Pleural Diseases

Jonathan Puchalski, MD

Najib M. Rahman, DPhil, MSc, FRCP

Pleural diseases affect at least 1.5 million people throughout the world and are associated with significant morbidity and mortality. The current issue of Seminars in Respiratory and Critical Care Medicine addresses the profound impact these diseases have and highlights evolving concepts in key aspects of pleural pathology from global leaders in the field.

DeBiasi and Feller-Kopman review the physiologic consequences of pleural disease that explain the morbidity and potential mortality these individuals encounter. In addressing pneumothorax, Hallifax and Janssen discuss both primary and secondary pneumothorax while discussing current guidelines, the roles of conservative and surgical approaches, and the importance of shared decision making when managing these conditions. Toth, Reed, and Ventola expertly review the drainage devices available to manage air and fluid that develop around the lung. This article is spectacular for novices and experts alike. Additionally, Cameron, Teodoro, and Evison incorporate the need for understanding pleural physiology, air leaks, and an expanding need for pleural disease teams and sub-sub-specialists while discussing the role for pleural services.

Malignant pleural effusions obviously have a profound impact. Maldonado and Lee incorporate new guidelines into managing malignant pleural effusions in their concise review of these diseases that have significant mortality. Oh, Ronaghi, and Cai discuss molecular testing on pleural fluid specimens, as many specific interventions and guided therapy could not be possible without the expression of these crucial genes and markers. Furthermore, Kim, Sterman, and Haas describe current strategies employed when evaluating and treating malignant pleural mesothelioma. Finally, Lamb and Lee provide insight into current strategies that focus on pleurodesis for recurrent effusions.

This series of articles also focuses on pleural disease affecting women, the not-so-benign impact of empyema, and an article that offers insight into “outside-the-box” thinking about pleural disease. Argento and Gillespie articulate the unique diseases that affect women rather than men and the fascinating physiology underlying these problems. Godfrey, Bramley, and Detterbeck exhaustively review the approach to infections in the pleural space. Puchalski reviews some advanced or perhaps unconventional approaches to diagnosing and treating various aspects of pleural disease, including the “fire and ice” approaches, or heat and cool techniques available for use through the thoracoscope.

We would truly like to thank all of the contributors throughout the world who have made special contributions to this issue of Seminars. We believe this will provide insight into important diseases that will help patients in the next decade and beyond.