Introduction
This topic covers inflammation of the pleura (pleurisy, or pleuritis) and the tumours of the pleura. Pleural disease is nearly always secondary to a lung, cardiac or systemic problem; the main primary tumour is malignant mesothelioma.
Pleurisy: definition and causes
Pleurisy is inflammation of the visceral and/or parietal pleura. It is almost always secondary.
- Infection: spread from pneumonia (the commonest), lung abscess, bronchiectasis, tuberculosis, subphrenic abscess, or haematogenous spread.
- Non-infectious: pulmonary infarct, malignant tumour, rheumatoid arthritis, systemic lupus erythematosus, uraemia, trauma and radiation.
The type of exudate defines the form, and pleurisy may be dry (fibrinous) or effusive (with fluid).
Complications and outcome of pleurisy
- Resolution when the cause is treated and the exudate is absorbed.
- Organisation of the fibrin: adhesions between visceral and parietal layers (synechiae), obliteration of the pleural cavity and, in severe cases, a thick fibrous pleural encasement restricting the lung (fibrothorax), with possible calcification.
- Compression atelectasis of lung due to large effusion.
- Empyema with possible rupture into a bronchus (bronchopleural fistula) or through the chest wall, and sepsis.
Clinically: pleuritic pain, which eases when an effusion separates the layers, and a friction rub in the dry phase.