PLEUROPULMONARY SYNDROMES: TYPES, CAUSES AND TREATMENTS - MEDICINE - 2025

The pleuropulmonary syndromes are a series of complex syndromatic affecting the respiratory system under (between the main bronchi and alveoli lung) and sharing two cardinal symptoms: cough and respiratory distress. Although the symptoms are similar, these syndromes have a well differentiated pathophysiology.

On the other hand, the cause of each syndromic complex is different, so clinical thoroughness is essential to be able to establish a correct diagnosis. The pathophysiological event common to all pleuropulmonary syndromes is a decrease in the space available for gas exchange (ventilation) in the lung.

Likewise, the accumulation of fluid in the interstitial spaces is also a common pathophysiological event, thus interfering with normal respiratory dynamics. While this is the common pathway responsible for cardinal symptoms (cough and shortness of breath with or without hypoxemia), the path to reach it varies depending on the type of syndrome.

Types, causes and treatments

Pleuro-pulmonary syndromes can be divided into 5 large groups:

- Pulmonary condensation syndrome.

- Atelectic syndrome.

- Pleural effusion.

- Pneumothorax.

- Air entrapment syndrome.

Each of these has different causes and characteristics, even though they share common symptoms. Likewise, treatment varies from one syndrome to another; hence the importance of an early and accurate diagnosis, since failure to identify the cause can lead to severe complications.

Pulmonary condensation syndrome

We speak of pulmonary condensation syndrome when there is a local or diffuse event that causes inflammation of the lung tissue.

This inflammation leads to increased cell density in the affected lung region, as well as fluid sequestration in the interstitial space.

The term "condensation" derives from the radiological finding (on chest X-rays) characterized by increased opacity in the diseased area.

That is, the tissue appears denser than the rest of the surrounding structures. Hence the use of the word condensation. Usually the patient presents with a cough, respiratory distress, and fever.

Causes

- Infections of the lung tissue (pneumonia, tuberculosis, fungal infections).

- Pulmonary contusion (secondary to trauma).

- Lung cancer.

Treatment

Treatment of pulmonary condensation syndromes depends on the cause. When it is due to infections, it is usually necessary to use antimicrobials specific to the causative agent.

In contrast, when the source of condensation is a contusion, rest is usually sufficient, unless the extent is such that surgical intervention is required (something very rare).

For its part, lung cancer requires specific treatments that go through surgery, radiation therapy and, in some cases, chemotherapy.

Atelectatic syndrome

Atelectatic syndromes are all those conditions in which the pulmonary alveoli collapse (close), allowing fluid to accumulate inside.

This increases the lung dead space; that is, the amount of lung tissue that does not receive air, generating the classic symptoms of cough and respiratory distress.

Although on radiography it may be almost indistinguishable from a condensation syndrome, there are subtle signs (such as deviation of the trachea to the side of the pathological image on the X-ray) that guide this diagnosis.

From the pathophysiological point of view, the great difference is that the condensation syndrome originates in the lung parenchyma (lung tissue), while atelectasis originates in obstructions at the level of the bronchi and bronchioles.

Causes

- Insufficient surfactant (in full-term newborn babies).

- Obstruction of the airway from any cause (foreign bodies, scars, mucus plugs, tumors).

- Prolonged mechanical ventilation (either for surgery or hospitalization in the intensive care unit).

- Upper abdominal surgery (the pain causes shallow breathing and, therefore, the alveoli at the base of the lung do not ventilate well, which ultimately favors the accumulation of fluid inside).

- Severe infections, such as lung abscess.

Treatment

Depending on the cause, appropriate treatment should be instituted, although there are measures common to all cases:

- Supply of supplemental oxygen by cannula or mask (depending on the level of hypoxemia).

- Incentive inspirations (respiratory physiotherapy using the Triball equipment).

- Chest percussion.

At this point it is important to emphasize that, although atelectasis can be treated, 90% of these can be prevented; hence the importance of respiratory physiotherapy and patient education before the event occurs, so that it can be avoided.

Pleural effusion

Pleural effusion is the accumulation of fluid in the pleural space; that is, between the chest wall and the lung. The severity of symptoms depends on the amount of fluid in the pleural space: the more fluid, the more severe the symptoms, especially respiratory distress.

Causes

Pleural effusions can be of two types: exudate and transudate. The exudates are usually due to lung problems, usually lung cancer and complicated infections (pneumonia with pleural effusion or complicated tuberculosis).

In the case of transudates, the problem is usually extrapulmonary and may be due to a decrease in plasma oncotic pressure (liver failure, hypoproteinemia), an increase in pulmonary venous pressure (right heart failure), or fluid overload (renal failure).

In addition, there is a third type of pleural effusion known as a hemothorax. In these cases it is neither a transudate nor an exudate but blood.

The most common cause of hemothorax is thoracic trauma (penetrating in the first place, and blunt in the second), although cases of hemothorax can occur without previous trauma as in certain blood dyscrasias.

Treatment

Treatment of pleural effusion (described in some texts as hydrothorax) consists of evacuating fluid from the pleural space, either by thoracentesis (puncture with a core needle through an intercostal space) or placement of a chest tube coupled to a closed drain (trap of water).

In general, these measures must be performed urgently to alleviate the patient's respiratory distress, which is usually severe. Once the situation has been temporized, the underlying cause should be corrected or at least controlled (whenever possible).

Pneumothorax

Pneumothorax is defined as the presence of air in the pleural cavity; that is, inside the thorax but outside the lung. When this happens, air pressure begins to build within the pleural space, which prevents the lung from expanding normally and interferes with gas exchange.

In the first hours of evolution, the pneumothorax is usually low pressure, so the symptoms are moderate (respiratory distress and hypoxemia); however, as it evolves and more air accumulates in the pleural space, the pressure in the pleural space increases, leading to a hypertensive pneumothorax.

In these cases, the deterioration of respiratory function is severe and rapid, for which urgent medical attention is required.

Causes

The most common cause of pneumothorax is penetrating trauma to the chest. In these cases there is lesion of the lung parenchyma, which allows air to escape into the pleural space.

However, trauma is not the only cause; in fact, there is a condition known as spontaneous pneumothorax in which air is present in the pleural space without any trauma.

The cause of this condition is the rupture of an emphysematous bulla (air pocket) or subpleural bleps (small air blisters).

Finally, pneumothorax can be the consequence of therapeutic procedures, such as barotrauma due to mechanical ventilation, accidental puncture of the lung during procedures such as pleural biopsy and liver biopsy, and the placement of central venous accesses, among others.

Treatment

Treatment of pneumothorax consists of evacuating air accumulated in the pleural space; This usually requires placing a chest tube (also known as a thoracostomy catheter) connected to a water-sealed drain that allows air to escape but does not enter again.

The pneumothorax usually resolves in 2 to 5 days; However, when it persists, it is necessary to perform some type of specific procedure that can range from surgery (usually in cases of trauma) to pleurodesis.

Air entrapment syndrome

This syndrome includes all those diseases in which there are alterations of the lung that prevent the air from entering (chronic bronchitis) or leaving (pulmonary emphysema, bronchial asthma).

In all these cases, the lung tissue undergoes inflammatory and / or degenerative changes that prevent adequate gas exchange, generating the already known symptoms of cough and respiratory distress.

Causes

Air entrapment syndromes are mainly due to two causes:

- Chronic Obstructive Bronchopulmonary Disease (EBPOC), which includes pulmonary emphysema and chronic bronchitis.

- Bronchial asthma.

There are other causes, such as alpha 1 antitrypsin deficiency, pneumonoiosis, and cystic fibrosis, although all these processes ultimately converge in the development of EBPOC, so that they would be included in this category.

Treatment

Treatment for air trapping syndrome is specific to the cause. Thus, there are special treatments for asthma, others for bronchitis, and protocols for the management of pulmonary emphysema.

Although the drugs may be the same in some cases, the doses, intervals between doses, and drug association change depending on the cause.

It is very important to emphasize that all pleuropulmonary syndromes are delicate conditions that require specialized medical treatment, so self-medication is never a good option.

On the other hand, pleuropulmonary syndromes can overlap or even lead to another, as in the case of pleural effusion, which can lead to atelectasis or atelectasis, which becomes secondarily infected, evolving into nemonia (condensation syndrome).

For this reason, clinical surveillance is essential to avoid unpleasant surprises during the patient's evolution.

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