Pleural Disease: advances in pathology, diagnosis and therapeutic approach

Due to the ever growing evidence base into the mechanisms, pathogenesis and management of the myriad conditions affecting the pleural space, as well as the growth of highly specialist physician-led interventions, pleural disease is now considered a distinct and important subspecialty of respiratory medicine. The burden of pleural disease is considerable, with pleural effusions alone estimated to affect over million people per year worldwide. The range of pleural disease is broad, including malignant and benign conditions, curative or palliative and acute or chronic, presenting as entities in themselves or as part of a wide-ranging number of other medical and surgical conditions. Pleural disease may therefore present to respiratory physicians or to many other healthcare professionals, including surgery, general internal medicine, oncology, infectious diseases and oncology hence the crucial requirement for interspecialty and multidisciplinary involvement. Interventions such as thoracoscopy, image-guided pleural biopsy and indwelling pleural catheters play a key role in pleural specialist practice, with thoracic ultrasound being the true revolutionary tool in the pleural physician’s arsenal. To coincide with the above, over the past decade there has been a surge in the number of major studies, many of them randomised controlled trials with patient-centred outcomes, focusing on conditions such as pneumothorax, malignant pleural effusion, mesothelioma and pleural infection. Their results have in many respects been practice changing, and provided a range of new treatment options to be offered to patients with pleural conditions. This wave of robustly designed, multicentre studies will hopefully continue over the coming years. Despite this substantial amount of high quality data, there remain significant gaps in the literature to be addressed, such as those relating to the phenotyping and optimal treatment of pleural infection, early diagnosis of mesothelioma, the optimal palliative strategy in malignant pleural effusion as well as the pathophysiology and mechanisms underpinning the development of pleural conditions. This collection will welcome original articles or reviews on the clinical and pre-clinical diagnosis and management of pleural diseases and we look forward to your important contributions.