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How is pleurisy treated?
External splinting of the chest wall and pain medication can
reduce the pain of pleurisy. Treatment of the underlying disease, of course,
ultimately relieves the pleurisy. For example, if a heart, lung, or kidney
condition is present, it is treated. Removal of fluid from the chest cavity (thoracentesis)
can relieve the pain and shortness of breath. Sometimes fluid removal can make
the pleurisy temporarily worse because without the lubrication of the fluid, the two inflamed pleural surfaces can
rub directly on each other with each breath.
If the pleural fluid shows signs of infection,
appropriate treatment involves antibiotics and drainage of the fluid. If there
is pus inside the pleural space, a chest drainage tube should be inserted. This
procedure involves placing a tube inside the chest under anesthesia. The
tube is then connected to a sealed chamber that is connected to a suction device
in order to create a negative pressure environment. In severe cases, in which
there are large amounts of pus and scar tissue (adhesions), there is a need for "decortication." This
procedure involves examining the pleural space under general anesthesia with a special
scope (thoracoscope). Through this pipelike instrument, the scar tissue, pus,
and debris can be removed. Sometimes, an open surgical procedure (thoracotomy) is required for more complicated cases.
In cases of pleural effusion that result from cancer, the
fluid often reaccumulates. In this setting, a procedure called pleurodesis is
used. This procedure entails instilling an irritant, such as bleomycin,
tetracycline, or talc powder, inside the space between the pleural layers in order to create
inflammation. This inflammation, in turn, will adhere or tack the two layers of pleura together as
scarring develops. This procedure thereby obliterates the space between the
pleura and prevents the reaccumulation of fluid.