The type of treatment you receive for a disorder of the pleura or mediastinum depends on which specific disorder you are diagnosed with.
Pleural Effusion and Pleurisy
Pleurisy often resolves without treatment or may require anti-inflammatory medications. However, in more extreme cases, treatment may involve:
- Sampling or draining the accumulated liquid: can be done by thoracentesis for smaller amounts of liquid. This involves inserting a needle between the two lower ribs and pushing it in until it reaches the built up fluid. The fluid can then be removed through the needle. For larger amounts of liquid, your doctor may use a chest tube, which involves inserting a tube between two ribs and connecting it to a drainage system that allows the fluid to drain and prevents air from leaking into the chest cavity. Occasionally, surgery may be required for more complex fluid collections.
- Treating underlying disorders: since pleural effusion can be caused by other disorders, such as pneumonia, your doctor may treat pleural effusion by treating the disorder that caused it. In the case of pneumonia, this most likely will involve administering antibiotics.
Treatment of pneumothorax is similar to treatment of pleural effusion, but in this case the goal of treatment is to remove the excess air from the pleural space. In some cases, pneumothorax resolves on its own and does not require treatment. If treatment is required, options include:
- Needle or chest tube insertion: your doctor will insert a needle or a tube between the ribs into the pocket of air that is pressing on your lung. The air can be removed from the chest cavity using a syringe or a suction device.
- Surgery: if the pneumothorax is not resolved by a chest tube, surgery may be necessary in order to treat it. This surgery usually involves inserting a fiber optic camera and special surgical tools through small incisions. The surgeon will attempt to find the source of the air and close it off.
The treatment of mediastinal masses depends on their cause. If the mass is benign, such as a pericardial cyst, it may require no treatment except observation. If the mass is malignant/cancerous, it will likely be treated with surgery, chemotherapy, radiation, or a combination of these treatments depending on the nature of the cancer.
In most cases, mediastinitis is treated with antibiotics. However, it is possible that your doctor will perform surgery to remove the inflamed area if there is scarring that causes your blood vessels, windpipe, or esophagus to be blocked.
Often, no treatment is required for pneumomediastinum. This is because the body may gradually absorb the air that has accumulated in the mediastinum. However, if your pneumomediastinum has caused your lung to collapse, your doctor may use a chest tube to remove the accumulated air and re-inflate your lung.