19 Problems that affect the integrity of the pleura or movement of the chest wall will impact on the patient’s ability to move sufficient air in and out of the lungs, thereby reducing the supply of oxygen to the tissues and carbon dioxide removal. This chapter explores some common pleural diseases. The pleura is a thin double-layered membrane covering the surface of the lungs (visceral layer), and the inside of the chest wall and thoracic surface of the diaphragm (parietal) (Figure 19.1). The pleural cavity is a potential space between the two layers, containing a small amount of fluid to reduce friction. As the parietal pleura is adherent to the chest wall, it moves with the wall during inspiration. The very small amounts of intrapleural fluid are bound by intramolecular forces, so the visceral pleura and lung tissue move with the chest wall, increasing the space within the thorax for air to flow into the lung (inspiration). Pleural fluid is formed, then drained through the lymphatics, with a balance of formation and reabsorption to maintain homeostasis and lung function. Some disorders affecting the pleura are identified in Table 19.1. The British Thoracic Society (2010) have issued guidelines for the management of pleural diseases that can be accessed from https://www.brit-thoracic.org.uk.1 This consists of an excess of fluid in the pleural space; parts of the lung collapse leading to decreased lung compliance, increased work of breathing and hypoxaemia (Figure 19.2). Common causes are identified in Table 19.2, with pleural fluid classified as transudate or exudate, according to whether the fluid originates from within the lung tissue, or from circulatory problems.2
Breathing problems: pleural disorders
The pleura
Pleural effusion
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