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Pleural Diseases, 4th Edition FREE TO VIEW

Lee K. Brown, MD, FCCP, Vice President Associate Medical Director (Specialties)
Author and Funding Information

Lovelace Health Systems, Inc, Clinical Professor of Medicine, University of New Mexico School of Medicine, Albuquerque, NM

Chest. 2002;121(1):311. doi:10.1378/chest.121.1.311-a
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By Richard W. Light. Philadelphia, PA: Lippincott Williams & Wilkins, 2001; 432 pp; $115.00

Only pulmonologists stranded on a desert island for the last several decades could be unfamiliar with the various editions of Pleural Diseases that Richard W. Light has issued with regularity over many years. For those stranded respirologists who have just returned to civilization, and for the nonpulmonologist audience of CHEST, it can be stated that Pleural Diseases is the “Everything You Ever Wanted to Know… But Were Afraid to Ask” of pleural disorders. Light’s latest edition is an admirable update of an old friend and heavily used resource.

The text begins with chapters on pleural anatomy, physiology, radiography, clinical manifestations, useful tests, and the general clinical approach to pleural disorders. These sections provide the reader with tools to interpret and understand the chapters on specific diseases that follow. Subsequent chapters cover transudative effusions and effusions caused by metastatic malignancy, primary pleural neoplasm, infection (bacterial, tuberculous, fungal, parasitic, and viral), and pulmonary embolization. Pleural effusion related to diseases of various organ systems (GI, cardiac, obstetric/gynecologic, collagen-vascular, and miscellaneous) and those caused by drug reactions complete this section of the text. There follow separate chapters on pneumothorax, hemothorax, and chylothorax/pseudochylothorax. The book concludes with chapters on various procedures: thoracentesis/pleural biopsy, tube thoracostomy, and thoracoscopy.

Light’s writing style is authoritative and encyclopedic, but somewhat dry. This is a text that is more palatable for use as a reference, consulting pertinent chapters at intervals as the need arises, rather than sitting down to a cover-to-cover read. His approach is so serious that when the one instance of humor appears (describing patients consuming green-dyed buttered bread to demonstrate chylothorax) the reader is more startled than amused. A few typographical errors were easily identified as such (eg, “mycoplasma tuberculosis”), but others might be confusing to the reader, such as the frequent misstating of ratios (eg, “0:75” instead of“ 0.75”).

Light has clearly spent considerable time gathering and incorporating the most up-to-date studies on pleural disease, and the references are laudably current. I could detect only one missing reference, in the discussion on laboratory testing to distinguish transudates from exudates. Heffner’s 1997 meta-analysis of these tests did add useful information on modifying or abbreviating Light’s criteria and might have been included, but I do admit to a personal bias as one of the study’s coauthors. Light includes valuable new insights; those concerning heart-lung transplantation (the disrupted mediastinum allows the contralateral spread of an iatrogenic pneumothorax), the use of pleural pressure measurement to prevent reexpansion pulmonary edema during therapeutic thoracentesis, and the use of adenosine deaminase or interferon-γ levels to identify tuberculous pleural effusions readily come to mind. There are also some details that are missing, including the use of independent lung ventilation in treating bronchopleural fistulas, duplex Doppler ultrasound in diagnosing lower extremity thrombophlebitis, and pneumonia as a cause of pleural effusion in sickle cell anemia pulmonary syndrome. The description of pleuropulmonary disease due to anthrax seemed unnecessary when read prior to September 11, but the terrorist events of that day and the later appearance of anthrax spread through the mail made that inclusion pertinent and even prescient.

Overall, this fourth edition of Light’s Pleural Diseases is an impressive update of a classic pulmonary text and should remain a staple of the clinician’s bibliographic armamentarium. It is equally recommended for the student, house officer, and experienced respirologist.




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