Common causes are heart failure, liver disease, infections and cancers. Patients experience dyspnea, chest pain and cough. Diagnosis is established via physical exam, chest x-ray or ultrasound showing a pleural fluid collection. Thoracentesis is done to obtain a fluid sample for analysis. Treatment involves identifying and managing the underlying problem, along with draining very large effusions. Repeated drainages may require pleurodesis.

Mesothelioma

Mesothelioma is a rare but aggressive form of cancer closely associated with asbestos exposure. It develops in the pleura or pericardium. Early symptoms are nonspecific but include chest wall pain, shortness of breath, fatigue and weight loss. Diagnosis requires tumor tissue analysis since symptoms mimic other pleural diseases. Staging helps determine the extent of disease spread. Treatment options range from surgery, chemotherapy to radiation therapy depending on the stage. Prognosis is typically poor even with aggressive treatment. Preventive measures focus on controlling asbestos exposure in high-risk occupations.

Tuberculosis

Tuberculosis or TB is a bacterial infection caused by Mycobacterium tuberculosis which primarily affects the lungs. Pulmonary TB is the most common form but TB can also spread to involve the membranes surrounding the lungs (pleura), called tuberculous pleurisy. Symptoms include cough with sputum or blood, chest pain, fever, night sweats and weight loss. Diagnostic tests for active TB include a tuberculin skin test, sputum cultures, blood tests or chest x-ray. Treatment involves a combination of antibiotics taken for at least 6-9 months. Proper treatment minimizes risks of development of multidrug resistant TB strains. Control strategies focus on early detection, contact tracing and treatment adherence.

In summary, the pleura can be involved in infections, inflammatory diseases as well as pulmonary and systemic illnesses. A high index of suspicion and appropriate diagnostic tests help identify the underlying pleural condition. Management is aimed at treating the cause and alleviating symptoms. Outcomes depend on early diagnosis and effective therapies. Further research continues to improve diagnostic methods and treatments for this important group of respiratory diseases affecting the chest cavity lining.