Pleura: anatomy, functions and treatment

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The pleura is a vital part of the airways , whose function is to soften the lungs and reduce any friction that may occur between the lungs, chest, and chest cavity. The pleura consists of a two-layered membrane that covers each lung. The layers are separated by a small amount of a viscous lubricant known as pleural fluid .

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There are a number of conditions that can affect the pleura, including pleural effusion, collapsed lung, and cancer. When excess fluid builds up between the pleural membranes, various procedures can be used to drain the fluid or eliminate the space between the membranes.

The multiple form of the pleura is the pleura .

Anatomy

There are two pleurae, one for each lung, and each pleura is a single membrane that folds to form two layers. The space between the membranes (called the pleural space) is filled with a liquid lubricating fluid (called pleural fluid ).

The pleura consists of two separate layers :

  • The visceral pleura is a thin, slippery membrane that covers the surface of the lungs and penetrates the areas that separate the different lobes of the lungs (called the gate).
  • The parietal pleura is the outer membrane that lines the inner wall of the chest and the diaphragm (the muscle that separates the chest and abdomen).

The visceral and parietal pleura meet at the gate, which also serves as the entry point for the bronchi, blood vessels, and nerves.

The pleural space, also known as the intrapleural space, contains pleural fluid secreted by mesothelial cells. The fluid allows the layers to slide over each other as the lungs inflate and deflate during breathing.

Function

The structure of the pleura is important for breathing as it provides the lungs with the lubrication and cushioning they need for inhalation and exhalation. The intrapleural space contains 4 to 5 cubic centimeters of pleural fluid, which reduces friction when the lungs expand or contract .

The pleural fluid itself has a slightly sticky ability that helps to pull the lungs outward during inhalation instead of sliding over the chest cavity. In addition, the pleural fluid creates surface tension that helps maintain the position of the lungs against the chest wall.

The pleura also serves as a separator between other organs of the body, preventing them from affecting lung function and vice versa.

Because the pleura is autonomous, it can help prevent infection from spreading to and from the lungs.

Related conditions

Several conditions can damage the pleura or affect its function. Damage to the membranes or overload of the pleural fluid can affect the way you breathe and lead to adverse respiratory symptoms.

Pleuritis

Pleurisy is an inflammation of the pleural membranes. Most of the time it is caused by a viral infection, but it can also be the result of a bacterial infection or an autoimmune disease such as rheumatoid arthritis or lupus .

Inflammation of the pleura makes the surface of the membrane rough and sticky. They don't slide over each other, but stick together, causing a sharp stabbing pain with every breath, sneeze, or cough. The pain may be worse when you breathe in cold air or take deep breaths. It can also get worse when moving or changing positions. Other symptoms include fever, chills, and loss of appetite.

Pleural effusion

Pleural effusion is the accumulation of excess fluid in the pleural space. When this happens, breathing can be affected, sometimes significantly.

Congestive heart failure is the most common cause of pleural effusion, but there are many other causes, including lung trauma or lung cancer (in which effusion occurs in about half of all cases) .

The pleural effusion can be very small (found only on chest x-rays or CT scan) or large and contain several liters of fluid. Common symptoms include chest pain, dry cough, shortness of breath, difficulty breathing deeply, and persistent hiccups.

Malignant pleural effusion

A malignant pleural effusion is an effusion that contains cancer cells. It is most commonly associated with lung cancer or breast cancer that has metastasized (spread) to the lungs .

Mesothelioma

Pleural mesothelioma is cancer of the pleura that is usually caused by exposure to asbestos in the workplace. Symptoms include pain in the shoulder, chest, or lower back, shortness of breath, trouble swallowing, and swelling of the face and hands .

Pneumothorax

Pneumothorax , also known as a collapsed lung, can develop when air collects in the pleural space. It can be caused by a variety of reasons, including chest trauma, chest surgery, and chronic obstructive pulmonary disease (COPD). In addition to shortness of breath, there may be crepitus, an abnormal cracking sound under the skin of the neck and chest .

Spontaneous pneumothorax is the term used to describe the collapse of the lung for no apparent reason. Tall and thin male adolescents are at higher risk, although women can also be affected. Risk factors include smoking, connective tissue disorders, and activities such as diving and flying, in which the air pressure changes rapidly .

The pneumothorax often goes away on its own, but sometimes a thoracentesis may be necessary to remove trapped air in the pleural space.

Hemothorax

Hemothorax is a condition in which the pleural space fills with blood, usually as a result of trauma or breast surgery; in rare cases, hemothorax can occur spontaneously due to rupture of the vessel.

The main symptom of hemothorax is pain or a feeling of heaviness in the chest. Others include rapid heartbeat, shortness of breath, cold sweats, pale skin, and fever, all signs that require medical attention.

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