Unexpandable lung from pleural disease

Abstract

Unexpandable lung is a common complication of malignant pleural effusions and inflammatory pleural diseases, such as pleural infection (e.g. empyema and complicated parapneumonic effusion) and noninfectious fibrinous pleuritis. Unexpandable lung due to pleural disease may be because of an active pleural process, and is referred to as malignant or inflammatory lung entrapment. An unexpandable lung may also be encountered in the setting of remote pleural inflammation resulting in a mature fibrous membrane overlying the visceral pleura preventing full expansion of the lung. This condition is termed trapped lung and may be understood as a form of defective healing of the pleural space. Trapped lung typically presents as a chronic, stable pleural effusion without evidence of active pleural disease. An unexpandable lung most often manifests itself as an inability of fully expanding the lung with pleural space drainage. Patients will either develop chest pain preventing complete drainage of the pleural space or develop a postprocedure pneumothorax. Pleural manometry and radiological imaging are useful in the assessment of an unexpandable lung. Pleural manometry can demonstrate abnormal lung expansion during drainage and imaging will demonstrate abnormal visceral pleural thickening found in trapped lung or malignant and inflammatory lung entrapment.

Pleural Pressure Pulse in Patients with Pleural Effusion: A New Phenomenon Registered during Thoracentesis with Pleural Manometry

“…The ability of the lung to re-expand after pleural fluid withdrawal can be reliably assessed by measuring pleural pressure (P pl ) during thoracentesis. Thus, pleural manometry has been increasingly used to assess local abnormalities of lung mechanics in patients with pleural effusion (PE) [8][9][10]. While performing pleural manometry, we found that the pleural pressure curve showed oscillations resembling the pulse tracing line.…”

Pleural manometry–historical background, rationale for use and methods of measurement

“…Consequently, the set consisting of a small-bore catheter, a pressure transducer and a urodynamics computer was used for continuous measurements of pleural pressure during fluid drainage. Interestingly, Table 1 Brief characteristics of three major patterns of pleural pressure changes during therapeutic thoracentesis [6,12,14,15,28,30].…”

“…It should be emphasized that pleural manometry is the only method to calculate pleural elastance and evaluate lung expandability. These data are crucial in predicting the risk of unsuccessful pleurodesis [2,6,[9][10][11][12][13][14]. More data on the usefulness of pleural manometry in clinical practice were presented in a comprehensive review published recently [15].…”

Non-expandable lung: an underappreciated cause of post-thoracentesis basilar pneumothorax

“…2 The pleural aetiologies can be separated into lung entrapment and trapped lung. 3 Both lung entrapment and trapped lung are associated with the development of pleural effusion; however, the pathophysiology of these two conditions is different. Lung entrapment occurs in the setting of an active pleuropulmonary process, such as pneumonia, pleurisy or pleural malignancy.…”