Diagnosis and Management of Trapped Lung

By Peter Doelken, MD, FCCP; and Steven A. Sahn, MD, FCCP

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Objectives

1. Describe visceral pleural restriction as part of the differential diagnosis of unexpandable lung.
2. Describe trapped lung as a clinical entity consisting of chronic pleural effusion caused by visceral pleural restriction and absent active pleural disease.
3. Describe the cause of persistence of pleural fluid in trapped lung as local deformation forces exceeding fluid removal forces.
4. Distinguish trapped lung from active pleural disease with coexisting lung entrapment.
5. Identify the patient with trapped lung who is a candidate for therapeutic intervention.

Key words

decortication; diagnostic pneumothorax; lung entrapment; pleural manometry; trapped lung; unexpandable lung

Abbreviation

CABG = coronary artery bypass grafting

Trapped lung is a persistent, benign pleural effusion with no apparent cause for the persistence of fluid other than mechanical restriction of the visceral pleura preventing lung expansion.¹ Trapped lung is thus a diagnosis to be considered during evaluation of the unexpandable lung. Failure of the lung to expand fully when subjected to negative pressure in the physiologic range may be caused by endobronchial, parenchymal, or pleural disease. Although the pleural effusion, if present, may be transudative in the unexpandable lung due to endobronchial or parenchymal disease, the fluid is exudative when associated with active pleural disease. Therefore, trapped lung is a diagnosis of exclusion and rests on the demonstration of a visceral pleural-restricting membrane in the absence of endobronchial, severe parenchymal, and active pleural disease.

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