Pleural Surgery

• Pleurectomy:

  • cutting at the pleural and stripping it away
  • when its taken off, the raw bit will stick the lung to the chest wall and obliterate the pleural space

  
• Pleurodesis:

  • irritating the pleura with chemical substance that has been put between 2 pleura in pleural space to cause inflammation and sticking them together
  • this also makes the pleural sticky, sticking the lung to the chest wall
• Indications for Pleural Surgery:

  • Recurrent or malignant pleural effusion
  • Recurrent pneumothorax
  • Empyema - infected material sitting between the 2 pleura, treated via antibiotics inserted to stop fibrotic change
  • Pleural mesothelioma - happens in patients who have had asbestos exposure
• Pleural Effusion:

  • Collection of fluid in pleural space
  • exudate - inflammatory fluid causing effusion
  • malignant - carcinogenic (having the potential to cause cancer)
  • blood - chest trauma and/or pneumothorax can cause bleeding into pleural space
  • Small - pigtail drain used, but can get blocked
  • Large - underwater sealed drain used, also indicates when negative pressure is reinstated in thoracic space
  • Accurate measure of drainage
  • Recurrent or malignant effusion - pleurodesis for management

  
• Pneumothorax:

  • Air in thoracic space
  • Small Pnx will spontaneously resolve itself 2/52
  • Large Pnx needs intervention:
  • intercostal drain +/- suction
  • Over sew of lung
  • pleurodesis
  • pleurectomy

  
• Empyema:

  • Collection of infected material within the pleural space
  • Often encapsulated - fibrotic tissue causes adherence to inside on chest wall
  • Small - pigtail drain
  • Large - intercostal drain +/- suction
  • Surgery – decortication and pleurodesis

  
• Mesothelioma:

  • Mesothelium is the sac that lines and protects organs e.g. heart and lungs
  • Pleural Mesothelioma is cancer of this lining around lungs and thorax
  • Associated with asbestos exposure
  • Treated with decortication and pleurectomy