Medical science understands pleurisy an inflammatory process affecting the pleura and leading to the formation of fluid accumulations (fibrin) on its surface.
The modern point of view is based on the idea that pleurisy is a syndrome, i.e. manifestation of any disease.
For dry pleurisy characterized by the presence of inflammation of the lung membrane, on the surface of which fibrinous plaque or fibrinous deposits form. In this group, the most common is adhesive pleurisy, in which adhesions form between the layers of the pleura.
At effusion form disease, there is an accumulation of inflammatory fluid in the pleural cavity.
The classification of pleurisy is based on several characteristics.
Character of the course:
serous pleurisy when serous exudate accumulates in the pleural cavity;
serous-fibrinous pleurisy, representing the next phase of serous pleurisy or a separate disease;
putrefactive pleurisy, in which the inflamed fluid in the pleura has a specific odor. As a rule, this type of pleurisy occurs with gangrene of the lung;
purulent pleurisy, characterized by the accumulation of pus in the pleural cavity;
chylous pleurisy occurs due to rupture of the milk duct, which leads to the entry of milky fluid into the pleural cavity;
pseudochylous pleurisy is formed on the basis of purulent, when fatty inclusions appear on the surface of the liquid. They are transformed purulent cells;
hemorrhagic pleurisy diagnosed when red blood cells - erythrocytes - enter the exudate;
mixed, including signs of several types of pleurisy that are pulmonary in nature.
Etiology:
infectious nonspecific;
infectious specific pleurisy.
Localization of the inflammatory process:
apical (apical) pleurisy, develops exclusively in the part of the pleura located above the apices of the lungs;
pleurisy of the costal part (costal), limited to areas of the costal pleura;
diaphragmatic, localized in the diaphragmatic pleura;
costodiaphragmatic;
interlobar pleurisy, located in the interlobar groove.
Scope of distribution:
unilateral(in turn divided into left-sided and right-sided);
bilateral pleurisy.
Pathogenesis:
hematogenous when a pathogen of an infectious nature enters the pleura through the bloodstream;
lymphogenous, in which the infectious agent enters the pleura through the lymphatic tract.
The main symptom of fibrinous pleurisy is pain in the chest, especially during inhalation. The pain intensifies when coughing and is stabbing in nature. The appearance of shortness of breath is associated with compression of the affected lung due to fluid accumulation. Clinic of the disease: the temperature rises, the painful dry cough intensifies.
Other symptoms and signs develop in relation to the underlying disease.
In the case of infectious pleurisy, the risk of suppuration and the formation of pleural epiema increases, which is characterized by purulent accumulation in the pleural area, requiring local treatment with surgical methods.
Epiema of the pleura can cause fever and intoxication of the body. Its breakthrough leads to the appearance of a lumen in the bronchi and, as a result, increased coughing with the production of large volumes of sputum.
The appearance of neoplasms damages the pleura and exudate is formed, and reabsorption becomes almost impossible.
Systemic diseases and privasculitis injure the vessels, and the pleura reacts with the appearance of an inflammatory focus in response to hemorrhage.
The chronic type of kidney failure leads to enzymatic pleurisy, when the body begins to produce toxins from the affected pancreas.
Non-infectious inflammation due to pulmonary infarction by contact method also affects the pleura, and myocardial infarction impairs the immune system, thereby contributing to the development of pleurisy.
Laboratory tests allow us to establish the etiology of pleurisy. The diagnosis is made during a comprehensive examination.
Treatment of pleurisy begins with treatment of the disease that contributed to the effusion. At the first consultation, the doctor must describe to the patient the seriousness of the disease and the need to comply with all the rules of treatment and recovery. At this stage, differential diagnosis is important.
Dry pleurisy and the accompanying dry cough are relieved by bandaging the chest with an elastic bandage. To enhance the effect, use a pillow, locally bandaged on the affected side. The dressing is changed 1-2 times a day to prevent irritation of the skin and hypostatic lungs.
For severe coughs, antitussive medications are prescribed in parallel with bandaging.
At the next stage of treatment, manipulations are carried out to remove excess pleural fluid: an operation is performed to puncture the pleura and pump out the fluid.
Interesting Facts
- The incidence of pleural effusion in industrialized countries is 320 per 100,000 population per year. This is about 5-10% of inpatients.
- In rare cases, pleurisy affects the lungs of cats. A similar disease is recorded in animals only in 4% of cases of the total number of pulmonary diseases.
Anti-inflammatory drugs relieve the syndrome and alleviate the course of the disease.
Diuretics are used when significant effusion develops. Diuretics are effective for pleurisy accompanied by liver cirrhosis, heart failure and nephrotic syndrome.
Physiotherapeutic techniques. Fibrous pleurisy at the initial stage of development is treated with alcohol compresses. Electrophoresis with calcium chloride solution and magnetic therapy are effective.
Having completed the course of inpatient treatment, rehabilitation through sanatorium treatment, preferably with the Crimean climate, is necessary.
The prognosis for pleurisy is quite favorable, but in general depends on the underlying disease and the capabilities of the human body.
The most complex metastatic pleurisy occurs against the background of serious diseases: lung cancer or in the case of breast cancer, and therefore requires constant monitoring after the main course of treatment.
Exudative pleurisy is relatively benign. As a result of treatment, the affected fluid tends to dissolve. In rare cases, areas with fused pleura may remain.
After proper treatment, ability to work is completely restored. However, those who have recovered from tuberculous exudative pleurisy should be under constant dispensary observation.
Overwork should be avoided; a correct sleep-wake schedule is necessary. It is imperative to get rid of bad habits, especially smoking and occupational hazards.
In most cases, folk remedies for getting rid of pleurisy are based on the use of products such as honey and horseradish.
Composition No. 1. Ingredients: 100 g honey (preferably May honey), 50 g pork fat, aloe leaves (plant age 5 years or more), 1 tbsp. l. cocoa, 1 tbsp. l. Sahara. Preparation: the leaves are peeled and crushed. All ingredients are mixed and heated in a water bath until the mass becomes homogeneous. Reception: 1 tbsp. l. 3 times a day before meals. Course – 2 months.
Composition No. 2. Ingredients: 1 tablespoon honey, 1 glass milk, 1 egg, 50 g internal pork fat. Preparation: melt honey. Boil the milk and cool until warm. Separate the white from the yolk. Mix all ingredients. Reception: the mixture is taken exclusively freshly prepared. The composition is consumed 2 times a day - morning and evening.
Composition No. 3. Ingredients: 1 glass of honey, 250 g of badger fat, 300 g of aloe leaves (plant age 3 years or more). Preparation: aloe leaves are cleaned and crushed. Preparation: mix melted honey with badger fat and add a mixture of aloe leaves. Heat the resulting composition in the oven for 15 minutes. Reception: 3 times a day, 1 tbsp. l. before meals.
Composition No. 4. Ingredients: 150 g horseradish root, 3 medium or 2 large lemons. Preparation: Squeeze juice from lemons. Grind the horseradish rhizome and mix with the resulting juice. Reception: ½ tsp. in the morning on an empty stomach or in the evening before bed.
The high effectiveness of many preparations based on medicinal plants has been proven. They have a positive effect in eliminating inflammatory processes in the lungs. But their use should take place in combination with drug treatment during the recovery stage.
Diseases of the upper respiratory tract require the use of expectorant and anti-inflammatory preparations, which include licorice rhizomes, fennel fruits, white willow bark, plantain, linden flowers, coltsfoot leaves.
These medicinal plants are used individually or mixed in 1:1 proportions. Pour boiling water over dry herbs, leave for 15-20 minutes and drink like tea. Such preparations strengthen the immune system and have a general strengthening and anti-inflammatory effect. They can be consumed all year round, alternating herbs every 1.5-2 months.
In the pulmonological section of medicine, among the many pathologies of the pleural cavity, the most common disease is pleurisy (pleuresia).
What it is? Pleurisy is a term that summarizes several diseases that cause inflammation of the serous membrane of the lung - the pleura. As a rule, it develops with already existing pathologies, accompanied by the outpouring of exudate or fibrin clots into the pulmonary pleural cavity.
The process of development of pleurisy
The pleura is a two-layer (in the form of two sheets) serous membrane surrounding the lungs - the inner (visceral) sheet and the outer (parietal). The pleural inner sheet directly covers the lung tissue itself and its structures (nervous tissue, vascular network and bronchial branches) and isolates them from other organs.
The outer pleural sheet lines the intracavitary chest walls. It ensures the safety of the lungs and the sliding of the leaves, preventing their friction during breathing.
In a healthy, normal state, the distance between the pleural sheet membranes does not exceed 2.5 cm and is filled with serous (serum) fluid.
Liquid enters between the sheets of pleura from the vessels of the upper zone of the lung, as a result of plasma filtration of blood. Under the influence of any injuries, serious illnesses or infections, it rapidly accumulates between the pleural membranes, causing the development of inflammatory reactions in the pleura - pleuresia.
The normal functioning of vascular functions ensures the absorption of excess exudate, leaving a sediment in the form of fibrin proteins on the pleural sheet, which is how the dry (fibrinous) form of pleurisy appears.
Failure of vascular functions provokes the formation of bloody, purulent or lymphoid fluid in the cavity of the pleural membrane - a type of exudative pleuresia.
The reason for the development of pleurisy is due to two broad groups of provocative factors - infectious and non-infectious.
The most common non-infectious factors are due to the influence of:
The manifestation of clinical forms of the disease is classified:
The disease usually develops with a dry (fibrinous) form of pleurisy, lasting from 1 to 3 weeks. The absence of positive dynamics of treatment contributes to its overflow into exudative pleuresia, or chronic.
Dry (fibrinous) pleuresia characterized by suddenness and severity of manifestation. The first symptoms of pleurisy are manifested by especially sharp chest pain in the area of development of inflammatory reactions. Coughing, sneezing and rocking movements cause increased pain.
Deep breathing is accompanied by a dry, hot cough. There is no temperature or increases slightly.
Noted:
Symptoms of dry pleurisy of various types of manifestation are distinguished by special characteristics.
Exudative, effusion form of pleurisy. Symptoms of pleurisy of the lungs of the effusion form, in its various forms, in the initial stage of development are similar to dry pleuresia. After a certain time, they become “blurred”, as the voids between the sheets are filled with effusion and the contact stops.
It happens that the exudative appearance develops without previous fibrous pleuresia.
For some time, patients may not feel changes in the thoracic region; characteristic symptoms appear after a while:
Patients try to avoid unnecessary movements and lie only on the uninjured side. Bloody sputum may be coughed up.
Purulent pleuresia. It occurs in rare cases, a very severe pathology with serious consequences, which, for the most part, end in death. Very dangerous in childhood and old age. Purulent pleurisy begins its development against the background of inflammation or abscess of the lungs. Manifests:
If the disease is a consequence of a lung abscess, then as a result of its rupture a painful, lingering cough appears, causing sharp pain in the side.
Purulent exudate causes intoxication in the form of pale skin and cold sweat. Blood pressure may rise and shortness of breath may increase, making it difficult to breathe properly. With these symptoms of pulmonary pleurisy, both treatment and subsequent monitoring of its effectiveness should take place within the walls of the hospital.
Tuberculosis form. It is characterized by the highest frequency of development in childhood and young age. It manifests itself in three main forms - para-specific (allergic), perifocal (local) and tuberculous pleuresia.
Para-specific begins with high temperature, tachycardia, shortness of breath and pain in the side. Symptoms disappear immediately after filling the pleural cavity with fluid.
The perifocal form manifests itself already in the presence of tuberculous lesions of the lung tissue, which lasts a long time with periods of exacerbation and spontaneous remissions.
Symptoms of the dry form of tuberculosis are caused by signs of friction of the pleural layers, causing noise when breathing and pain in the sternum. The presence of effusion is accompanied by distinct symptoms:
There is no single treatment regimen for pleurisy. The basis of the treatment process is a physical diagnosis by a doctor, after which appropriate instrumental diagnostic techniques are prescribed, based on the results of which individual therapy is selected taking into account all parameters of the pathology (shape, type, localization, severity of the process, etc.
Drug therapy is used as a conservative treatment.
The neglect of inflammatory processes in the pulmonary pleura leads to dangerous complications of pleurisy - gluing of pleural layers by adhesive process, local disturbances of blood circulation caused by compression of vessels by effusion, the development of single and multiple pulmonary-pleural communications (fistulas).
The most dangerous complication is pleural empyema (pyothorax), in which the lack of adequate drainage of pus causes the development of multi-chamber empyema processes.
With processes of scarring and thickening of the pleural membrane, development in adjacent tissues (septicopyemia), pathological changes in the bronchi (bronchiectasis), amyloid dystrophy.
All this, in more than 50% of cases, can end in death. The mortality rate is much higher in children and elderly patients.
Bronchopulmonary diseases represent a whole group of pathological processes in which the functionality of the organs of the respiratory system is disrupted: bronchi, trachea, lungs, pleura. Pulmonology today is considered one of the important areas of medicine, since these diseases occur in almost every second person, including children. Pleurisy is considered one of the few pulmonary pathologies, which most often develops against the background of other diseases of the respiratory system. Pleurisy can be acute or chronic, affect part of the chest or spread to both sides of the chest, and be of infectious or non-infectious origin. For what reasons does pleurisy develop, what are the symptoms of the disease? How to treat pleurisy, and how dangerous it is for human health, read in our article.
Pleurisy is an inflammation of the pleura resulting from the deposition of fibrin, serous fluid or purulent exudate on its surface. The pleura is located around each lung and consists of two layers (visceral and parietal). The visceral pleura covers the lung itself and separates them from each other. The parietal pleura is located on the outer surface of the lung and ensures that the layers of the lungs do not rub during breathing. Between the two layers of the lungs there is a small space filled with fluid, which ensures normal breathing. Normally, pleural fluid should not exceed 25 mil. In the presence of pleurisy, the amount of fluid increases, inflammation of the pleural cavity occurs, which leads to severe symptoms.
Pleurisy, like other diseases of the respiratory system, can have an infectious or non-infectious course. The first group includes bacteria: pneumococci, streptococci, staphylococci, mycobacterium tuberculosis, rickettsia, as well as viruses and fungi.
Non-infectious pleurisy can be caused by malignant neoplasms, systemic connective tissue diseases, chest injuries and other causes. The most common diseases that lead to pleurisy are:
There are a large number of diseases that can lead to the development of pleurisy. Pleurisy often develops as a complication after an underlying disease of the respiratory system.
According to the nature of the pathological process, pleurisy is divided into dry (fibrinous - without the formation of fluid) and exudative pleurisy (with the formation of fluid).
According to the nature of the effusion, serous, serous-fibrinous, purulent, putrefactive, hemorrhagic, eosinophilic, cholesterol, chylous, and mixed pleurisy are distinguished.
According to the course, pleurisy can be acute, subacute and chronic.
Depending on the localization of the inflammatory process, they are distinguished: diffuse, encysted (limited), left-sided pleurisy, right-sided pleurisy, bilateral pleurisy.
The clinical picture of pleurisy is severe and is characterized by pain in the side, which intensifies with inhalation, coughing, and walking. The pain subsides when lying on the affected side. There is also a limitation in the respiratory mobility of the chest. With percussion sounds, weakened breathing and pleural friction noise can be heard. In addition to the main symptoms, the patient has: 
Symptoms of pleurisy directly depend on the type and classification of the pathological process. The above symptoms may indicate the presence of other diseases, so only a doctor can make a diagnosis after the results of the examination.
The main method in diagnosing pleurisy is X-ray examination. Pleural fluid is also examined and collected 
puncture. Examination of the fluid allows the doctor to determine the cause of the disease, the stage and course of the pathological process.
Considering that pleurisy occurs against the background of other diseases, it treatment should be comprehensive and aimed at eliminating the underlying disease. Treatment is carried out in a hospital. In case of pleurisy, fluid in the pleural cavity is evacuated, this will help eliminate the effect on the lungs and improve breathing. Exudate evacuation (puncture) is performed when there is a large volume of exudate (more than 1.5 liters), when surrounding organs are compressed by exudate, or when the development of emphysema (pus in the pleural cavity) of the pleura is suspected.
The doctor also prescribes symptomatic therapy, which includes taking the following medications: 
The course of treatment and dose of any drug is prescribed by the doctor individually for each patient. Treatment of pleurisy takes from 2 weeks to 2 months, it depends on the form of the disease, its cause and other characteristics of the patient’s body. Usually the prognosis after the completed course of treatment is favorable.
Patients who have suffered pleurisy are monitored at the dispensary for 2 - 3 years. Such patients need to monitor their health, eat right, and avoid hypothermia.
Pleurisy of the lungs Symptoms and treatment are well understood, but hospitalization and the use of strong anti-inflammatory drugs may be required.
If you ignore the symptoms, there is a high risk of serious complications or even death.
Pleurisy of the lungs is a disease of the respiratory system, during the development of which the pulmonary (visceral) and parietal (parietal) layers of the pleura - the connective tissue that covers the inside of the chest and lungs - become inflamed.
With pleurisy of the lungs, fluids such as blood, pus, putrefactive or serous exudate may be deposited in the pleural cavity (between the layers of the pleura).
The causes of privitis can be divided into infectious and inflammatory or aseptic (non-infectious).
Infectious causes include:
Non-infectious pulmonary pleurisy has the following causes:
The following factors increase the risk of developing pulmonary pleurisy:
The course of pulmonary pleurisy can be:
Microorganisms enter the pleural cavity in different ways.
Infectious agents can enter by contact, through lymph or blood.
Their direct entry into the pleural cavity occurs during wounds and injuries, during operations.
If pleurisy has developed, all symptoms should be identified by a doctor. In most cases, fibrous pleurisy is a sign of another disease, so a full diagnosis is necessary.
In this case, the patient feels a sharp stabbing pain in the side, in the lungs, cough, and tension in the abdomen.
With this type of pathology, the patient has shallow breathing, and every movement causes discomfort. Inflammation of the pleura of this type threatens the occurrence of adhesions, so treatment cannot be ignored.
When fluid accumulates in the pleura, exudative pleurisy develops. Only one part of the organ is affected, as a result of which the pain is localized on the left or right. Accompanied by a dry cough, increasing shortness of breath, and a feeling of heaviness.
The signs are:
The pain decreases when turning over to the other side in a supine position.
The peculiarity of the disease is the accumulation of fluid in the pleura, so the lungs swell, which gives radiating pain and causes a deterioration in the general condition.
Fluid in the lungs can vary, and sometimes blood accumulates.
Privrit is one of the signs of tuberculosis. There are several types of this disease: perofocal, allergic or empyema. In some cases, inflammation of the pleura is the only symptom of the disease.
The disease is not acute, and the pain, and along with it the cough, goes away, but even the absence of symptoms may not be evidence of cure.
With such symptoms, severe shortness of breath, fever, weakness, and chest pain appear. Sometimes the disease is chronic.
If pus accumulates in the pleura, then this is effusion pleurisy, but it is isolated separately, since the disease occurs only in acute form.
Symptoms of this disease: chest pain, cough, fever, shortness of breath, gradual increase in blood pressure due to the pressure of the accumulated mass on the heart.
The purulent form of the disease is more common in older people or young children and requires hospitalization and specialist supervision.
This is one of the most severe forms of pulmonary pleurisy, in which the fusion of the hymen leaves leads to the accumulation of extrudate.
This form develops as a result of prolonged inflammatory processes in the pleura and lungs, which lead to adhesions and also delimit exudate and the pleural cavity. So, the effusion accumulates in one place.
In the case of pleurisy, symptoms may differ depending on the course of the pathological process.
Dry pleurisy is characterized by the following symptoms:
With exudative pleurisy, the manifestations are somewhat different:
The most severe course is observed with purulent pleurisy:
If the course of pulmonary pleurisy becomes chronic, changes in the form of pleural adhesions form in the lung, preventing complete expansion of the lung.
Accompanied by a decrease in the perfusion volume of lung tissue, thereby aggravating the symptoms of respiratory failure.
Before determining the course of treatment for pulmonary pleurisy, you should undergo an examination and identify the causes of its occurrence.
To diagnose pulmonary pleurisy, the following examinations are performed:
Diagnosis is usually not difficult. The main difficulty with this pathology is to determine the exact cause that provoked inflammation of the pleura and the formation of pleural effusion.
If pleurisy is suspected, the patient is hospitalized. Depending on the type of disease, the attending physician prescribes medications to relieve inflammation and reduce symptoms.
But full organ restoration requires more than just pills: you need proper nutrition and exercise.
Until the inflammation is relieved, the patient is prohibited from leaving the bed. He needs recovery from the fever and rest. In this case, it is necessary not to burden the stomach and heart, so a diet high in vitamins is prescribed.
The basis of nutrition is fruits, vegetables and cereals. It is also important not to worry and eliminate any stressful situations.
Doctors prescribe different groups of drugs to patients with pleurisy:
The prescription of medications is related to the characteristics of the patient and the course of the disease:
During treatment, mustard plasters and a tight bandage on the chest are indicated, since pleurisy sometimes causes fusion of the organ cavity. In order to prevent these complications, the patient is prescribed breathing exercises.
Physical therapy is also additionally needed if the patient spent more than 2 months in the hospital.
The purulent version of the pathology is sometimes treated for longer than 4 months under the supervision of doctors.
With purulent pleurisy of the lungs, surgical intervention is sometimes necessary. The surgeon performs drainage and rinsing with an antiseptic solution. More serious operations can be performed for chronic forms of the disease.
Pleurisy is an inflammatory process in the area of the pleural layers (visceral and parietal), in which fibrin deposits form on the surface of the pleura (the membrane covering the lungs) and then adhesions form, or different types of effusion (inflammatory fluid) accumulate inside the pleural cavity - purulent, serous , hemorrhagic.
Pleurisy is not an independent disease, it is a secondary process. It accompanies many diseases in the lungs, mediastinum, and diaphragm.
Often pleurisy is one of the symptoms of systemic diseases (oncology, rheumatism, tuberculosis). However, the striking clinical manifestations of the disease often force doctors to put the manifestations of pleurisy in the foreground, and based on its presence, find out the true diagnosis.
Pleurisy can occur at any age, many of them remain unrecognized.
The causes of pleurisy can be divided into infectious and aseptic or inflammatory (non-infectious).
Non-infectious pleurisy usually occurs
Based on the nature of the exudate (fluid formed in the pleural cavity) and its amount, pleurisy is divided into:
dry or fibrinous (little exudate, fibrin forms on the surface)
exudative (with the formation of a fairly significant amount of inflammatory fluid in the pleural cavity)
The course of pleurisy can be:
With dry pleurisy, the main symptoms are:
With exudative pleurisy, the clinic is somewhat different. Manifest:
With a significant accumulation of fluid, the heart and other organs of the mediastinum can shift with a decrease in pressure, a change in the frequency and depth of breathing, and a sharp disturbance in well-being.
Pleurisy can be suspected upon examination and percussion (tapping with fingers) of the chest area - the boundary of the fluid is determined.
When listening to the lungs, a friction noise of the inflamed pleura is heard, especially when fibrin is applied. When fluid accumulates, breathing can be heard faintly.
The study is complemented by ultrasound and chest x-ray, and additionally a puncture (puncture with a needle to take samples of exudate) and examination of the contents are performed. General and biochemical blood tests show signs of inflammation.
For the purpose of visual inspection of the pleural cavity, thoracoscopy (examination of the cavity with a special apparatus with a camera) and taking a biopsy of the pleura are performed.
Pleurisy is treated by therapists and surgeons. For infectious pleurisy the following is prescribed:
If there is a lot of effusion, more than 500-1000 ml, a pleural puncture and removal of exudate are performed in a surgical hospital. If necessary, special drainage tubes are placed and the pleural cavity is washed with antibiotics and special solutions (with hormones, enzymes).
In treatment, it is necessary to ensure that no adhesions appear between the layers of the pleura - they will interfere with the lungs, and they will not be able to move normally when breathing.
In the presence of non-infectious pleurisy, the underlying disease is initially treated.
Patients with pleurisy are monitored for a long time, about 2-3 years after recovery. They are shown a special regime for the prevention of colds and hypothermia.
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