How Are Pleurisy and Other Disorders of the Pleura Treated?

Goals of Treatment

The goals of treatment are to:

• Remove the fluid, air, or blood from the pleural space
• Relieve symptoms
• Treat the underlying condition

Remove Fluid, Air, or Blood From the Pleural Space

If large amounts of fluid, air, or blood aren't removed from the pleural space, they may put pressure on your lung and cause it to collapse.

The procedures used to drain fluid, air, or blood from the pleural space are similar.

• During thoracentesis, the doctor inserts a needle or a thin, hollow, plastic tube through the ribs in the back of your chest into your chest wall. A syringe is attached to draw fluid out of your chest. This procedure can remove more than 6 cups of fluid at a time.
• When larger amounts of fluid must be removed, a chest tube may be inserted through your chest wall. The doctor injects a local painkiller into the area of your chest wall outside where the fluid is. He or she will then insert a plastic tube into your chest between two ribs. The tube is connected to a box that suctions the fluid out. A chest x ray is taken to check the tube's position.
• A chest tube also is used to drain blood and air from the pleural space. This can take several days. The tube is left in place, and you usually stay in the hospital during this time.
• Sometimes the fluid contains pus that is very thick or blood clots. Or it may have formed a hard skin or peel. This makes it harder to drain the fluid. To help break up the pus or blood clots, the doctor may use the chest tube to put certain medicines into the pleural space. These medicines are called fibrinolytics. If the pus or blood clots still don't drain out, you may need surgery.

Relieve Symptoms

For relief of pleurisy symptoms, your doctor may recommend:

• Acetaminophen or anti-inflammatory agents, such as ibuprofen, to control pain.
• Codeine-based cough syrups to control a cough.
• Lying on the painful side. This may make you more comfortable.
• Breathing deeply and coughing to clear mucus as the pain eases. Otherwise, you may develop pneumonia.
• Getting plenty of rest.

Treating the Underlying Condition

Looking at the fluid under a microscope can often tell the doctor what's causing the fluid buildup. Then treatment of the underlying condition can begin.

If the fluid is infected, treatment involves antibiotics and draining the fluid. If the infection is tuberculosis or from a fungus, treatment involves long-term use of antibiotics or antifungal medicines.

If the fluid is caused by tumors of the pleura, it may build up again quickly after it's drained. Sometimes antitumor medicines will prevent further fluid buildup. If they don't, the doctor may seal the pleural space. This is called pleurodesis.

In pleurodesis, the doctor drains all the fluid out of the chest through a chest tube. Then he or she pushes a substance through the chest tube into the pleural space. This substance irritates the surface of the pleura. This causes the two layers of the pleura to squeeze shut so there is no room for more fluid to build up.

Chemotherapy or radiation treatment also may be used to reduce the size of the tumors.

If congestive heart failure is causing the fluid buildup, treatment usually includes diuretics and other medicines.