Part 2 book “Principles of pulmonary medicine” has contents: Pleural disease, mediastinal disease, disorders of ventilatory control, disorders of the respiratory pump, lung defense mechanisms, tuberculosis and nontuberculous mycobacteria, acute respiratory distress syndrome, and other contents. | 15 Pleural Disease ANATOMY, 206 PHYSIOLOGY, 207 PLEURAL EFFUSION, 209 Pathogenesis of Pleural Fluid Accumulation, 209 Etiology of Pleural Effusion, 210 Clinical Features, 212 Diagnostic Approach, 212 Treatment, 214 PNEUMOTHORAX, 215 Etiology and Pathogenesis, 215 Pathophysiology, 216 Clinical Features, 217 Diagnostic Approach, 217 Treatment, 218 In moving from the lung to other structures that are part of the process of respiration, we next consider the adjacent pleura. In clinical medicine, the pleura is important not only because diseases of the lung commonly cause secondary abnormalities in the pleura, but also because the pleura is a major site of disease in its own right. Not infrequently, pleural disease is a manifestation of a multisystem process that is inflammatory, autoimmune, or malignant. This chapter discusses the anatomy of the pleura, followed by a presentation of several physiologic principles of fluid formation and absorption by the pleura and a discussion of two types of abnormalities that affect the pleura: liquid in the pleural space (pleural effusion) and air in the pleural space (pneumothorax). A comprehensive treatment of all the disorders that affect the pleura is beyond the scope of this text. Rather, this chapter aims to cover the major categories and give the reader an understanding of how different factors interact in producing pleural disease. The primary malignancy of the pleura, mesothelioma, is discussed in Chapter 21, which deals with neoplastic disease of the thorax. ANATOMY The term pleura refers to the thin lining layer on the outer surface of the lung (visceral pleura), the corresponding lining layer on the inner surface of the chest wall (parietal pleura), and the space between them (pleural space) (Fig. ). Because the visceral and parietal pleural surfaces normally touch each other, the space between them is usually only a potential space. It contains a thin layer of serous fluid coating the apposing surfaces. When air
