Experience from a specialist pleural clinic

Abstract

Pleural disorders are common reason for referral to respiratory clinics. There are a number of conditions that can cause pleural disorders. Over 3000 patients per million develop pleural effusion each year. Similarly, around 100 new patients for every million of the population are diagnosed with a malignant pleural effusion (MPE) each year. Patients with pleural diseases can present to a number of specialties such as respiratory medicine, acute medicine, oncology, cardiology, rheumatology, nephrology, gastroenterology and thoracic surgery. The specialist pleural clinics allow for more streamline investigations and management of patients with pleural disorders. Through the designated specialist pleural clinics a systematic investigational approach can be applied based on the initial use of imaging such as a chest radiograph, thoracic ultrasound and computed tomography. In addition, specialised pleural clinics allow for more invasive investigations such as pleural fluid sampling. Another advantage of a specialist pleural clinic is in relation to the close work of a multidisciplinary team including respiratory specialists, radiologists, histopathologists, oncologists and palliative care specialists. This allows for a multidisciplinary approach of managing patients with pleural disorders.
Malignant pleural effusion is probably the most common reason for referral to respiratory clinics. It is recognised that a number of cancers can metastasize to the pleura with breast and lung cancer being the most common. In addition, malignant mesothelioma a primary cancer of the pleura usually due to previous asbestos exposure, may present with pleural thickening or pleural effusion. There are a number of non-malignant causes of pleural effusion including infection, inflammatory conditions, renal disorders, liver disorders and cardiac disorders. Similarly, there are other conditions such as pneumothorax, pleural thickening including asbestos related pleural disease, which form a proportion of patients with pleural disorders. In this report, we describe our experience from a specialist pleural clinic in a large tertiary teaching hospital covering both rural and inner city population.