Pleurisy is a general name for diseases in which inflammation of the serous membrane around the lungs - the pleura - occurs. The disease usually develops against the background of pre-existing diseases and may be accompanied by the formation of effusion on the surface of the membrane (exudative pleurisy) or fibrin (dry pleurisy). This problem is considered one of the most common pulmonary pathologies (300–320 cases per 100 thousand population), and the prognosis for treatment depends entirely on the severity of the primary disease and the stage of inflammation.
What is pleura? This is a two-layer serous membrane around the lungs, consisting of two so-called layers - the internal visceral and external parietal. The visceral pleura directly covers the lung, its vessels, nerves and bronchi and separates the organs from each other. The parietal membrane covers the inner walls of the chest cavity and is responsible for ensuring that no friction occurs between the layers of the lung when breathing.
In a healthy state, between the two pleural layers there is a small space filled with serous fluid - no more than 25 ml. The fluid appears as a result of filtration of blood plasma through vessels in the upper pulmonary part. Under the influence of any infections, serious illnesses or injuries, it rapidly accumulates in the pleural cavity, and as a result, pulmonary pleurisy develops.
If the vessels are functioning normally, excess fluid is absorbed back, and fibrin protein settles on the pleura. In this case, they talk about dry or fibrinous pleurisy. If the vessels do not cope with their function, effusion (blood, lymph, pus) forms in the cavity - the so-called effusion, or exudative pleurisy. Often in a person, dry pleurisy subsequently turns into effusion.
Secondary pleurisy is diagnosed in 5–10% of patients in therapeutic departments. It is believed that both men and women are equally susceptible to this pathology, but statistics more often indicate damage to the pleura in adults and elderly men.
Pleurisy very rarely occurs as an independent disease; it is usually recorded against the background of other pathologies of an infectious and non-infectious nature. In accordance with this, all types of the disease (both fibrinous pleurisy and effusion) are divided into 2 large groups based on the reasons for their appearance.
Infectious lesions of the pleura most often cause inflammation and the formation of purulent exudate between the pleural layers. The pathogen enters in several ways: as a result of direct contact with the source of infection (usually in the lung), through lymph or blood, and also due to direct contact with the environment (trauma, penetrating wounds, unsuccessful operations).
Non-infectious pleurisy can occur due to systemic diseases, chronic pathologies, tumors, etc. The most popular causes of such ailments are:
When a tumor forms, the pleura is damaged and the formation of effusion increases. As a result, effusion pleurisy begins to develop.
After a pulmonary embolism, inflammation spreads to the pleural membrane; with myocardial infarction, the disease develops against a background of weakened immunity. In systemic pathologies (vasculitis, lupus), pleurisy develops due to vascular damage; renal failure causes exposure of the serous membrane to uremic toxins.
Modern medicine knows of pleurisy of various types and forms, and there are several classifications of this pathology. But in Russian practice, the classification scheme of Professor N.V. Putov is traditionally used. In accordance with it, the following types of pleural pathologies are distinguished.
By etiology:
According to the presence of effusion and its nature:
According to the course of inflammation:
According to the location of the effusion (degree of pleural damage):
The types of disease are also distinguished according to the scale of distribution: unilateral (left- and right-sided) or bilateral inflammation of the pleural membrane.
Traditionally, inflammation of the serous membrane in adults and children begins with the development of fibrinous pleurisy.
Typically, this form of the disease lasts 7–20 days, and then, if recovery does not occur, it develops into effusion or chronic. Advanced forms of pleural inflammation can also cause dangerous consequences - a sharp decrease in immunity, pleural adhesions, empyema (large accumulation of pus), kidney damage and even death. One of the most dangerous forms, which most often provokes complications, is encysted effusion pleurisy, a transitional stage between acute and chronic inflammation.
With dry pleurisy, the disease begins acutely and suddenly. The first symptoms of pleurisy are:
One of the main diagnostic symptoms of fibrinous pleurisy is auscultatory (noise) signs. When listening, the noise of friction of the pleural layers against each other (due to fibrinous deposits) or wheezing is noticeable.
Dry pleurisy of different types has its own specific manifestations. Most often, the parietal form of inflammation is diagnosed; the main symptoms are chest pain, which always worsens when coughing and sneezing.
With diaphragmatic inflammation, pain can radiate to the shoulder, the anterior part of the peritoneum; there is discomfort when swallowing and hiccups. Apical dry pleurisy can be recognized by pain in the shoulders and shoulder blades, as well as in the arm, along the nerve endings. Dry pleurisy in this form usually develops with tuberculosis and can subsequently develop into encysted pleurisy.
In contrast to the dry form of the disease, the symptoms of effusion inflammation of the pleura are almost the same for different types and locations of effusion fluid. Typically, exudative pleurisy begins with the fibrinous stage, but soon pain and discomfort in the chest are smoothed out due to the fact that the visceral and parietal layers are separated by fluid and no longer touch.
Sometimes this form of the disease develops without the traditional dry stage. In such a situation, the patient does not feel any discomfort in the chest for several days, and only then do characteristic signs appear: fever, weakness, heaviness in the chest, shortness of breath, etc.
The main external manifestations of exudative pleurisy are:
Purulent pleurisy is quite rare, but is one of the most severe forms of this disease, which entails serious consequences. Half of all complications of such inflammation end in death. This disease is especially dangerous for young children in the first year of life and elderly patients. The purulent variety usually develops against the background of a lung abscess.
The symptoms of this pathology vary depending on age: in young patients the disease can be disguised as umbilical sepsis, staphylococcal pneumonia, etc. In older children, the signs of purulent inflammation of the pleura are the same as in adults.
Purulent pleurisy can be recognized by the following signs:
If the disease develops due to a pulmonary abscess, then the breakthrough of the abscess begins with a protracted, painful cough, which ends with a sharp and severe pain attack in the side. Due to intoxication, the skin turns pale, becomes covered in cold sweat, blood pressure drops, and the patient cannot breathe fully. Shortness of breath increases.
Tuberculous pleurisy is the most common pathology among all exudative forms. With respiratory tuberculosis, pleural inflammation is more often diagnosed in children and young people.
In clinical practice, there are three main forms of tuberculous pleurisy:
The allergic stage begins with a sharp increase in temperature to 38ºC and above, tachycardia, shortness of breath, and pain in the side are observed. As soon as the pleural cavity fills with effusion, these symptoms disappear.
Perifocal tuberculous pleurisy usually occurs against the background of an existing one and proceeds for a long time, with periods of remission and exacerbation. Symptoms of the dry form of tuberculous pleurisy are smoothed out: chest pain, noise from pleural friction. With the effusion form, more distinct signs appear - fever, sweating,...
With pulmonary tuberculosis, the classic clinical picture of effusion of the pleura develops: shortness of breath, pressing pain in the chest and side, wheezing, fever, bulge on the affected side of the chest, etc.
In order to make the correct diagnosis and select the appropriate treatment for pleurisy, it is important to determine the cause of inflammation and the formation of exudate (in effusion forms).
Diagnosis of this pathology includes the following methods:
The most effective method for diagnosing pleural pathology today is x-ray. An x-ray allows you to identify signs of inflammation, the volume and location of exudate, as well as some causes of the disease - tuberculosis, pneumonia, tumors, etc.
When diagnosing pleurisy, treatment pursues two important goals - to eliminate the symptoms and eliminate the cause of the inflammation. How to treat pleurisy, in a hospital or at home? Dry forms of the disease in adults can be treated on an outpatient basis, while exudative forms require mandatory hospitalization. Tuberculous pleurisy is treated in tuberculosis dispensaries, purulent - in surgical departments.
Pleurisy is treated with medications depending on the type:
Complex treatment of pleurisy also includes physiotherapeutic procedures, taking multivitamins, and a gentle diet. Surgical removal of exudate from the pleural cavity is indicated in the following cases: when there is too much fluid and the effusion reaches the second rib or the fluid begins to compress neighboring organs, and also when there is a threat of developing purulent empyema.
After successful recovery, patients who have suffered pleurisy are monitored at the dispensary for another 2–3 years.
Prevention of pleurisy is the prevention and timely diagnosis of diseases that can provoke the development of inflammation of the pleural layers.
To do this, you need to follow simple recommendations:
Strengthening the immune system, paying attention to your health and timely consultation with a doctor will help not only protect yourself from inflammation of the pleura, but also prevent such dangerous consequences as pleural adhesions, empyema, pleurosclerosis and overgrowth of the pleural cavity.
Pleurisy is usually called an inflammatory process that affects the lining of the lungs - the pleura.
The relationship of the pleural layers.
In this case, a plaque may form on the pleura, consisting mainly of fibrin substance: in this case, pleurisy is called fibrinous or dry. Or there is an increase in the release of fluid, that is, the formation of effusion, into the pleural cavity and a decrease in its absorption by the layers of the pleura: in this case, pleurisy is usually called effusion or exudative. In normal condition, the pleural layers produce about 1-2 ml of fluid, which is yellowish in color and somewhat similar in composition to plasma - the liquid part of the blood. Its presence reduces the friction of the pleura against each other and ensures normal breathing.
Diagram of the anatomical relationships of the pleura and lung.
Symptoms of pleurisy are quite characteristic. Pleurisy itself is always a secondary pathological process that is part of the picture of any disease or is a complication of it. Dry and effusion pleurisy in adults can either represent stages of one process or occur in isolation.
By origin, two main forms of inflammation of the lung lining in adults can be distinguished: infectious, which is caused by a pathogenic microorganism, and non-infectious, which is most often based on systemic lesions of the body, tumor processes, as well as acute, life-threatening conditions.
In infectious pleurisy, there are several main routes through which pathogenic microorganisms reach the pleura and pleural cavity:
Microphotograph: Mycobacterium tuberculosis.
In this regard, any new appearance of a bacterial agent can cause an active reaction in the form of inflammation of the lung membrane, which is usually exudative in nature.
The main symptoms and signs of dry pleurisy are somewhat different from those in its effusion form. The first complaint characteristic of this disease is usually pain in the side: quite difficult for the patient to bear, worsening during inhalation and coughing. This pain occurs due to the fact that pain nerve endings are scattered in the lining of the lungs. If the patient takes a position on his side on the side of the lesion, and his breathing becomes slow and calm, then the pain decreases somewhat. This is due to the fact that in this position the mobility of the half of the chest on the affected side and the friction of the pleura against each other are correspondingly reduced: this alleviates the patient’s condition.
Breathing in the affected area is weakened as the patient spares the affected side. When listening to the lungs, a pleural friction rub may be detected. The patient's body temperature usually does not exceed 37-37.5 degrees; chills and night sweats may occur, accompanied by weakness and lethargy of the patient.
In general, the course of dry pleurisy in adults is very favorable: the time during which symptoms of the disease appear usually does not exceed 10-14 days. However, within a few weeks after recovery, dry pleurisy may occur again, that is, a relapse may occur, the signs and course of which will repeat the signs and course of the first inflammatory process. Perhaps the patient’s complaints may be somewhat less persistent: repeated lesions may be easier.
The symptoms that occur if effusion accumulates in the pleural cavity are usually in the background after, as a rule, more striking manifestations of the underlying disease. However, the course of effusion pleurisy may be accompanied by respiratory failure, which significantly complicates treatment.
We can distinguish the so-called triad of symptoms, which usually represent the patient’s main complaints:
Diagram of atelectasis resulting from compression of lung tissue by effusion.
It should be noted that pain and cough symptoms with effusion pleurisy are not as pronounced as with its dry form. The pain is usually a feeling of heaviness and can be acute in rare cases. The cough is caused by the fact that inflammation affects the nerve endings that are located in the layers of the lining of the lungs, the pleura. It can also be a consequence of mechanical compression of the bronchi, if the lung tissue collapses - atelectasis, under the influence of exudate, which also puts strong pressure on the organ.
Shortness of breath is more pronounced than the above symptoms. Dyspnea is difficulty breathing. It appears due to the fact that part of the lung tissue, the parenchyma, which directly takes part in gas exchange, ceases to perform its function due to the pressure of the effusion.
The signs usually revealed when examining the chest and listening to the lungs are reduced to a lag in breathing and some visual asymmetry of the affected half of the chest, which are accompanied by a weakening or complete absence of respiratory noise over the site of accumulation of exudate.
If you start percussing, that is, tapping, the chest, the same sound will be heard above the exudate as above the thigh. The latter is called blunt or femoral and is an important, reliable diagnostic sign for pleural effusions, thanks to which you can immediately approximately determine the level of effusion fluid.
To confirm the presence of effusion in the pleural cavity, radiographic examination is now mandatory: the radiograph reveals an area of darkening corresponding to the exudate.
Darkening (exudate) is white.
It is also important to have the patient X-rayed in the lateral position. If the exudative fluid is displaced, then it is possible to exclude its encystation, that is, the restriction of mobility due to the formation of dense “walls” of connective tissue, and the transition of this inflammatory process to chronic.
However, it should be noted that if the volume of pleural effusion is small: 200-250 ml, radiography may give questionable results. In this case, you should resort to an ultrasound examination, which will reveal an effusion of less than 200 ml. In addition, if it is technically possible to do this, identifying fluid in the pleural cavity will not be difficult using computed tomography.
When the presence of pleural effusion is determined and beyond doubt, it is necessary to perform a surgical procedure - thoracentesis, that is, puncture or puncture of the pleural cavity.
Thoracentesis technique. Scheme.
This will allow you to obtain exudate and examine it. In addition, the evacuation of exudate from the pleural cavity will allow the previously compressed area of the lung parenchyma to straighten. At the same time, it will gradually again begin to perform the function of gas exchange. There are only two main indications for puncture of the pleural cavity. Firstly, these include the unclear nature and origin of the effusion. Secondly, its quantity: if there is a lot of exudate, the patient can quickly develop respiratory failure.
Most often, the symptoms of pleurisy are combined with pneumonia, heart failure, rheumatism and tumor metastases. Pleurisy occurs a little less frequently when infected with tuberculosis.
Pleurisy with pneumonia usually occurs if the main diagnosis is “lobar pneumonia.” As a rule, even at the first stage of the disease, that is, the flushing stage, dry pleurisy occurs. Pleurisy usually ends at the stage of resolution of pneumonia.
With heart failure, tuberculosis and metastasis, that is, spread, of tumors there is usually an effusion form of pleurisy. The course of the latter depends on the initial, initial disease.
If the course of the disease is severe, and the patient’s breathing is significantly weakened due to the pressure that the exudate exerts on the lung tissue, then the effusion must be evacuated from the pleural cavity. With tumors and heart failure, effusion can accumulate again and again.
When the contents from the pleural cavity are obtained, it is important to examine it in the laboratory: the composition of the effusion often reliably indicates the root cause of pleurisy.
The main respiratory organ in the human body is the lungs. The unique anatomical structure of the human lungs fully corresponds to the function they perform, which is difficult to overestimate. Pulmonary pleurisy is caused by inflammation of the pleural layers for infectious and non-infectious reasons. The disease does not belong to a number of independent nosological forms, as it is a complication of many pathological processes.
Pulmonary pleurisy is one of the most complex inflammatory diseases, most severely occurring in children and the elderly. The pleura is the serous membrane of the lung. It is divided into visceral (pulmonary) and parietal (parietal).
Each lung is covered with pulmonary pleura, which along the surface of the root passes into the parietal pleura, lining the walls of the chest cavity adjacent to the lung and delimiting the lung from the mediastinum. The pleura that covers the lungs allows them to painlessly come into contact with the chest during breathing.
The lungs are a paired organ. Every person has two lungs - right and left. The lungs are located in the chest and occupy 4/5 of its volume. Each lung is covered with pleura, the outer edge of which is tightly fused with the chest. Lung tissue resembles a finely porous pink sponge. With age, as well as with pathological processes of the respiratory system, long-term smoking, the color of the pulmonary parenchyma changes and becomes darker.
Breathing is a largely uncontrolled process carried out at a reflex level. A certain zone is responsible for this – the medulla oblongata. It regulates the pace and depth of breathing, focusing on the percentage of carbon dioxide concentration in the blood. The rhythm of breathing is affected by the work of the whole organism. Depending on the breathing rate, the heart rate slows down or speeds up.
Depending on the cause of the disease, the forms of manifestation of the disease may also differ and are divided into:
By distribution area:
According to the nature of the lesion, pleurisy is divided into:
Pleurisy is also divided according to the nature of its spread:
It must be said that the disease in its pure form is rare. For example, its development can be caused by trauma to the chest or hypothermia. In most cases, it accompanies any disease or occurs as a complication of it.
Pulmonary pleurisy is characterized by the formation of fibrinous deposits on the surface of the pleural layers and/or accumulation of exudate in the pleural cavity. Symptoms depend on the form of the disease.
Infectious pleurisy is the most common. Sensitization of the body also plays a major role in the mechanism of development of pathology. Microbes and their toxins lead to changes in the body's reactivity and allergization of the pleura. The immune system begins to “send” produced antibodies to the site of inflammation, which, when combined with antigens, affect the production of histamines.
About 70% of forms of pathology are caused by bacterial agents:
The causes of non-infectious pulmonary pleurisy are as follows:
Is pleurisy contagious?
To answer this question unambiguously, you need to know the cause of pleurisy itself. If the suffering is associated with a chest injury, then, naturally, such pleurisy is not contagious. With a viral etiology, it can be quite contagious, although the degree of contagiousness is low.Patients often miss the onset of pleurisy because its symptoms are similar to the common cold. However, the signs of this pathology still differ from other respiratory diseases. You should know that the signs of different types of pleurisy are also different.
The very first and most obvious sign of pulmonary pleurisy is:
The rate at which symptoms increase also plays a big role:
How does pulmonary pleurisy occur in older people? In old age, there is a sluggish course and slow resorption of the source of inflammation.
| Types of pleurisy | Description and symptoms |
| Dry | Dry pleurisy develops at the initial stage of inflammatory damage to the pleura. Often, at this stage of pathology, there are still no infectious agents in the lung cavity, and the changes that occur are due to the reactive involvement of blood and lymphatic vessels, as well as an allergic component.
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| Purulent | Purulent pleurisy can form either due to direct damage to the pleura by infectious agents, or due to the spontaneous opening of an abscess (or other accumulation of pus) of the lung into the pleural cavity. Patients with purulent pleurisy complain of:
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| Exudative | During the period of exudate accumulation, intense pain in the chest occurs. Symptoms intensify with deep breathing, coughing, and movements. Increasing respiratory failure is manifested by pallor of the skin, cyanosis of the mucous membranes, and acrocyanosis. Typically the development of compensatory tachycardia and a decrease in blood pressure. |
| Tuberculous | The clinical picture of tuberculous pleurisy is diverse and is closely related to the characteristics of tuberculous inflammation in the pleural cavity and lungs. In some patients, simultaneously with pleurisy, other manifestations of tuberculosis, especially primary tuberculosis (paraspecific reactions, specific damage to the bronchi), are noted. |
Inflammation of the pleura develops in response to the introduction of pathogenic microbes and consists of 3 stages: exudation, formation of purulent discharge and recovery.
Exudate is a liquid coming out of microvessels, containing a large amount of protein and, as a rule, blood elements. Accumulates in tissues and/or body cavities during inflammation.
At the first stage, under the influence of the pathogen, the blood vessels dilate, the degree of their permeability increases, and the process of fluid production intensifies.
The exudation stage gradually turns into the stage of formation of purulent discharge. This occurs during the further development of the pathology. Fibrin deposits appear on the pleural layers, which create friction between them during breathing. This leads to the formation of adhesions and pockets in the pleural cavity, complicating the normal outflow of exudate, which becomes purulent in nature. Purulent discharge consists of bacteria and their waste products.
At the third stage, the symptoms gradually subside, the patient either recovers, or the disease becomes chronic. Despite the fact that the external symptoms of the disease subside and cease to annoy the patient, internal pathological processes gradually develop further.
Why is pulmonary pleurisy dangerous? As a result of the formation of scars (moorings), individual blocks of the lung are blocked, which contributes to less air intake during inhalation, resulting in increased breathing.
Advanced forms of pleurisy can lead to the development of health and life-threatening complications - pleural adhesions, local circulatory disorders due to compression of blood vessels by exudate, bronchopleural fistulas.
The main complications of pleurisy:
The prognosis for such complications is very serious: mortality reaches 50%. The percentage of dying patients is even higher among elderly and frail people and young children.
If symptoms are detected, you should immediately consult a doctor: if there is no temperature, contact your local general practitioner; in case of unstable health or associated infectious disease - go to the emergency department
Upon examination, the diseased half of the chest lags behind in the act of breathing, this can be seen by the movement of the shoulder blades. When listening to the lungs, a very characteristic sound of pleural friction is detected. Radiography for acute dry pleurisy does not provide sufficient information. Laboratory tests will characterize the underlying disease.
After the patient has been diagnosed, fluid is collected from the pleura to determine what fluid is accumulating in it. Most often it is exudate or pus, in rare cases it is blood. It is noteworthy that the purulent form of the disease is more common in children.
The following examinations are used to diagnose pleurisy:
If you have been diagnosed with “pulmonary pleurisy,” your doctor will explain what it is and how to treat the disease. If pleurisy is suspected, the symptoms and all previous treatments are analyzed and the patient is hospitalized.
Depending on the type of disease, certain medications are prescribed that help eliminate inflammation and reduce symptoms. But it is necessary not only to take pills: you will need proper nutrition and exercise to restore the organs completely.
Drug treatment depends on the cause of pleurisy, namely:
The type of drug depends on the cause of the disease. If it is infectious in nature, antibiotics are used, if it is allergic, anti-allergenic drugs are used.
In the early stage of fibrinous pleurisy of the lungs, semi-alcoholic warming compresses and electrophoresis with calcium chloride are recommended.
When treating exudative pleurisy of the lungs, physiotherapy is carried out in the resolution phase (resorption of exudate) in order to accelerate the disappearance of exudate and reduce pleural adhesions.
In case of exacerbation, patients are prescribed warming of the chest with infrared rays, ultraviolet irradiation of the chest, and daily paraffin applications. After acute inflammation subsides, calcium and iodine electrophoresis is performed. A month after recovery, water procedures, exercise therapy, manual and vibration massage are indicated.
Patients need to eat a balanced diet and drink plenty of fluids. The patient is also prescribed a special diet, which is based on a lot of vitamins and proteins.
After discharge from the hospital, patients must perform breathing exercises prescribed by the doctor to restore full lung function. Moderate physical activity, long walks in the fresh air are recommended, and yoga is very useful. Being in a coniferous forest is especially useful for those recovering.
It is important to understand that it is impossible to treat pleurisy with folk remedies alone, since the disease can quickly progress and lead to respiratory failure and suppuration of the effusion.
Treatment of pulmonary pleurisy with folk remedies involves the use of compresses and the use of infusions, decoctions, and tinctures.
Very simple: it is necessary to adequately treat the primary infectious disease, monitor nutrition, alternate physical activity with quality rest, not overheat and not succumb to excessive cooling.
Remember that pleurisy is a consequence of another disease. Never stop treatment halfway due to laziness or lack of time, and always try to avoid situations that could provoke an infection.
Turning to human anatomy, the mechanism of the disease becomes clear.
Pleura- consists of outer and inner layers with an intermediate fissure or pleural cavity. Under the influence of any reasons (autoimmune, infection), the level of permeability in the pleural vessels increases, liquid plasma components of the blood, as well as proteins, enter the cavity. With a small volume, the liquid is absorbed back, with the exception of fibrin (blood protein), which becomes a sediment on the pleura - they thicken. In this way it is formed fibrinous or dry pleurisy. With a larger volume of fluid in the pleural cavity, exudative pleurisy.
In contact with
Pleurisy makes the pathological processes occurring in the human body more complex. Symptoms of this inflammation are often observed in patients with tuberculosis, after suffering from cancer, and also against the background of oncology. Men under 40 years of age are more susceptible to the disease. contribute to its occurrence:
In general, there are three main reasons or ways of inflammation formation:
Aseptic etiology:
Mixed ancestry:
The clinical picture of pleurisy is divided into dry and exudative.
In the acute course of the disease, the doctor diagnoses pleural noise by auscultation, which does not stop after pressing with a stethoscope or coughing. Dry pleurisy, as a rule, goes away without any negative consequences - of course, with an adequate treatment algorithm.
Acute serous pleurisy is usually of tuberculous origin
characterized by three stages:
In the initial period (exudative) smoothing or even bulging of the intercostal space is noted. The mediastinal organs are shifted to the healthy side under the influence of a large amount of fluid in the pleural fissure.
Stabilization period characterized by a decrease in acute symptoms: the temperature drops, chest pain and shortness of breath disappear. At this stage, pleural friction may appear. In the acute phase, a blood test shows a large accumulation of leukocytes, which gradually returns to normal.
It often happens that fluid accumulates above the diaphragm, so it is not visible with a vertical x-ray. In this case, it is necessary to conduct the study in a lateral position. Free fluid moves easily in accordance with the position of the patient's torso. Often its accumulations are concentrated in the cracks between the lobes, as well as in the area of the diaphragm dome.
Clinical manifestations of pleural inflammation are divided into:
Acute symptoms, in addition to the described serous pleurisy, include purulent forms - pneumothorax and pleural empyema. They can be caused by tuberculosis and other infections.
Purulent pleurisy caused by pus entering the pleural cavity, where it tends to accumulate. It should be taken into account that non-tuberculous empyema can be treated relatively well, but with an inadequate algorithm of action it can develop into a more complex form. Tuberculous empyema is severe and can be chronic. The patient loses significant weight, suffocates, experiences constant chills, and suffers from coughing attacks. In addition, the chronic form of this type of pleurisy causes amyloidosis of internal organs.
If optimal care is not provided, complications arise:
Very simple: it is necessary to adequately treat the primary infectious disease, monitor nutrition, alternate physical activity with quality rest, not overheat and not succumb to excessive cooling.
Perifocal pleurisy– in patients with pulmonary forms of tuberculosis, it is of a chronic, stagnant nature. Relapses are possible. The exudate is serous, also without mycobacteria.
If you find the described signs of pleural inflammation in yourself or people close to you, you should urgently contact your local physician.
After an initial examination of the clinical picture, which can tell a specialist a lot, take a series of tests and follow the doctor’s further instructions. Most likely, a referral to a pulmonologist will follow.
It is important to remember that if the disease is diagnosed early, the doctor will prescribe adequate therapy, following which you can count on a final full recovery.
Most people, experiencing periodic tingling pain in the chest, do not consult a doctor, believing that such symptoms can be caused by a common uncomfortable position. And even the cough that appears is not a cause for concern - everything is attributed to a cold. But the symptoms presented may indicate the onset of a serious illness - pulmonary pleurisy. It is this that can lead to serious consequences, some of which can only be treated with surgery.
To prevent this scenario, it is necessary to be fully informed about the dangers and other features of the disease presented. You should know all the symptoms in order to consult a doctor in time. And do not be alarmed if purulent pleurisy is diagnosed - with timely medical treatment, such forms of the disease will not occur, and the range of actions will be limited to taking antibiotics.
The pleura is the protective membrane of the lung, which helps the respiratory organs to fully open when inhaling and “eliminates” pain when it comes into contact with the diaphragm. Its inflammation leads to pleurisy, which causes pain and other unpleasant symptoms.
The protective shell consists of numerous blood and lymphatic vessels. With inflammation, the pleural cavity fills with fluid or pus, which leads to an enlargement of the lung, and, consequently, difficulty breathing and pain when inhaling.
It should also be noted that inflammation can be carried out without fluid accumulation. This is called the dry form of pleurisy. It is quite common and can be “hidden” for a long time from a sick person. Therefore, it is not enough to know what pulmonary pleurisy is. You need to be aware of all the incidents and features that are rare, but have quite severe forms of manifestation.
Experts say that pleurisy cannot occur suddenly without any prerequisites. This disease can be classified as a “postscript” of dangerous ailments, which, in turn, are divided into infectious and non-infectious.
Infectious causes of pleurisy:
Non-infectious causes include:
But, despite the presented peculiarity of the causes of pleurisy, this disease can also occur due to hypothermia of the lungs, and a person may not notice this - a draft in the summer can provoke the development of inflammation of the pleura.
The danger of pleurisy lies in its long-term development. For example, inflammation can be a rather lengthy process, and the symptoms will be expressed in a slight pain syndrome when inhaling. Such signs of pleurisy will intensify over time, a rise in temperature and coughing attacks are possible, but this can only begin in a month, and this already indicates that the disease is advanced.
Symptoms of pleurisy, depending on its form, can vary significantly. In the dry form, a person begins to experience general malaise, shivering and possibly a slight increase in temperature. Already behind these listed symptoms, you can notice rapid breathing due to the inability to take a full breath with your lungs, since actions lead to pain. After some time, the patient is bothered by a slight cough, which then becomes permanent and results in corresponding attacks.
During inflammation of the lining of the lungs, the patient tries to take a comfortable position, because it is uncomfortable for him to lie on his side on the side of the affected lung. He has a bluish complexion and swollen veins in his neck.
Symptoms of pulmonary pleurisy in adults are no different from small representatives of humanity. Children also often suffer from inflammation of the pleura, which occurs due to reduced immunity or hypothermia. If your baby complains to you about pain in the chest or side, take a closer look at him at rest or during sleep. During rest, the baby does not control his breathing and the opening of his lungs, so you will notice rapid breathing, and in the presence of accumulated fluid, characteristic wheezing. You will also be able to independently determine the affected lung - the baby will lie on the side of the healthy respiratory organ. If both lungs are affected, he will sleep restlessly and constantly change position.
With exudative pleurisy - when fluid or pus accumulates - the patient may feel some relief. The pain in his side will stop, but his cough will not decrease. As the amount of foreign content in the lungs increases, a person develops shortness of breath, and the heart and other internal organs become displaced. Therefore, in addition to pain in the side, rapid heartbeat and abdominal pain may appear, which indicates the impact of the respiratory organ on the stomach and other components of the gastrointestinal tract.
As mentioned above, pleurisy has several forms of manifestation. They are characterized by the characteristics of inflammation of the pleura and the course of the disease. There are also characteristic differences in the treatment of a certain form. When diagnosing pleurisy, the doctor always indicates the form of inflammation. There are three main forms: exudative, dry and purulent pleurisy. All forms can lead to the formation of another variety, leading to different symptoms and treatment.
Dry pleurisy occurs more often than forms with accumulation of exudate - liquid with a high concentration of fibrin. The presented form of pleurisy is always accompanied by severe pain when breathing and sneezing. Elevated body temperature often leads to fever.
The dry form of the present disease is characterized by severe inflammation of the protective membrane, which is diagnosed by an auscultated pleural friction noise. Here the specialist will note weakened breathing in the area of fibrinous pleural overlays. That is why the presented form also has a second name – fibrinous.
Fibrinous pleurisy occurs much more often, but recovery time takes much less. With timely intervention, you can reach a healthy state within 2-3 weeks. Also, treatment of the disease can be significantly delayed if adhesions have formed on the mucous membrane of the pleura. Depending on the location of the cysts and adhesions, fibrinous pleurisy is divided into types:
If you experience these symptoms, you should immediately consult a doctor. If intervention is not timely, dry pleurisy turns into exudative.
Exudative pleurisy most often results from pneumonia, tuberculosis or rheumatism. Characterized by the accumulation of exudate in the pleural cavity. Exudate is a liquid that, in large quantities, causes additional pressure and thereby makes breathing difficult. There are often cases of accumulation of exudate in the amount of several liters.
The main symptoms of this form of the disease are shortness of breath and general malaise, accompanied by headaches and fever. When fluid accumulations increase, the doctor notes a shortened percussion sound in the patient. The exudative form of pleurisy is easily diagnosed by X-ray examination.
Exudative pleurisy also has its own varieties, which are characterized by the structure of the accumulated exudate. Types of exudative pleurisy include:
Exudative pleurisy can be cured by taking antibiotics, but only at the initial stage of the disease. Large quantities of accumulated fluid are removed using puncture.
Tuberculous pleurisy directly indicates the development of a tuberculosis process, which is hidden. For example, the presented form of the disease rarely occurs independently. Here, the consequences of the development of tuberculosis of the lymph nodes or the lungs themselves are more often noted. In turn, this form is also divided into varieties:
Tuberculous pleurisy is a rather dangerous disease, so at the first symptoms it must be diagnosed and effective treatment initiated.
Encapsulated pleurisy is the accumulation of fluid in one cavity of the lungs. Often the patient feels pain in only one place and is not aware of the development of tuberculosis, which is accompanied by encysted pleurisy. Such ignorance and untimeliness of diagnosis significantly increases the treatment time, and its elimination methods become more complicated.
Adhesive pleurisy has a second name - chronic. This form of the disease occurs every time the acute form is not treated in a timely manner. It also accompanies diseases such as tuberculosis and hemothorax. It is characterized by thickening of the pleura, which provokes a violation of the ventilation function of the respiratory organs.
With this form of pleurisy, the volume of the lungs decreases significantly, resulting in significant oxygen starvation of the entire body, which is expressed by dizziness and nausea. It should also be noted that pain with adhesive pleurisy in the initial stages appears only when coughing or sneezing. Such features can lead to a complicated form quite quickly, which will entail long and complex treatment.
Purulent pleurisy develops as a consequence of a lung abscess caused by the occurrence of multiple or single ulcers. The infection subsequently passes through the lymphatic ducts to the pleura or direct entry of pus into the pleural cavity occurs. This form can occur as a result of untimely intervention in the treatment of tuberculous serous pleurisy, as well as as a consequence of advanced pneumonia. It should also be noted that purulent pleurisy can develop through the formation of metastases during the spread of peritonitis or purulent appendicitis.
Acute purulent pleurisy is characterized by the spread of the lesion throughout the pleural cavity, which significantly complicates the diagnosis of the disease. Here the patient experiences a high fever, which is accompanied by prolonged fever with sweating. A sick person has difficulty breathing, pale skin is noted, indicating general intoxication of the body.
Diagnosis of pleurisy is a rather important aspect, since a timely diagnosis can directly affect the patient’s speedy recovery. The following diagnostic methods are used here:
As a rule, when conducting diagnostics, doctors use all of the listed methods to make a diagnosis with accuracy.
As already described above, treatment of pleurisy depends on its form. But the initial actions to eliminate the disease are aimed at alleviating the symptoms and eliminating the factor that caused the presented disease.
The consequences caused by pneumonia are treated with antibiotic therapy. Non-steroidal anti-inflammatory and glucocorticosteroid drugs are prescribed here. Dry pleurisy is always treated with antibiotics. The main role in treatment is played by antihistamines and painkillers, which will quickly eliminate unpleasant symptoms in the form of pain. If you experience severe coughing attacks, your doctor may prescribe antitussive medications. Self-treatment of pleurisy with antibiotics is prohibited, as this can only worsen the situation. Also, with the dry form of the disease, the use of expectorants is under no circumstances allowed, since in this case there is no sputum, and, therefore, coughing attacks will lead to increased pain.
Tuberculous pleurisy is subject to taking antibiotics such as rifampicin, isoniazid, streptomycin. The medications presented should be taken only as prescribed by a doctor and continued until complete recovery.
As for the treatment of the exudative form of pleurisy, everything is somewhat more complicated. To begin with, the patient is admitted to the hospital in the pulmonology department. The beginning of treatment consists of a puncture, since the results of fluid tests need to determine the cause of the disease. If tuberculosis is detected in a patient, he is transferred to the department for tuberculosis patients. If the reason is oncology, oncology is treated in the department for patients with oncological inflammation.
It should also be noted that puncture is not only a method for identifying the cause, but also as an independent treatment. That is, a patient with exudative pleurisy must undergo fluid removal, since in large quantities it can lead to the formation of adhesions. This procedure is performed under local anesthesia and more than once, because in some cases the formation of fluid can be diagnosed already 5 days after the first puncture. Antibiotic therapy is also carried out here, depending on the form and course of the disease.
Pleurisy of the lungs and treatment with traditional methods is a rather dangerous activity, as it can lead to severe complications. Such methods of treatment can be used as additional, but not primary ones. It is also recommended to consult with your doctors when using the specific prescription you have chosen. Due to various forms and features, “mismatch” can be fraught with the occurrence of any complications.
Experts say that treatment of pulmonary pleurisy with traditional methods can only be carried out if the disease is in a dry form. Exudative pleurisy is most often subject to puncture. Even experienced doctors do not risk using only antibiotic therapy as the main treatment.
Traditional treatment methods include:
As a folk remedy for treating pleurisy, get regular massage from an experienced specialist. Don't forget about regular walks. But the described methods cannot be used at the stage of exacerbation of the disease. This is fraught with additional hypothermia and, as a result, complications.
How to treat pleurisy at home and not harm yourself? Of course, carry out therapeutic exercises, which will significantly facilitate the patient’s breathing and provoke the resorption of fluid from the pleural cavity. It should be noted that any exercise is prohibited if there are symptoms in the form of pain during inhalation and exhalation.
Some exercises are used as treatment to help prevent the formation of adhesions and other cysts on the pleura, which entails surgical intervention. Use the following simple sets of exercises:
Combine breathing exercises with self-massage of the chest and intercostal spaces.
Many people are interested in a completely objective question: is pulmonary pleurisy contagious to others? Here, experts offer some encouragement to people who, for whatever reason, were forced to communicate with the sick. The presented disease is dangerous only if the cause of pleurisy is a viral disease. In other cases, pulmonary pleurisy is not transmitted to interlocutors and simply surrounding people.
Many studies have proven that even the presence of viral causes of pulmonary pleurisy, the likelihood of infection is very low. But experts themselves warn people to be careful and try not to come into contact with sick people. If such actions are unavoidable, follow the rules and safety precautions. Use a respiratory mask, and if you experience coughing or chest pain when inhaling, consult a doctor immediately.
Complications of pulmonary pleurisy, the consequences of which can only be eliminated by surgical intervention, involve the formation of adhesions in the pleural cavity. Also, circulatory disorders due to compression of blood vessels due to exposure to exudate can be identified as complications.
More complicated processes include thickening of the pleura, which can lead to complete deformation of the pleural cavity and the respiratory organ as a whole. Such disorders lead to a failure of the respiratory mobility of the lungs. As a result, the risk of respiratory and heart failure increases.
It is important to know what diseases can be complicated by exudative pleurisy. Due to compression of the abdominal cavity, there is a high probability of developing gastrointestinal diseases, complications of cancer and other inflammatory diseases. You can also note the occurrence of problems with joints, which is revealed as a result of impaired blood circulation, and, therefore, the enrichment of joints and internal organs with useful microelements. A dangerous disease, such as exudative pleurisy, can cause complications even with fractures, which is also provoked by poor provision due to disorders of the respiratory and cardiovascular systems.
More dangerous consequences caused by exudative pleurisy may be the fusion of the lungs with other internal organs. And if, when connecting the respiratory organ with the diaphragm and other internal organs, a separation operation can be performed, then in the case of fusion with the heart, surgeons do not take responsibility. Such actions can only occur in case of serious problems that threaten the life of the sick person.
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