Diseases of the thoracic wall and pleura, and their treatment

1. Big picture

Diseases of the thoracic wall and pleura are surgically important because they can cause:

• Respiratory compromise
• Pleural space infection
• Lung collapse
• Massive intrathoracic bleeding
• Chronic trapped lung
• Chest wall deformity
• Malignant pleural disease
• Chest wall instability or tumor invasion

For the surgery exam, the key decision is:

Is this an emergency pleural problem, a chronic pleural disease, or a chest wall structural/tumor problem?

The most important emergency diagnoses are:

• Tension pneumothorax
• Massive hemothorax
• Empyema with sepsis
• Flail chest with respiratory failure
• **Large