Pleural diseases are conditions which affect the pleura. The pleura is a thin tissue that lines the outside of the lungs and on the inside of the chest wall. There is usually only a very thin layer of fluid in healthy normal people between the two layers of 1-10mL and this occupies minimal space between the two layers of pleura. When there are abnormalities or pathology in the pleura, this usually manifests in the space between the two layers expanding (e.g., with fluid, air or blood).
In Australia, pleural disease affects 60,000 people every year. Pleural disease encompasses a wide range of conditions, including:
One of the most common type of pleural diseases that is encountered that often results in a hospital admission is pleural effusions. Pleural effusion occurs when abnormalities or pathology in the pleura, can disturb the healthy balance of fluid and can result in increased fluid secretion and not enough reabsorption of fluid. There are multiple difference conditions which can cause fluid in the pleural space, including heart failure, infection, cancers or autoimmune conditions.
Common symptoms of pleural effusion include:
To confirm the presence of a pleural effusion, you doctor will perform a detailed history and physician examination, and may organize further investigations, including a CT chest and chest ultrasound for you to further characterize your effusion size and whether it is safe to drain.
At Sydney West Respiratory and Sleep Service, our doctors are skilled at pleural ultrasounds and we have on site bedside ultrasound service available through our practice, which is a non invasive, painless method way of assessing fluid on the lungs, without requiring radiation.
Pleural effusions need drainage when they require a diagnosis to be made, or when they are large enough to cause symptoms. If the diagnosis cannot be made from drainage of the effusion, a biopsy of an area of pleural thickening or nodularity may also need to be performed to ascertain the cause of the pleural disease.
The type, size and cause of your pleural effusion will determine the treatment you require. Your doctor will guide carefully through the investigation process and treatment options once the cause is identified.
If you have a recurrent pleural effusion caused by cancer that is causing you to be breathless, your doctor may recommend that you have an indwelling pleural catheter.
An IPC is a new and innovative device that acts as a long-term drain in the chest, utilising a thin flexible tube that is inserted into your pleural space with the other end sitting outside your body. It has a one-way valve, to prevent leakage of fluid when you are not being drained. This is a long-term device that can be used to manage recurrent pleural effusion in the comfort of your own home. Community nurses will assist with draining your pleural effusion into a vacuum bottle regularly, to help you improve your symptoms without repeated needles into the chest, invasive surgery or prolonged hospital stays. Indwelling pleural catheter has been shown to reduce hospital stays and improve quality of life.
Our doctors are experienced in the management of pleural disease and pleural effusions, and are skilled at the insertion of indwelling pleural catheter insertion, its aftercare and long term management. Both Dr Roy and Dr Wu have admitting rights at Westmead Hospital and routinely perform pleural procedures, including IPC insertions here. We provide a comprehensive and holistic pleural service, and will guide you from the initial investigation process, advise you on how best to manage your pleural effusion and assist you through any aftercare that you may require. We work closely with radiologists, cardiothoracic surgeons, oncologists and community nurses to ensure you receive the best possible care for your pleural disease and effusion.
