Pleural Pathologies and Malignant Effusion

This chapter focuses on the diagnosis and treatment of pleural disorders such as pleural effusion, pneumothorax, and pleural tumors. While in the management of benign pleural effusions, effective treatment of the underlying disease is crucial, drainage and pleurodesis are the mainstay of treatment for patients with recurrent malignant effusion. Pneumothorax, either primary or secondary, is another common pleural pathology, which often requires surgical treatment in the form of air-leak closure and pleurodesis, commonly performed by video-assisted thoracoscopic surgery (VATS). Solid tumors of the pleura are rather rare findings. Whereas pleural fibroma usually shows a benign course of disease, malignant pleural mesothelioma (MPM) is one of the most aggressive and most difficult to treat tumors of the human body. Only few cancers have caused so much controversy as MPM. For now, trimodality treatment concepts including chemotherapy, followed by extirpative surgery (e.g., extrapleural pneumonectomy or lung-sparing pleurectomy/decortication) and postoperative high-dose radiation therapy, seem to be the most promising strategy.