Diagnosis and management of pleural causes of unexpandable lung
- Richard W Light, MD
Richard W Light, MD
- Professor of Medicine
- Vanderbilt University School of Medicine
- David J Feller-Kopman, MD
David J Feller-Kopman, MD
- Professor of Medicine
- Johns Hopkins Hospital
Unexpandable lung is present when the lung is unable to expand to the chest wall and achieve visceral and parietal pleural apposition [1,2]. Full expansion of the lung can be prevented by inflammatory or fibrotic processes affecting the visceral pleura or by extrapleural processes such as endobronchial obstruction, chronic lung atelectasis, or processes that will increase the elastic recoil of the lung (ie, interstitial lung disease or lymphangitic carcinomatosis) .
Unexpandable lung usually comes to medical attention when removal of pleural fluid does not result in lung reexpansion. This may result in patients developing chest discomfort or the presence of a post-procedure pneumothorax.
The two types of pleural disease that result in unexpandable lung are lung entrapment and trapped lung. The diagnosis and management of these conditions will be reviewed here. The evaluation of pleural effusions, including those of undetermined etiology, the measurement of pleural pressures, and the physiology of excess pleural fluid production and accumulation are discussed separately. (See "Diagnostic evaluation of a pleural effusion in adults: Initial testing" and "Diagnostic evaluation of pleural effusion in adults: Additional tests for undetermined etiology" and "Diagnostic thoracentesis" and "Measurement of pleural pressure" and "Mechanisms of pleural liquid accumulation in disease".)
The two types of pleural disease that result in unexpandable lung are lung entrapment and trapped lung. Both of these processes are associated with the presence of pleural fluid.
●In lung entrapment, the lung cannot expand fully because of an active disease, such as malignancy or infection that restricts expansion of the lung and/or visceral pleura.
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- LUNG ENTRAPMENT
- Clinical, radiographic, and laboratory features
- - Recurrent symptoms after relief of dyspnea with thoracentesis
- - Inadequate improvement with pleural fluid removal
- TRAPPED LUNG
- Clinical and laboratory features
- Management of trapped lung
- SUMMARY AND RECOMMENDATIONS
- Lung entrapment
- Trapped lung