Pleura - 1268759

Hi Judy,

You should hear from a faculty in a bit.

I hope you're doing alright and the family is well and happy.

Janine

Hi Judy,

Sorry I missed your question. Generally in a pneumonectomy the pleura is not removed, only the lung. In cases of mesothelioma (in which the pleura is involved) a procedure called an extrapleural pneumonectomy is performed, in which part of the pleura, as well as part of the pericardium and part of the diaphragm, are removed.

JimC
Forum moderator

Thanks Jim. Does that answer your question Judy?

BTW, I'm doing really well and D just got another clean scan!

Thanks,
Janine

Judy, Just an FYI because I don't think we've changed the guidelines or given an official note yet, we're changing the forum works a little. Dr. West has stepped back just a bit from the forums. He's needed to for a long time and as we've all suspected it takes much time from his day, evening, nights...So instead of closing the forum we're trying to answer the questions without his input on every thread. Of course there are times when we need expert input. For example I knew your question had been discussed here but couldn't remember where so I sent out a request for a faculty to respond. Now this is where Dr. West must practice a hands off approach and give the other docs a chance to respond. What this means is it will sometimes take longer for that response.

I'm sorry for the confusion and of course we'll hit up Dr. West when needed. No problems.

Hi Judy,

I think the source of your confusion is that the pleura is not the lining of the lung, but a membrane folded over itself to form a structure, consisting of the inner (visceral) and outer (parietal) pleura, which holds the pleural fluid. That structure rests outside the lung, so the lung can be removed while the pleura remains in place.

Hope that helps.

JimC
Forum moderator

It's confusing. The pleural lining is actually two parts -- the visceral pleura is around the outside of the lung, and the parietal pleura is the lining on the inside of the chest wall. With a pneumonectomy, the lining outside of the lung comes out with it, but not the visceral pleura on the inside of the lung. A pleurectomy removes the lining of the lung and inside of the chest wall but leaves the lung.

I hope that clarifies things.

Good luck.

-Dr. West

In July of 2013, I was exposed to mold from a flood; as a result, I contracted pneumonia and was hospitalized for three days. I never seemed to get over it and had constant severe pain in my back and below my right lung. There was wheezing, coughing and shortness of breath. After finally getting to a pulmonary specialist that was not a quack, he referred me to a surgeon. I recently had a thoracotomy and decortication for a pleural effusion of the right lung. The sac was very thick and very hard to remove from the lung; cauterized lung after removal. About a quart of fluid was drained from the sac and there were no cancer cells present. The tissue from the sac was sent for pathology to Vanderbilt University and came back that it was squamous cell carcinoma in situ on the pleural lining of my lung; they said it had not invaded the lung and was very rare. My surgeon has presented my case to a symposium for possible treatment and to experts in the fields of chemotherapy and radiation. They said they have never seen this before and could offer no treatment; to watch it and have a CT scan every three months. Have you heard of this malady before and what treatment did the patient receive, if any?

I personally do not like the watch and wait until it invades and am considering going to M. D. Anderson in Houston for an evaluation. I am a 65 year old female non smoker; although I did smoke a little in the 70s, 40 years ago. Any information you may have would be very much appreciated.

Judy B.

Hi Judy,

I am sorry to hear of your diagnosis.

Although I understand your concern, one which I would probably share, when all visible evidence of cancer has been surgically removed it is not uncommon to "watch and wait". The alternative would usually be some form of adjuvant (post-surgery) chemotherapy, which would seek to destroy cancer cells (if any are present) that cannot be seen on scans.

Due to the unusual nature of the diagnosis, I think a second opinion at a cancer center affiliated with an academic institution (such as MD Anderson) would be a very good idea. Many patients with uncommon diagnoses gravitate toward such centers, and even if the doctors there have not seen such a case they tend to be connected with the top experts at other institutions with whom they can share ideas.

JimC
Forum moderator

Thanks so much for your prompt reply; I felt the answer you gave me was what I was going to receive. I see my pulmonary specialist today at the University of Tennessee, Knoxville, and sure he will tell me the same thing; this will be the first time I have seen him since surgery. I think my best bet is to go to M. D. Anderson and just see what they say; probably the same thing, but they may have treated someone with the same disorder and can give me more insight to what I am dealing with. I suggested to my surgeon to remove the lung or a lobe; he said that was easier said than done. After reading some of your other responses regarding the pleura, I understand. I didn't realize the pleura was not removed when the lung was removed and that part of the diaphragm had to also be removed; sounds very involved and dangerous; although, I live in coal mining country and with all the black lung and emphysema, there are a lot of old miners walking around with one lung and have done very well.

Again, thanks for the information and I may be contacting you again in the future.

Judy B.