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Pleura clinic:

The chest (thoracic or pleural) cavity is a space that is enclosed by the spine, ribs, and sternum (breast bone) and is separated from the abdomen by the diaphragm. The chest cavity contains the heart, the thoracic aorta, lungs and esophagus (swallowing passage) among other important organs. The wall of the chest cavity is made up of the rib cage and diaphragm. The chest cavity is lined by a thin shiny membrane called the pleura, which covers the inside surface of the rib cage and spreads over the lungs as well. Normally, the pleura produces a small amount of fluid which serves as a lubricant to the lungs as they move back and forth against the chest wall during respiration.  

A variety of conditions involve the pleura and pleural cavity, each with different causes, symptoms, and treatments.

Types of Pleural Diseases

Hemothorax: Accumulation of blood in the pleural cavity.

Causes: Most chest trauma; other causes include lung/pleural cancer and chest/heart surgery

Symptoms: Chest pain, shortness of breath, anxiety/restlessness, increased heart rate, respiratory failure if large

Pleural effusion: Accumulation of excess fluid in the pleural cavity; this accumulation pushes against the lung and prevents full expansion with breathing. This is one of the most common problems associated with the pleura.

Causes: Congestive heart failure, lung cancer, pneumonia, tuberculosis, liver disease, pulmonary embolism, lupus, adverse reaction to specific medications

Symptoms: May be asymptomatic (no symptoms), or produce shortness of breath and cough

Empyema: The accumulation of pus in the pleural cavity. This is a type of pleural effusion that is usually associated with pneumonia (an infection in the adjacent lung). The symptoms are those of the pneumonia (cough, fever) in addition to shortness of breath and impaired breathing.

Pleural tumors: Malignant tumors arising from the pleura (e.g. mesothelioma) or spreading to the pleura (metastatic) from another site, and benign tumors arising from the pleura.

Symptoms: Shortness of breath, chest pain, cough, unexpected weight loss

Pleurisy: Inflammation of the pleura

Causes: Infection of the respiratory system by a virus or bacteria, leak of air into pleural cavity from a punctured lung, chest injury, tuberculosis or other infection, tumor in the pleural cavity, rheumatoid arthritis, lupus, sickle cell crisis, pulmonary embolism, pancreatitis, complications from heart surgery

Symptoms: Chest pain on taking a deep breath, shortness of breath, fever and/or chills, joint swelling and/or soreness, unexpected weight loss

Pneumothorax: Accumulation of air within the pleural cavity between the outside of the lung and the inside of the rib cage.

Causes: Injury to the lung causing a leak of air, chronic obstructive pulmonary disease or other lung disease, tuberculosis, ruptured air blisters (blebs), mechanical ventilation

Symptoms: Shortness of breath, rapid breathing, chest pain when taking a deep breath (pleurisy), cyanosis (bluish discoloration of the skin), respiratory distress if large

Pleural disease may be suspected on the basis of a medical history and findings on a physical examination. It is confirmed with a chest x-ray, which shows the interior of the chest cavity, and a CT scan—a series of images of the inside of the body, taken from different angles and depths, to reveal a high level of detail. To ensure that the blood vessels and organs show up clearly in these scans, dye may be swallowed or injected into a vein during performance of the scan. Certain blood tests may also be useful in determining the cause and severity of the pleural disease. Video assited thoracoscopy (VAT); using key hole opening in the chest wall to visualize the pleural and biopsy it. 

The treatment of pleural disease is dictated by the condition and may vary from just treating the underlying cause, placement of a chest tube to evacuate air, draining fluid with a needle (thoracentesis) or a chest tube, or opening the chest to remove the diseased pleura (decortication).

Abrading the pleural surface or injecting a material to achieve adherence of the lung to the chest wall may be required for recurrent pneumothorax or malignant pleural effusion using thoracoscopy.

What Are Mediastinal Tumors (Neoplasms)?

The mediastinum is the area in the middle of the chest that lies between the sternum (breastbone) and spinal column. The area contains vital organs including the heart, esophagus, and trachea.

Mediastinal tumors develop in one of three areas of the mediastinum: the anterior (front), the middle, or the posterior (back). The position of the tumor in the mediastinum typically depends on patient’s age.

Children are more likely to develop them in the back of the mediastinum. These are often benign, or noncancerous. Adults are more likely to develop them in the front of the mediastinum. These tumors are typically cancerous. Affected adults are usually between the ages of 30 and 50. As a whole, mediastinal tumors are very rare.

What Causes Mediastinal Tumors?

There are a number of different types of mediastinal tumors. What causes these tumors depends on where they form in the mediastinum.

 In the front of the mediastinum, tumors can be caused by:

  • lymphoma, including Hodgkin’s disease and non-Hodgkin’s lymphoma
  • thymoma and thymic cyst (a tumor of the thymus)
  • thyroid mass mediastinal (generally a benign growth, but it can sometimes be cancerous)

In the middle of the mediastinum, tumors can be caused by:

  • bronchogenic cyst (a benign growth that starts in the respiratory system)
  • lymphadenopathy mediastinal, or enlargement of the lymph nodes
  • pericardial cyst (a benign growth on the heart lining)
  • thyroid mass mediastinal
  • tracheal tumors (usually benign growths)
  • vascular complications, such as swelling of the aorta

In the back of the mediastinum, tumors can be caused by:

  • extramedullary haematopoiesis (rare growths that start in the bone marrow and are related to severe anemia)
  • lymphadenopathy mediastinal (enlarged lymph nodes)
  • neuroenteric cyst mediastinal (a rare growth involving both the nerves and the gastrointestinal system)
  • neurogenic neoplasm mediastinal (cancerous cells of the nerves)

Neurogenic neoplasm mediastinal is the most common cause of posterior mediastinal tumors. 

Symptoms of a Mediastinal Tumor

If you have a mediastinal tumor, you may not have any symptoms. Tumors are typically found during a chest X-ray that was ordered to diagnose another health condition.

If symptoms develop, it’s often because the tumor is pushing on surrounding organs. Symptoms can include:

  • cough
  • shortness of breath
  • chest pain
  • fever/chills
  • night sweats
  • coughing up blood
  • unexplained weight loss
  • swollen lymph nodes
  • respiratory blockage
  • hoarseness

How Are Mediastinal Tumors Diagnosed?

If you have symptoms of a mediastinal tumor, your doctor will order additional tests to confirm your diagnosis. These tests may include:

  • a chest X-ray
  • a CT scan of the chest
  • an MRI of the chest
  • a mediastinoscopy with biopsy; through a small incision under the breastbone.
  • Video assited thoracoscopy (VATs); using key hole opening in the chest wall.
  • Endobronchial ultrasound (EBUS); sampling of mediastinal lymph glands using a needle through bronchoscopy guided by ultrasound.

How Are Mediastinal Tumors Treated?.

Treatment for mediastinal tumors will depend on their location and will be determined by your doctor. Surgery is often used first to remove the tumor. Once the tumor is removed, your doctor may use chemotherapy and/or radiation therapy to destroy remaining cancer cells.

What Complications Are Associated with Mediastinal Tumors?

Both benign and malignant tumors require treatment. As benign tumors grow, they’ll push against surrounding organs and tissues and can affect organ function. Cancerous tumors can spread to other areas of the body. Tumors that invade the heart or the vessels of the heart can lead to death. It may invade the spinal column as well.

Welcome to the Vein Center with specialist treatment.

We offer comprehensive and Patient-centric approach for treatment of all types of varicose veins, spider veins, venous reflux and chronic venous disease.
Some of the services our highly dedicated team of specialists provides are:Vein Center with specialist treatment

  • Endovenous Laser Treatment (EVLT)
  • VenaSeal Closure procedure
  • Foam sclerotherapy under ultrasound guidance (injection treatment with ultrasound monitoring)
  • Miniphlebectomies (ambulatory stab evulsions)
  • Vascular ultrasound by vascular specialists
  • Diagnosis and venous disease management

We help our patients to reclaim their lifestyle, provide long lasting relief from signs and symptoms and restore the appearance of their legs.

Most of the specialist procedures are covered by your health insurance.
We encourage you to contact our board certified vascular surgeon for more information and treatment.



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