Pleural Space Diseases

Pleural space diseases are conditions affecting the pleura.

The pleura are thin membranes that surround the lungs and line the inside of your chest cavity. They help the lungs move smoothly during breathing. Between the two layers of the pleura, there is a small space called the pleural cavity, which contains a microscopic amount of fluid. Pleural space diseases happen when fluid, air, blood or tissue builds up in the pleura, causing lung problems and difficulty breathing.

At WashU Medicine, expert thoracic surgeons and interventional pulmonologists work together to care for people with pleural space diseases. Our multidisciplinary team has the experience to treat even the most severe and complex cases, including pneumothorax, pleural effusion and pleural tumors.

What are the pleura?

The pleura are two thin layers of tissue that surround your lungs and line the inside of your chest cavity. Think of them as a protective lining that helps your lungs move smoothly every time you breathe.

There are two parts of the pleura:

• Visceral pleura: This layer covers the outside surface of the lungs.
• Parietal pleura: This layer lines the inside of the chest wall and diaphragm.

Between these two layers is a very small area called the pleural space. The pleural space normally contains a small amount of fluid that acts like a lubricant, allowing the lungs to expand and contract smoothly as you breathe.

The pleura play an important role in normal breathing. They help reduce friction and help the lungs move with the chest wall during inhalation and exhalation.

When disease, injury, or inflammation affects the pleura or pleural space, problems can develop. Fluid can build up around the lungs, air can leak into the pleural space, or the pleura can become inflamed. These conditions are known as pleural space diseases and may make breathing difficult or uncomfortable.

Understanding the pleura can help explain why conditions affecting the lining around the lungs can cause symptoms such as chest pain, shortness of breath, or cough.

What are the types of pleural space diseases?

Pleural space diseases are conditions that affect the pleura—the thin layers of tissue around the lungs—or the space between them. These conditions can develop because of infection, inflammation, injury, cancer, or other underlying medical conditions. Some pleural diseases cause fluid or air to collect around the lungs, while others affect the lining itself.

Below are some of the most common types of pleural space diseases.

Pneumothorax (Collapsed lung)

A pneumothorax, sometimes called a collapsed lung, occurs when air leaks into the pleural space. This air buildup can place pressure on the lung and prevent it from fully expanding, leading to symptoms such as sudden chest pain and shortness of breath.

Pleural effusion (Fluid around the lungs)

A pleural effusion occurs when excess fluid builds up in the pleural space. Often described as fluid around the lungs, pleural effusions can develop for many reasons, including infection, heart failure, cancer, or inflammation. Larger fluid collections may make breathing more difficult.

Pleural tumors

Pleural tumors are abnormal growths that develop in the pleura. Some tumors are benign (noncancerous), while others are malignant (cancerous). Tumors affecting the pleura may arise from the pleural tissue itself or spread from cancers elsewhere in the body.

Pleurisy (Inflammation of the pleura)

Pleurisy, also called pleuritis, occurs when the pleura become inflamed. This inflammation can cause sharp chest pain that often worsens with deep breathing, coughing, or sneezing. Pleurisy may develop because of infections, autoimmune diseases, or other medical conditions.

Other pleural space conditions

Other conditions can also affect the pleural space, including infections of the pleura, bleeding into the pleural space, and more complex disorders that may require specialized treatment. Accurate diagnosis is important because symptoms of pleural diseases can overlap.

Because many pleural space diseases can cause similar symptoms—such as chest pain, cough, or shortness of breath—your care team may use imaging tests and other evaluations to determine the cause and recommend the most appropriate treatment.

How are pleural space diseases diagnosed?

Diagnosing pleural space diseases begins with understanding your symptoms and medical history. Because many pleural conditions can cause similar symptoms—such as chest pain, cough, or shortness of breath—your care team may use several tools to determine the cause.

Evaluation often starts with a physical exam and a discussion about your symptoms, overall health, and medical history. Your doctor may then recommend imaging tests to look more closely at the lungs and pleural space.

Tests used to diagnose pleural space disease may include:

• Chest X-ray: Can help identify fluid around the lungs, a collapsed lung, or other abnormalities
• CT scan: Provides more detailed images of the lungs and pleura
• Ultrasound: May help detect fluid in the pleural space and guide procedures
• Laboratory testing: Blood tests or analysis of fluid samples may help identify infection, inflammation, or other causes
• Biopsy or specialized procedures: In some cases, additional testing may be needed to evaluate abnormal tissue or determine a diagnosis

The specific tests recommended will depend on your symptoms and the type of pleural condition being evaluated. Once a diagnosis is made, your care team can recommend the treatment approach that best fits your condition and needs.

How are pleural space diseases treated?

Treatment for pleural space diseases depends on the specific condition, its cause, and the severity of symptoms. Because pleural disorders can affect breathing and lung function in different ways, treatment plans are tailored to each patient’s needs.

Some pleural space conditions may improve with medication and monitoring, while others require procedures to remove fluid or air from around the lungs. In certain cases, surgery or specialized therapies may be recommended.

Treatment options for pleural space diseases may include:

• Observation and monitoring: Some mild conditions can be safely watched over time
• Medications: Treatment may include antibiotics, anti-inflammatory medications, or therapies that address an underlying condition
• Drainage procedures: Removing excess fluid or air from the pleural space can help relieve symptoms and improve breathing
• Minimally invasive procedures: Some conditions can be treated using image-guided or thoracoscopic techniques
• Surgery: More complex pleural diseases may require surgical treatment

The right treatment approach depends on an accurate diagnosis and a careful evaluation of your symptoms and overall health. Your care team will work with you to determine the most appropriate plan and discuss what to expect throughout treatment.

What are the potential risks and complications of pleural space diseases?

The risks and complications of pleural space diseases vary depending on the specific condition and how severe it is. Some pleural disorders cause mild symptoms and improve with treatment, while others can affect breathing and lead to more serious health concerns if left untreated.

Potential complications of pleural space diseases may include:

• Difficulty breathing: Fluid, air, inflammation, or abnormal tissue around the lungs can limit the lungs’ ability to expand normally
• Progressive symptoms: Chest pain, cough, or shortness of breath may worsen over time
• Infection: Some pleural conditions can become infected or develop as a result of infection
• Recurring pleural problems: Certain conditions, such as some pneumothoraces or pleural effusions, may return after treatment
• Reduced lung function: Ongoing pleural disease can affect how well the lungs work
• Complications related to underlying disease: In some cases, pleural conditions are associated with broader medical issues that also require treatment

Because symptoms of pleural space disease can overlap with many other lung and chest conditions, it is important to seek medical evaluation if symptoms persist or worsen.

Early diagnosis and treatment can often help prevent complications, improve symptoms, and support better long-term outcomes.