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. |