The evaluation and clinical application of pleural physiology

Pleural disease is commonly encountered by the chest physician. Evaluation of pleural disease typically begins with thoracentesis and pleural fluid analysis. With improvements in minimally invasive procedures, imaging, and the use of pleural manometry, a more complete understanding of lung, pleural, and chest wall physiology is possible. The improved knowledge of pleural physiology can help the clinician in clinical decision making, as well as the diagnosis and treatment of pleural disease. This article reviews pleural physiology and summarizes the relevant data supporting the use of ultrasound and manometry in the evaluation and treatment of pleural disease.