Diagnosis and Management of Trapped Lung

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

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Definition of Terms

A number of conditions may mechanically prevent the lung from expanding. Among them are malignancy involving the visceral pleura or the fibrinous peel of pleuritis itself. These conditions are distinguished from trapped lung by the presence of an active pleural process, which may either progress or resolve, spontaneously or with specific therapy. The mechanism of pleural fluid accumulation in active inflammatory or malignant conditions associated with lung entrapment also differs from the mechanism in trapped lung. In the latter, there is no alternate explanation other than mechanical restriction of lung expansion for the persistence of pleural effusion, whereas intense inflammation or malignancy are sufficient to cause effusion even in the absence of entrapment. The mechanical restriction of the visceral pleura from any cause will be called lung entrapment throughout this manuscript, whereas trapped lung will refer solely to the chronic condition previously described. Trapped lung is considered an outcome of fibrinous or granulomatous pleuritis. The value of this precise definition of trapped lung for the clinician is that the diagnosis describes a clinical entity for which therapy is not necessarily required but spontaneous improvement is not expected.

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