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Trapped lung.

P Doelken1, S A Sahn

  • 1Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology, Medical University of South Carolina, Charleston, South Carolina 29425, USA. doelkenp@musc.edu

Seminars in Respiratory and Critical Care Medicine
|August 10, 2005
PubMed
Summary
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Trapped lung, a condition causing chronic pleural effusion, occurs when a fibrous peel restricts lung expansion. Surgical decortication is the only effective treatment for symptomatic cases.

Area of Science:

  • Pulmonology
  • Thoracic Surgery

Background:

  • Trapped lung results from fibrinous or granulomatous pleuritis, leading to chronic, benign, unilateral pleural effusion.
  • It is characterized by a restrictive fibrous visceral pleural peel preventing lung expansion and causing a fluid-filled pleural space maintained by hydrostatic equilibrium.

Purpose of the Study:

  • To define trapped lung, its causes, diagnostic criteria, and treatment options.
  • To differentiate trapped lung from other pleural conditions and establish management guidelines.

Main Methods:

  • Review of literature on pleuritis, pleural effusion, and trapped lung.
  • Analysis of diagnostic findings including negative pleural liquid pressure, increased pleural space elastance, and pleural peel visualization.
  • Evaluation of treatment outcomes, focusing on surgical decortication.

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Main Results:

  • Trapped lung is a consequence of conditions like inadequately treated parapneumonic effusion, tuberculosis complications, cardiac surgery, or chest trauma.
  • Diagnosis requires evidence of chronicity, stability, and absence of active inflammation, malignancy, or obstruction.
  • Key diagnostic findings include initial negative pleural liquid pressure, increased pleural space elastance, and a demonstrable pleural peel.

Conclusions:

  • Surgical decortication is the definitive therapy for symptomatic trapped lung.
  • Asymptomatic patients with trapped lung require observation, not surgical intervention.