Diagnosis and Management of Trapped Lung

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

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Prevention and Management

It is likely that the development of trapped lung can be prevented with appropriate management of the pleural space during the acute inflammatory phase of most contributing conditions.¹³ Fortunately, trapped lung is relatively uncommon as a result of the rapid resolution of pleural effusions or lack of reaccumulation after thoracentesis while specific therapy is administered.²¹ Trapped lung in the asymptomatic patient does not require therapy, and the patient can be reassured about the benign nature of the condition. Occasionally, trapped lung may lead to physiologic impairment when substantial amounts of lung are involved. Pulmonary function testing usually reveals restrictive dysfunction in these patients. Before recommending decortication, the physician should try to exclude other causes of dyspnea because decortication is associated with morbidity. In particular, in patients who experience relief after thoracentesis, other causes of transudative effusion, such as congestive heart failure, should be suspected. Only if all other causes of dyspnea have been excluded or successfully treated should decortication be considered. A CT scan may demonstrate coexisting severe parenchymal disease in the lung affected by the restricting visceral pleural membrane and may demonstrate scar tissue extending into the lung parenchyma, making decortication technically difficult. The ideal candidate for decortication is the patient in good general health with only a visceral pleural membrane involving a substantial part of the lung. Subpleural atelectasis may be expected to resolve after decortication. Patients with complete atelectasis of a lobe due to trapped lung present a more difficult situation because the atelectatic lung cannot be assessed by CT preoperatively.

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