Pulmonary Self-Study Resources-Feller-Kopman, Pleural Disease, NEJM 2019

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The article from The New England Journal of Medicine discusses pleural disease, focusing on pleural effusions and pneumothorax. The pleural space, bordered by the visceral and parietal pleura, can be affected by conditions such as congestive heart failure, pneumonia, and cancer, leading to pleural effusions. Each year in the United States, over 1.5 million cases of pleural effusion and around 20,000 cases of spontaneous pneumothorax occur. Advances have been made in understanding pleural biology and in managing conditions such as parapneumonic effusions, empyema, and malignant pleural effusions.<br /><br />A pleural effusion involves fluid buildup in the pleural space, diagnosed via medical imaging and thoracentesis. Treatment often includes drainage, especially in conditions such as empyema. For infections, appropriate antibiotics based on local microbiology are critical. The British Thoracic Society recommends ultrasound to guide pleural interventions for better accuracy and fewer complications.<br /><br />Malignant pleural effusions, commonly resulting from lung, breast cancer, and lymphoma, have high morbidity and poor prognosis, with median survival ranging from 4 to 7 months. Management aims at palliating symptoms through pleurodesis or tunneled pleural catheters, tailored to whether the lung reexpansion occurs after drainage.<br /><br />For pneumothorax (air in the pleural space causing lung collapse), treatment varies from needle aspiration for stable cases to small-bore chest tubes for more severe or recurrent cases. Emphasis is shifting toward less invasive methods and accurately monitoring air leaks using digital devices.<br /><br />Future research may focus on improving diagnostic methods, pleurodesis compounds, understanding pharmacodynamics in the pleural space, and developing patient-centered approaches to treatment. Interdisciplinary collaboration remains essential for optimizing patient outcomes in pleural disease.

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Asset Type PDF

Curriculum Category Pleural Disease

Curriculum Subcategory Diagnostic and therapeutic procedures

Keywords

pleural disease

pleural effusions

pneumothorax

pleural space

congestive heart failure

empyema

malignant pleural effusions