Benign thoracic disease in the elderly

The spectrum of benign thoracic disease in the elderly includes structural abnormalities, infectious disease and their complications, benign neoplastic growths, and autoimmune disease. Differences in physiologic reserve in this population make diagnosis difficult, as elderly patients may not present in the classic fashion, as well as complicate treatment. Benign thoracic disease in the elderly can pose a challenging clinical problem. Older patients with comorbid diseases may have poor tolerance of unnecessary surgical interventions. However, benign disorders of the chest associated with symptoms attributable to effusion or obstruction of airways can limit quality of life. Minimally invasive techniques (eg, video-assisted thoracoscopic surgery) can limit the morbidity associated with intervention. Additionally, prompt intervention may spare the patient more invasive treatments. For example, early effusions can be managed with simple drainage rather than thoracotomy and decortication. With respect to suspected benign thoracic lesions in the elderly, guiding principles for management include avoiding unnecessary interventions while not overlooking potential malignancies. Close surveillance of progressive symptoms, ensuring no radiographic change in the size of the lesion over 2 years, and use of positron-emission tomography remain the diagnostic keys to accurate management.