Pleural diseases

Pleural diseases include:

• Pneumothorax
• pleurisy (P. sicca, P. exsudativa, P. tuberculosa and others)
• Asbestos pleurisy
• Malignant tumors such as pleural mesothelioma, pleural carcinomatosis (metastasis of e.g. breast carcinoma)
• Pleuraleffusion such as MB. Transsudate, exudate, malignant effusion...,
• Pleural empyema
• Hematothorax
• Chylothorax
• Pleural rash
• Synechiae
• Fibrothorax
• Pleural plaques

The incidence of pleural diseases is about 300 - 400 / 100,000 inhabitants.

In relation to Germany, this means about 250,000 diseases per year.

In Western countries, cardiac-related pleural diseases dominate, followed by infectious causes and malignant diseases. Alone 57 % of the patients hospitalised because of pneumonia develop pleural diseases, mostly in the form of effusion.

In developing countries, especially in Africa, tuberculous infections are the most common cause of pleural diseases.

In the apical region of the pleura are typically localized:

• Pneumothorax
• Pleural rind (in case of tuberculous genesis)

In the basal area of the pleura are typically localized:

• Pleural effusion
• Pleural rind (e.g., in cases of pleurisy).

Diffuse distribution is predominantly found in:

• Pleural carcinomatosis
• Mesothelioma
• Asbestos pleurisy

Diseases of the pleura express themselves through:

• Dyspnoea (especially under stress)
• thoracic pain during inspiration and expiration
• tracheal cough

The therapeutic measures for pleural disorders depend on the underlying disease. They consist of:

• Pleural puncture
• Pleural drainage
• Pleurolysis (surgical dissolution of adhesions of the pleura; mainly performed in cases of tuberculosis-related adhesions, but also in cases of empyema etc.)
• Pleurodesis (surgical procedure in which the pleura parietalis is connected to the pleura visceralis; used to prevent pneumothorax recurrence, pleural effusion recurrence, etc.)
• Pleurectomy (partial or complete surgical resection of the pleura visceralis with restriction of lung function due to adhesions of the pleura visceralis; is mainly used as a palliative measure for malignant diseases, but also for tuberculosis, recurrence of a pneumothorax, etc.)

1. Brüning R et al (2008) Multi-slice CT: A guide 294-297
2. Gerok W et al.(2007) The Internal Medicine - Reference Work for the Medical Specialist 409, 435, 473- 477, 1332
3. Herold G et al (2017) Internal Medicine 428-430
4. Kasper DL et al (2015) Harrison's Principles of Internal Medicine 1109, 1114, 1162, 1662, 1688, 1689, 1706, 1756,
5. Kasper DL et al (2015) Harrison's Internal Medicine 1343, 1355, 2012, 2101, 2102, 2103, 2617,
6. Köhler D et al (2010) Pneumology 182-192
7. Kroegel C et al (2014) Clinical Pneumology - The Reference Work for Clinics and Practices 476 - 489
8. Rodriguez-Panadero F et al (2013) Pleurodesis mechanisms. Bare Compass Pneumol 1. 91-98
9. Stoelben E et al (2018) Diagnosis and therapy of spontaneous pneumothorax and postinterventional pneumothorax AWMF Guideline No. 010-007