Pleural Space Disease

• Abnormalities within the pleural space may include pleural effusion, pneumothorax, or space-occupying soft tissue structures (diaphragmatic hernia, neoplasia). • A diagnostic thoracocentesis may also prove therapeutic in severely affected patients. • Fluid analysis and cytologic evaluation should always be performed on aspirates from a patient with newly diagnosed pleural effusion of unconfirmed etiology. • Aerobic and anaerobic culture and susceptibility testing of suppurative effusions are imperative. • Comparison of pleural fluid and serum triglyceride levels and cholesterol concentrations are necessary to confirm the diagnosis of chylothorax. • Clinical evidence of cardiovascular shock often precedes dyspnea in patients with hemothorax. • Tension pneumothorax, regardless of its origin, rapidly may be fatal. Immediate drainage via thoracocentesis or thoracostomy tube placement is required before taking thoracic radiographs. • Clinical signs of a traumatic diaphragmatic hernia may be delayed; however, early detection and correction are important because perioperative outcome is worse in chronically affected patients. • Tools such as ultrasonography, computed tomography (CT), and thoracoscopy are becoming increasingly available to aid in the diagnostic evaluation and treatment of pleural space disease.