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I believe what she was speaking of is the treatment of an acute pneumothorax or a large hydrothorax. When the substance of the lung is violated, upon drawing in a breath, some of the air goes through the trachae,bronchus, bronchial tubules, alveoli and out into the space between the lung and the chest wall. The air will accummulate because it cannot transgress the opposite direction passing through a perforation in the parenchyma of the lung. What happens then is the pressure builds up and presses on the lung and it collapses. When that happens gasses are not exchanged. If the pressure continues and becomes great it will creat what is called a tension pneumothorax and will push the heart and great vessels to the opposite direction. This is an acute surgical emergency and we "stab" the paitient with a stented chest tube. Now, that is not what Mr. Clinton has.

If it is true that he is to undergo a pleuredesis he probably has a loculation of fluid between the lung and chest wall which has "walled off" and accummulated fluid. I suspect, if that is the case, they have "needled" the fluid under ultrasound direction or possibly CT direction and drained the fluid, only for it to recur. The decortication proceedure will create an enormous inflammatory reaction between the lung which has been stripped of its pleura (covering over the lung) and the chest wall. It will then adhese and obliterate the "pocket" where the fluid has recurred.

As one freeper said, it may be possible to do this with a thoracoscope,(that is without completely opening the chest wall). If they have to do an open thoracotomy, he will have a more difficult post operative period with much pain. Those freepers who have had their chest opened can attest that it is very, very painful to spread the ribs. Most of the time when you do that you have to break ribs to get your hand into the chest. This will sound paradoxical, but once you break the adhesions and enter the pocket of fluid, then you rub the pleura with a 4 by 4 or laparotomy sponge to irritate it (sometimes putting in medication or talc) to create an inflammatory response to "cement" the lung with the chest wall. ONce it fuses, (grows together) there is not a potential space for fluid to accummulate.