Pleurisy is one of the most common pathological conditions respiratory system. It is often called a disease, but this is not entirely true. Pleurisy of the lungs is not an independent disease, but rather a symptom. In women, in 70% of cases, pleurisy is associated with malignant neoplasms in the mammary gland or reproductive system. Very often the process develops in cancer patients against the background of metastases in the lungs or pleura.
Timely diagnosis and treatment of pleurisy helps prevent dangerous complications. Diagnosis of pleurisy for professional doctor won't be difficult. The patient’s task is to seek medical help in a timely manner. Let's take a closer look at what signs indicate developing pleurisy and what forms of treatment exist for this pathological condition.
Characteristics of the disease and types of pleurisy
Pleurisy is an inflammation of the pleura, the serous membrane that envelops the lungs. The pleura looks like translucent sheets connective tissue. One of them is adjacent to the lungs, the other lines the chest cavity from the inside. Fluid circulates in the space between them, which ensures the sliding of the two layers of the pleura during inhalation and exhalation. Its amount normally does not exceed 10 ml. With pleurisy of the lungs, fluid accumulates in excess. This phenomenon is called pleural effusion. This form of pleurisy is called effusion, or exudative. It occurs most often. Pleurisy can also be dry - in this case, fibrin protein is deposited on the surface of the pleura, and the membrane thickens. However, as a rule, dry (fibrinous) pleurisy is only the first stage of the disease, which precedes further formation of exudate. In addition, when the pleural cavity is infected, the exudate can be purulent.
As already mentioned, medicine does not classify pleurisy as an independent disease, calling it a complication of other pathological processes. Pleurisy may indicate lung disease or other diseases that do not cause damage to the lung tissue. Based on the nature of the development of this pathological condition and the cytological analysis of the pleural fluid, along with other studies, the doctor is able to determine the presence of the underlying disease and take adequate measures, but pleurisy itself requires treatment. Moreover, in the active phase it is able to come to the fore in the clinical picture. That is why in practice pleurisy is often called a separate disease of the respiratory system.
So, depending on the state of the pleural fluid, the following are distinguished:
- purulent pleurisy;
- serous pleurisy;
- serous-purulent pleurisy.
The purulent form is the most dangerous, since it is accompanied by intoxication of the entire body and, in the absence of proper treatment, threatens the life of the patient.
Pleurisy can also be:
- acute or chronic;
- severe or moderate;
- affect both parts chest or appear only on one side;
- development is often provoked by infection, in which case it is called infectious.
There is a wide list of non-infectious causes of pulmonary pleurisy:
- connective tissue diseases;
- vasculitis;
- pulmonary embolism;
- chest injuries;
- allergy;
- oncology.
In the latter case, we can talk not only about lung cancer itself, but also about tumors of the stomach, breast, ovaries, pancreas, melanoma, etc. When metastases penetrate into the lymph nodes of the chest, the outflow of lymph occurs more slowly, and the pleura becomes more permeable. Fluid leaks into the pleural cavity. It is possible to close the lumen of a large bronchus, which lowers the pressure in the pleural cavity, and therefore provokes the accumulation of exudate.
In non-small cell lung cancer (NSCLC), pleurisy is diagnosed in more than half of the cases. In adenocarcinoma, the frequency of metastatic pleurisy reaches 47%. At squamous cell carcinoma lung - 10%. Bronchiolo-alveolar cancer leads to pleural effusion at an early stage, and in this case, pleurisy may be the only signal of the presence of a malignant tumor.
Vary depending on the shape clinical manifestations pleurisy. However, as a rule, it is not difficult to determine pulmonary pleurisy. It is much more difficult to find the true cause that caused inflammation of the pleura and the appearance of pleural effusion.
Symptoms of pleurisy
The main symptoms of pulmonary pleurisy are pain in the chest, especially when inhaling, a cough that does not bring relief, shortness of breath, and a feeling of tightness in the chest. Depending on the nature of the pleural inflammation and location, these signs may be obvious or almost absent. With dry pleurisy, the patient feels pain in the side, which intensifies when coughing, breathing becomes difficult, weakness, sweating, and chills are possible. The temperature remains normal or increases slightly - no more than 37° C.
With exudative pleurisy, weakness and bad feeling more pronounced. Fluid accumulates in the pleural cavity, compresses the lungs, and prevents them from expanding. The patient cannot breathe fully. Irritation of nerve receptors in the inner layers of the pleura (there are practically none in the lungs themselves) causes a symptomatic cough. In the future, shortness of breath and heaviness in the chest only intensify. The skin becomes pale. A large accumulation of fluid prevents the outflow of blood from the neck veins, they begin to bulge, which eventually becomes noticeable. The part of the chest affected by pleurisy is limited in movement.
With purulent pleurisy, noticeable temperature fluctuations are added to all the above symptoms: up to 39–40° in the evening and 36.6–37° in the morning. This indicates the need to urgently consult a doctor, since the purulent form is fraught with serious consequences.
Diagnosis of pleurisy takes place in several stages:
- Examination and interview of the patient. The doctor finds out the clinical manifestations, how long ago it occurred and the patient’s level of well-being.
- Clinical examination. Apply different methods: auscultation (listening with a stethoscope), percussion (tapping with special instruments for the presence of fluid), palpation (palpation to identify painful areas).
- X-ray and CT scan. X-ray allows you to visualize pleurisy, assess the volume of fluid, and in some cases, identify metastases in the pleura and lymph nodes. Computed tomography helps to determine the extent of prevalence more accurately.
- Blood analysis. During the inflammatory process in the body, the ESR, the number of leukocytes or lymphocytes increases. This study is necessary to diagnose infectious pleurisy.
- Pleural puncture. This is the collection of fluid from the pleural cavity for laboratory research. The procedure is carried out in cases where there is no threat to the patient’s life. If too much fluid has accumulated, thoracentesis (thoracentesis) is immediately performed - removal of exudate through a puncture using a long needle and electric suction, or a port system is installed, which is the preferred solution. The patient's condition improves, and some of the fluid is sent for analysis.
If after all the stages the exact picture remains unclear, the doctor may prescribe a video thoracoscopy. A thoracoscope is inserted into the chest - this is an instrument with a video camera that allows you to examine the affected areas from the inside. If we're talking about about oncology - it is necessary to collect a fragment of the tumor for further research. After these manipulations, it is possible to make an accurate diagnosis and begin treatment.
Treatment of the condition
Treatment of pulmonary pleurisy should be comprehensive, aimed at eliminating the disease that caused it. Therapy for pleurisy itself is usually symptomatic, designed to accelerate the resorption of fibrin, prevent the formation of adhesions in the pleural cavity and fluid “bags,” and alleviate the patient’s condition. The first step is to remove pleural edema. At high temperatures, the patient is prescribed antipyretics, and for pain, analgesic NSAIDs. All these actions make it possible to stabilize the patient’s condition, normalize respiratory function and effectively treat the underlying disease.
Treatment of pleurisy in a mild form is possible at home, in a complex form - exclusively in a hospital. It may include different methods and techniques.
- Thoracentesis . This is a procedure in which accumulated fluid is removed from the pleural cavity. Prescribed for all cases of effusion pleurisy in the absence of contraindications. Thoracentesis is performed with caution in the presence of pathology of the blood coagulation system, high blood pressure in the pulmonary artery, severe obstructive pulmonary disease, or the presence of only one functional lung. Local anesthesia is used for the procedure. A needle is inserted into the pleural cavity on the side of the scapula under ultrasound guidance and exudate is collected. The compression of the lung tissue decreases, making it easier for the patient to breathe.
- Often the procedure needs to be repeated, for this purpose modern and completely safe intrapleural port systems
, providing constant access to the pleural cavity both for evacuation of exudate and for insertion medicines, including during chemotherapy.
We are talking about a system consisting of a catheter, which is inserted into the pleural cavity, and a titanium chamber with a silicone membrane. Installation requires only two small incisions, which are later sutured. The port is installed in the soft tissue of the chest wall, under the skin. In the future, it does not cause any inconvenience to the patient. The manipulation takes no more than an hour. The patient can go home the very next day after the port is installed. When you need to evacuate the exudate again, it is enough to pierce the skin and the silicone membrane under it. It's fast, safe and painless. In the event of a sudden need and lack of access to medical care, with a certain skill and knowledge of the rules of the procedure, even relatives are able to independently empty the patient’s pleural cavity of fluid through a port. - Another type of intervention is pleurodesis . This is an operation for artificial creation adhesions between the layers of the pleura and destruction of the pleural cavity so that fluid has nowhere to accumulate. The procedure is usually prescribed for cancer patients when chemotherapy is ineffective. The pleural cavity is filled with a special substance that prevents the production of exudate and has an antitumor effect - in the case of oncology. These may be immunomodulators (for example, interleukins), glucocorticosteroids, antimicrobial agents, radioisotopes and alkylating cytostatics (derivatives of oxazaphosphorine and bis-β-chlorethylamine, nitrosourea or ethylenediamine, platinum preparations, alkyl sulfonates, triazines or tetrazines), which depends solely on the specific clinical case .
- If the above methods do not work, it is shown removal of the pleura and installation of a shunt . After shunting, fluid from the pleural cavity passes into the abdominal cavity. However, these methods are considered radical and can cause serious complications, so they are resorted to last.
- Drug treatment . In cases where pleurisy is of an infectious nature or complicated by an infection, antibacterial drugs are used, the choice of which depends entirely on the type of pathogen and its sensitivity to a specific antibiotic. Medicines, depending on the nature of the pathogenic flora, may include:
- natural, synthetic, semi-synthetic and combined penicillins (benzylpenicillin, phenoxymethylpenicillin, methicillin, oxacillin, nafcillin, ticarcillin, carbpenicillin, Sultasin, Oxamp, Amoxiclav, mezlocillin, azlocillin, mecillam);
- cephalosporins (“Mefoxin”, “Ceftriaxone”, “Keyten”, “Latamoccef”, “Cefpirome”, “Cefepime”, “Zeftera”, “Ceftolozane”);
- fluoroquinolones (“Microflox”, lomefloxacin, norfloxacin, levofloxacin, sparfloxacin, moxifloxacin, gemifloxacin, gatifloxacin, sitafloxacin, trovafloxacin);
- carbapenems (“Tienam”, doripenem, meropenem);
- glycopeptides (“Vancomycin”, “Vero-Bleomycin”, “Targotsid”, “Vibativ”, ramoplanin, decaplanin);
- macrolides (“Sumamed”, “Yutacid”, “Rovamycin”, “Rulid”);
- ansamycins (“Rifampicin”);
- aminoglycosides (amikacin, netilmicin, sisomycin, isepamycin), but they are incompatible with penicillins and cephalosporins during simultaneous therapy;
- lincosamides (lincomycin, clindamycin);
- tetracyclines (doxycycline, Minolexin);
- amphenicols (“Levomycetin”);
- other synthetic antibacterial agents (hydroxymethylquinoxaline dioxide, fosfomycin, dioxidine).
To treat inflammation of the pleura, anti-inflammatory and desensitizing drugs are also prescribed (electrophoresis of a 5% solution of novocaine, analgin, diphenhydramine, 10% solution of calcium chloride, 0.2% solution of platyphylline hydrotartrate, indomethacin, etc.), regulators of water-electrolyte balance ( saline and glucose solution), diuretics (“Furosemide”), lidase electrophoresis (64 units every 3 days, 10–15 procedures per course of treatment). They may prescribe drugs for dilation of the bronchi and cardiac glycosides that enhance myocardial contraction (Eufillin, Korglykon). Pleurisy of the lungs in oncology responds well to chemotherapy - after it, swelling and symptoms usually go away. Medications are administered systemically - by injection or intrapleurally through the membrane valve of the port system.
According to statistics, chemotherapy courses in combination with other treatment methods help eliminate pleurisy in approximately 60% of patients sensitive to chemotherapy.
During the course of treatment, the patient must be constantly under medical supervision and receive supportive therapy. After completing the course, it is necessary to conduct an examination, and after a few weeks it is necessary to schedule it again.
Disease prognosis
Advanced forms of pulmonary pleurisy can have severe complications: the occurrence of pleural adhesions, bronchopleural fistulas, circulatory disorders due to compression of blood vessels.
During the development of pleurisy, under fluid pressure, arteries, veins and even the heart can shift in the opposite direction, which leads to an increase in intrathoracic pressure and disruption of blood flow to the heart. In this regard, preventing pulmonary heart failure is the central task of all therapeutic measures for pleurisy. If displacement is detected, the patient is indicated for emergency thoracentesis.
A dangerous complication is empyema - the formation of a “pocket” of pus, which can ultimately lead to scarring of the cavity and the final sealing of the lung. A breakthrough of purulent exudate into the lung tissue can be fatal. Finally, pleurisy can cause amyloidosis of parenchymal organs or kidney damage.
Special attention is paid to pleurisy when diagnosing it in cancer patients. Effusion in the pleural cavity aggravates the course of lung cancer, increases weakness, gives additional shortness of breath, and provokes pain. When the vessels are compressed, tissue ventilation is disrupted. Taking into account immune disorders, this creates favorable environment for the spread of bacteria and viruses.
The consequences of the disease and the chances of recovery depend on the underlying diagnosis. In cancer patients, fluid in the pleural cavity usually accumulates in the later stages of cancer. This makes treatment difficult and the prognosis is often poor. In other cases, if the fluid from the pleural cavity is removed in time and adequate treatment is prescribed, there is no threat to the patient’s life. However, patients need regular monitoring in order to promptly diagnose a relapse when it occurs.
Pleurisy - inflammatory disease layers of the pleura, which is characterized by the deposition of fibrin on their surface (fibrinous or dry pleurisy), or the accumulation of fluid in the pleural cavity (exudative pleurisy).
Normally, the pleura is a thin transparent membrane. The outer layer of the pleura covers the inner surface of the chest (parietal pleura), and the inner layer covers the lungs, mediastinal organs and diaphragm (visceral pleura). Between the layers of the pleura under normal conditions there is no a large number of liquids.
Causes of pleurisy
Depending on the cause of occurrence, all pleurisy is divided into two groups: infectious and non-infectious. Infectious pleurisy is associated with the activity of pathogenic organisms. The causative agents of infectious pleurisy can be:
As a rule, such pleurisy occurs against the background of pneumonia, active pulmonary tuberculosis, and less often with an abscess of the lung or subphrenic space.
Non-infectious pleurisy occurs with the following diseases:
Malignant tumors. This can be either a primary tumor of the pleura or a metastatic lesion from a tumor of another organ.
systemic diseases such as systemic lupus erythematosus, rheumatoid arthritis and other systemic vasculitis.
chest trauma and surgery.
pulmonary infarction after pulmonary embolism.
myocardial infarction (post-infarction Dressler syndrome).
enzymatic pleurisy in acute pancreatitis, when pancreatic enzymes dissolve the pleura and end up in the pleural cavity.
terminal stage of chronic renal failure(uremic pleurisy).
For infectious pleurisy to occur, penetration of microorganisms into the pleural cavity is necessary. This can occur by contact from foci of infection of the lung tissue, lymphogenously with the lymph flow, hematogenously - when the pathogen circulates in the blood. In more rare cases, direct penetration of the pathogen from environment for chest injuries, as well as during surgery. Penetrated microorganisms cause inflammation of the pleura with leakage of fluid (exudate) into the pleural cavity. If the pleural vessels function normally, then this fluid is reabsorbed. Fibrin (a protein found in significant quantities in effusion) settles on the pleural layers, and dry pleurisy is formed. With a high intensity of the process, the pleural vessels cannot cope with a large volume of exudate; it accumulates in a closed cavity. In this case, exudative pleurisy is diagnosed.
In neoplasms, toxic tumor products damage the pleura, which leads to the formation of exudate and significantly complicates its reabsorption. In systemic diseases, as well as in vasculitis, pleurisy is caused by damage to the small vessels of the pleura. Traumatic pleurisy occurs as a reaction of the pleura to hemorrhage. Pleurisy in chronic renal failure is associated with the action of uremic toxins. Enzymatic pleurisy is associated with irritation of the pleura by enzymes from the damaged pancreas. During a pulmonary infarction, non-infectious inflammation spreads to the pleura by contact. And in case of myocardial infarction, the leading role in the occurrence of pleurisy is played by impaired immunity.
Symptoms of pleurisy
In most cases, dry pleurisy develops acutely. Patients usually clearly indicate the time of onset of the disease. Characteristic complaints are chest pain, increased body temperature, and severe general weakness.
Chest pain is associated with irritation of the nerve endings of the pleura by fibrin. The pain is often unilateral on the affected side, quite intense, with a tendency to intensify with a deep breath, coughing, or sneezing. Body temperature rises to 38°C, rarely higher. At gradual beginning At first, the body temperature may be normal. Also concerning is general weakness, sweating, headache, intermittent pain in muscles and joints.
With exudative pleurisy, symptoms are caused by the accumulation of fluid in the pleural cavity. Complaints vary depending on the onset of the disease. If exudative pleurisy occurs after fibrinous pleurisy, then it is possible to trace a clear chronology of events. At the beginning of the disease, the patient is bothered by intense unilateral chest pain, which intensifies with deep inspiration. Then, when exudate forms, the pain disappears, and in its place comes a feeling of heaviness, pressure in the chest, and shortness of breath. A dry cough, increased body temperature, and general weakness may also occur. If exudative pleurisy occurs primarily, then in this case pain syndrome is not typical. In this case, patients complain of general weakness, sweating, fever, and headache. After a few days, shortness of breath appears, a feeling of heaviness in the chest with little physical activity, and with a large amount of exudate - at rest. At the same time, nonspecific symptoms of intoxication intensify.
If the above complaints occur, you should immediately consult a therapist.. With progressive deterioration of the condition (increase in body temperature, difficulty breathing, increased shortness of breath), hospitalization in a hospital is indicated.
Diagnosis of pleurisy
An external examination performed by a doctor is very important for diagnosing pleurisy and determining its nature. During auscultation (listening to the lungs in different phases of breathing with a stethoscope), a pleural friction noise can be detected, which is specific for fibrinous pleurisy; with exudative pleurisy, during percussion (tapping a certain area to identify characteristic sound phenomena), a dullness of the percussion sound over the area of effusion is noted. Thus, it is possible to determine the distribution of exudate in the pleural cavity.
In general and biochemical blood tests, nonspecific inflammatory changes are noted: acceleration of ESR, increase in the number of leukocytes; the appearance or increase in the concentration of inflammatory proteins - CRP, seromucoid and others.
Instrumental methods play a significant role in the diagnosis of pleurisy, as they allow one to see the affected area and determine the nature of the inflammatory process. When X-raying the lungs in the case of fibrinous pleurisy, it is possible to determine the high position of the dome of the diaphragm on the affected side, limited mobility of the pulmonary edge during breathing, as well as compaction of the pleura.
X-ray of the lungs with fibrinous pleurisy. The arrow shows the thickened pleura.
With exudative pleurisy, a characteristic feature is a compressed, reduced in size lung on the affected side, below which a layer of liquid, homogeneous or with inclusions, is visible.
X-ray of the lungs with exudative pleurisy. The arrow shows the liquid layer.
Ultrasound of the pleural cavities in fibrinous pleurisy reveals the deposition of fibrin on the layers of the pleura with their thickening, and in case of essudative, a layer of fluid below the lung. The nature of the effusion, and often the cause of pleurisy, is determined based on the analysis of the exudate obtained as a result of pleural puncture.
Treatment of pleurisy
Treatment of pleurisy should be comprehensive, individual and aimed at the main cause of the disease. At pleurisy caused by infections, the use of broad-spectrum antibacterial drugs during the first few days is indicated. Then, after identifying the pathogen, specific therapy is recommended. Anti-inflammatory drugs (Voltaren, indomethacin) and desensitizing therapy are also used.
Non-infectious pleurisy, as a rule, are a complication of another disease. Therefore, along with nonspecific treatment, comprehensive treatment of the underlying disease is necessary.
Surgical evacuation of exudate is performed in the following cases:
Large volume of exudate (usually reaching the 2nd rib);
when surrounding organs are compressed by exudate;
to prevent the development of empyema (formation of pus in the pleural cavity) of the pleura.
Pleural puncture is usually performed in a hospital setting. This manipulation is carried out with the patient sitting on a chair, leaning forward on his hands. As a rule, the puncture is performed in the eighth intercostal space along the posterior surface of the chest. The site of the intended puncture is anesthetized with a solution of novocaine. Using a long, thick needle, the surgeon pierces the tissue layer by layer and enters the pleural cavity. Exudate begins to flow down the needle. After removing the required amount of fluid, the surgeon removes the needle, and a sterile bandage is applied to the puncture site. After the puncture, the patient is under the supervision of specialists for several hours due to the risk of a drop in pressure or the development of complications associated with the puncture technique (hemothorax, pneumothorax). The next day, a control X-ray of the chest organs is recommended. After this, when feeling good the patient can be sent home. Pleural puncture is not a complex medical procedure. Preoperative preparation and subsequent rehabilitation are usually not required.
For fibrinous pleurisy characterized by a favorable course. Usually after 1-3 weeks of treatment the disease ends in recovery. An exception is pleurisy in tuberculosis, which is characterized by a long, sluggish course.
During exudative pleurisy Several stages are distinguished: at the first stage, intensive formation of exudate occurs and the entire clinical picture described above is revealed. This stage, depending on the cause of inflammation and the concomitant condition of the patient, lasts 2-3 weeks. Then comes the stabilization stage, when exudate is no longer formed, but its reabsorption is minimal. At the end of the disease, exudate is removed from the pleural cavity naturally or artificially. After removal of the exudate, very often connective tissue strands - adhesions - form between the pleural layers. If the adhesive process is pronounced, this can lead to impaired mobility of the lungs during breathing and the development of congestion, which increases the risk of re-infection. In general, in most cases, patients with exudative pleurisy experience complete recovery after treatment.
Complications of pleurisy
Complications of pleurisy include: the formation of adhesions in the pleural cavity, pleural empyema, circulatory disorders due to compression of blood vessels big amount exudate. Against the background of inflammation, especially with long-term or recurrent pleurisy, thickening of the layers of the pleura occurs, their fusion with each other, as well as the formation of adhesions. These processes deform the pleural cavity, leading to impaired respiratory mobility of the lungs. In addition, due to fusion of the pericardium with the pleural layer, displacement of the heart is possible. With a pronounced adhesive process, there is a high risk of developing respiratory and heart failure. In this case, surgical separation of the pleural layers and removal of adhesions are indicated. Pleural empyema occurs when exudate suppurates.
The prognosis for the development of pleural empyema is always serious; in elderly and weakened patients, mortality is up to 50%. Suppuration of exudate can be suspected in the following cases:
if the body temperature persists or the fever returns during antibiotic therapy.
when chest pain or shortness of breath appears or worsens.
while maintaining a high level of blood leukocytes against the background of antibiotic therapy, as well as the addition of anemia.
To diagnose pleural empyema, a pleural puncture is necessary. If there is pus, a large number of leukocytes and bacteria in the punctate, the diagnosis of pleural empyema is beyond doubt. Surgical treatment consists of evacuation of purulent contents, washing of the pleural cavity with antiseptic solutions, as well as massive antibiotic therapy.
Another dangerous complication of exudative pleurisy is compression and mixing of blood vessels when a large volume of fluid accumulates. When blood flow to the heart is obstructed, death occurs. To save the patient's life, urgent removal of fluid from the pleural cavity is indicated.
General practitioner Sirotkina E.V.
Pleurisy is an inflammatory process that affects the serous membrane lining the chest and the surface of the lungs. The etiology of the disease can be different, and treatment is prescribed according to the reasons. It often accompanies other inflammations of internal organs or is a consequence of the formation of malignant neoplasms. Pleurisy is a fairly common pathology (especially among men); if prolonged, it can lead to various complications.
The serosa forms a closed cavity in the chest. One of its parts (visceral) covers the lungs and is tightly fused with them, and the other - parietal - is adjacent to the diaphragm, ribs, and mediastinal organs. The pleural cavity is filled with a small amount of fluid, which allows its walls to slide together. Its main functions are to protect the lungs and ensure the respiratory process.
Inflammation of the serous membrane - pleurisy - has a code according to ICD-10 R09.1, but some types of pathology are designated differently. For example, A15-A16 in the case of tuberculosis origin. And pleurisy with effusion (accumulation of fluid in the cavity) has its own coding J90.
The image shows a left-sided pleural effusion.
The danger of any form of this disease lies in the fact that the inflammatory process occurs in the area of vital organs. Purulent pleurisy is especially difficult, and with exudative pleurisy, the heart rhythm and breathing are disturbed. The most common consequences of a protracted disease are obliteration of the pleural cavity, impaired mobility of the diaphragm, and respiratory failure. Cancerous focal or metastatic pleurisy has the most unfavorable prognosis for recovery.
Classification of pleurisy
For more than 30 years, the classification of Professor N.V. Putov has been used to determine the specific form of this disease. First of all, the inflammatory process can occur acutely, subacutely, or become chronic; accordingly, the severity of symptoms at each stage gradually weakens. If the pleura is affected only on the right or left, we are talking about right- or left-sided pleurisy, and when the membrane of both lungs is involved in the process, it is bilateral.
Dry pleurisy, also called fibrinous, is distinguished from exudative pleurisy by the absence of fluid in the pleural cavity. In the second case, there is an effusion of purulent, serous, hemorrhagic, chylous, cholesterol or mixed nature. The effusion can be localized in a certain area or spread over the entire surface of the pleura, therefore pleurisy of the lungs can be encysted (parietal, interlobar, apical, diaphragmatic, etc.) or diffuse.
Causes
Pleurisy is rarely diagnosed as an independent pathology. It usually accompanies or is a consequence of other diseases. For example, the development of pleurisy after pneumonia is observed in at least 5% of cases and is called metapneumonic. Parapneumonic pleurisy occurs with greater frequency, which precedes and then accompanies pneumonia.
The latter is detected in a fifth of patients with inflammation of the pleura, and in more than half of those who suffer from an exudative form of inflammation. In this regard, a logical question arises: is tuberculous pleurisy contagious or not? Since its cause in most cases is pulmonary tuberculosis, and the pathogen is transmitted by airborne droplets, prolonged contact with a patient can lead to infection. The maximum risk of infection is observed in patients with reduced immunity, diabetes mellitus, cardiac vascular pathologies etc.
An aseptic or non-infectious inflammatory process develops for other reasons:
- Malignant tumors localized both in the pleura itself (mesothelioma) and in other organs. In the second case, metastases affect the pleura in breast, lung, ovarian, and skin cancer. Oncology is the cause of pleurisy in 25% of patients.
- Pulmonary or myocardial infarction, pulmonary embolism.
- Pleurisy of the lungs can be a consequence of systemic damage to connective tissue - vasculitis, SLE, scleroderma.
Other probable causes of inflammation of the pleura include leukemia, hemorrhagic diathesis, pancreatitis and other pathologies.
Development mechanisms
Infectious pleurisy develops as a result of pathogens entering directly into the pleural cavity with blood or lymph or through contact from foci of inflammation. This happens with tuberculosis, pneumonia, cysts, abscesses, and bronchiectasis. Direct infection occurs as a result of a violation of integrity (surgery, wounds and other injuries).
Diagnostics
A preliminary diagnosis can be made already during the initial examination: the chest is asymmetrical, the intercostal spaces on the affected side are protruded, and it lags behind the rhythm during breathing. When tapping (percussion), the sound above the exudate is muffled, and breathing during auscultation is not heard there or is very weak.
To clarify the boundaries of the effusion, ultrasound and radiographic examination are used. A puncture of pleural fluid is performed, the composition, density and volume of which can be used to determine the cause of the pathology. Bacteriological analysis allows you to identify the pathogen, and general analysis blood shows an increase in ESR, leukocytosis. A pleural biopsy is also performed using thoracoscopy.
Pleurisy of the lungs - symptoms and treatment
The symptoms of pleural inflammation depend on the type - dry or exudative, the cause of the pathology, and the location of the effusion. Treatment is prescribed based on the results diagnostic examination and can take from several weeks to many months (with tuberculosis, for example).
Symptoms of dry pleurisy
The defining signs of pleurisy in adults, occurring in the fibrinous form, are stabbing pains localized in the chest, which intensify with coughing, bending over, and simply breathing movements. In this case, the patient is forced to take a lying position on the affected side of the body in order to limit the mobility of the chest to the maximum. For the same reason, breathing becomes shallow, and there is a lag behind the respiratory rhythm of one of the halves of the chest. The temperature rises to subfebrile levels, excessive sweating and chills at night occur. When listening, a characteristic rustling is detected - a consequence of the friction of the pleura against each other.
Signs of exudative pleurisy
It begins in the same way as acute (pain, cough), but as exudate accumulates in the cavity, the following symptoms of pulmonary pleurisy in adults appear:
- feeling of heaviness on the affected side;
- smoothing and then protruding the spaces between the ribs;
- moderate cyanosis of the skin and increasing shortness of breath;
- persistent febrile temperature (and with empyema - hectic, with significant changes during the day);
- tachycardia, decreased blood pressure;
- weakness, sweating, loss of appetite.
Some forms of inflammation have specific symptoms. For example, serous may be accompanied by hemoptysis, and with encysted paramediastinal, the neck and face swell, the voice becomes hoarse, and dysphagia appears. With SLE, joint and kidney damage and pericarditis are associated. The occurrence of pleurisy without fever and other pronounced signs is characteristic of the metastatic type of oncology.
Treatment in hospital
In a medical facility, complex therapy is carried out for severe cases of inflammation, aimed at eliminating their cause and alleviating symptoms. Along with medication, treatment of exudative pleurisy may include punctures (thoracentesis) or drainage to remove exudate, washing the cavity with antiseptics for empyema. According to indications for the chronic course of the disease (especially its tuberculosis variety), surgical intervention is performed - pleurectomy.
How to treat pleurisy at home
All treatment should be prescribed exclusively by a specialist; self-medication is unacceptable.
First of all, the patient is provided with rest and bed rest. In the dry form of the inflammatory process, tight bandaging and warming of the chest, cupping or mustard plasters are indicated. Drug therapy is required, including the following groups of drugs:
- antibiotics for pleurisy of infectious origin, selected according to the type of pathogen;
- anti-tuberculosis drugs for the corresponding form of pleurisy (isoniazid, rifampicin);
- NSAIDs and glucocorticosteroids - for rheumatic inflammation;
- Treatment of pleurisy also includes taking antitussive drugs for the fibrinous type of pathology.
- Antipyretics are indicated for significant increases in temperature.
- Specific chemotherapy is prescribed in case of oncological cause of the disease.
Breathing exercises after pleurisy are included in the complex of therapeutic measures for the fibrinous variety. As soon as the symptoms of dry inflammation decrease, it is necessary to perform special exercises to prevent adhesive pleurisy - gluing and obliteration of the parietal and visceral pleura.
Treatment of pulmonary pleurisy with folk remedies
The use of alternative medicine recipes for any disease is possible only after diagnosis and with the approval of the attending physician. The use of herbal infusions, decoctions, warming compresses, ointments, and inhalations is advisable only as an adjunct if there are no contraindications. The main treatment for pleurisy is drug therapy. It is even more unacceptable to rely on folk remedies if the cause of the disease is a malignant tumor.
Pleurisy of the lungs in oncology
As already mentioned, in a quarter of cases of inflammation of the serous membrane of the lungs, its cause is cancer. Mesothelioma of the pleura itself is not so common, but a secondary lesion - metastatic or secondary pleurisy - is a common phenomenon. Metastases of the primary tumor, at any location, primarily affect the liver and lungs.
The basis of treatment for pulmonary pleurisy in oncology is chemotherapy and radiation therapy, as well as surgery, which will help cope with the cause of the disease. At the same time, medications are taken to relieve the painful symptoms of inflammation. Prognosis for recovery depends on the stage of the cancer process and the effectiveness of treatment of the underlying disease.
Consequences of pleurisy
Timely diagnosis of the disease in an acute form and the prescription of adequate therapy help to quickly cope with inflammation. However, the duration and success of treatment depend on the form and nature of the disease. So, with the fibrinous variety it will take about 2 weeks, and treatment of pulmonary pleurisy of tuberculous origin can take a year.
The negative consequences of the disease usually appear when it becomes chronic. Most often, an adhesive process is observed, leading to fusion of interlobar fissures, obliteration of the cavity, and, accordingly, respiratory failure. Pleurisy of the lungs is especially dangerous in the elderly: severe symptoms and treatment for a long time often lead to chronicity of the process, frequent relapses, and a general deterioration in health.
Prevention
As preventive measures Doctors recommend strengthening the immune system and promptly treating any infectious diseases. Special meaning has regular testing for tumor markers for people at risk. Periodic examinations will help detect cancer at an early stage.
Pleurisy is a disease characterized by inflammation of two layers of the pleura - pulmonary and parietal. U healthy person the lungs are covered with a thin film consisting of two layers, between which there is a negligible amount of liquid. Pleurisy is characterized by significant formation of effusion (exudate) between the membranes. Fluid can accumulate if it is not excreted by the body (exudative pleurisy), and can leave plaque on the walls of the pleura (fibrous pleurisy). In any case, this is a serious disease that rarely goes away on its own and without complications. Treatment of pulmonary pleurisy is successful if the patient is diagnosed in time and treatment is started.
Pleurisy of the lungs is an inflammation of two layers of the pleura
Causes of the disease
Pleurisy can be of infectious or non-infectious origin; depending on its etiology, the causes and methods of treatment differ. Infectious pleurisy occurs as a result of inflammatory pathogens entering the pleura directly from the lungs and bronchi or internal organs of the peritoneum.
Pathogens include:
- fungi;
- anaerobic bacteria;
- legionella;
- viruses;
- tubercle bacilli;
- pneumococci.
Infectious pleurisy is always a consequence of neglected infectious disease. It is also sometimes found in patients with typhus and those infected with echinococcus and mycoplasmosis.
Non-infectious pleurisy occurs as a result of unsuccessful surgical operations, lung injury, allergic reaction to certain substances, and there may also be concomitant symptoms of the following diseases:
- sarcoidosis;
- pulmonary embolism;
- pleural methiolioma;
- ovarian tumor, etc.
Also, non-infectious pleurisy can be observed after an electric shock. Exact reason Only a doctor can determine the onset of the disease. Treatment is prescribed depending on the type of disease.
Exudative pleurisy and its symptoms
This type of pleurisy is also called exudative, since it accumulates in the pleura. significant amount liquids. The disease affects only a localized part of the pleura, so the patient feels pain in a specific area on the right or left side. In this case, dryness, shortness of breath and heaviness in the area of the left or right lung are often observed. The fluid compresses the lung, it swells, as a result of which the patient cannot breathe fully and feels very bad. The pain usually subsides if the patient lies on his side.
The following symptoms are also observed:
- general weakness;
- elevated temperature (usually low-grade, but sometimes febrile);
- loss of appetite up to complete refusal of food, nausea;
- swelling of the limbs, neck and face.
Pleurisy of the lungs can be of infectious or non-infectious origin Fibrous pleurisy and its symptoms
This disease does not lead to the accumulation of fluid in the pleura, since all of it is removed from the body, but a dry residue remains on the pleura, which leads to increased inflammation. Such a disease is always an “addition” to inflammatory processes in the lungs, so the main disease must be treated first. It can also be difficult to determine the symptoms of fibrous pleurisy, since they are “lost” against the background or.
But the following main features can be identified:
- the patient experiences dryness, accompanied by sharp pain in the side or back;
- it is impossible to take a deep breath; when trying, severe pain is felt;
- breathing is difficult, shallow;
- constant tension in the abdominal muscles.
Advanced fibrous pleurisy threatens the formation of irreversible adhesions in the lungs, so treatment should be immediate.
Purulent pleurisy and its symptoms
This form of the disease is characterized by the accumulation of pus in the pleura and always occurs in an acute form. Has the following characteristics:
- increase in temperature to febrile;
- increase and due to pus in the pleura on the heart;
- dry cough;
- constant pain and feeling of pressure in the chest;
- labored breathing.
Purulent pleurisy is treated exclusively in a hospital.
Manifestation of purulent pleurisy Tuberculous pleurisy and its symptoms
This disease is often a companion to the lungs and manifests itself in the form of empyema, perfocal or allergic pleurisy. Sometimes it can be detected only due to inflammation of the pleura, since it can occur hidden. Tuberculous pleurisy most often has no obvious symptoms.
It is characterized by:
- slight increase in temperature;
- general fatigue, weakness, depression;
- shortness of breath and difficulty breathing;
- cough;
- mild chest pain.
This type of pleurisy can be chronic and last for years, pain may disappear for a while, but this does not indicate a cure. It is difficult to diagnose.
Photo of tuberculous pleurisy of the lungs U different forms The symptoms of the disease are different, but in any case the person will feel pain in the chest, side or back, and it will be difficult for him to breathe deeply. In advanced cases, the size of the chest increases, it appears swollen, veins bulge in the neck, and the face often swells. Changes in skin color on the chest or face can also be a sign of pleural inflammation. Often when the lung is compressed, it is observed, which is often confused with rheumatic. That is why it is important not to self-medicate, but to immediately consult a doctor if one of the above symptoms persists for more than two weeks.
Diagnosis of pleurisy
The therapist makes the diagnosis based on listening to the patient’s breathing and feeling his chest for an increase in the size of the lungs. The patient also needs to have blood and urine tested to determine the presence of persistent inflammation in the body. X-rays and ultrasonography lungs.
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.
If there is a suspicion of cancer or the patient has been diagnosed lung cancer, the pleura is performed, but such cases are extremely rare.
Important! Despite the fact that pleurisy is a secondary disease, it is contagious. This applies exclusively to the infectious form of the disease. Therefore, the patient should avoid contact with others and wear a gauze bandage, which must be replaced every few hours. The disease is transmitted by airborne droplets. Tuberculous pleurisy is especially dangerous, since it is difficult to diagnose, manifests itself poorly and is often chronic.
Treatment of pleurisy
After the diagnosis is established, the patient is hospitalized and prescribed anti-inflammatory drugs and antibiotics. Most medications are aimed at relieving symptoms and inflammation, but the main efforts are aimed at treating the disease, the consequence of which was pleurisy.
In addition to medications, patients are prescribed special diet, and after the condition improves, physiotherapeutic procedures that help the respiratory system restore its function. The patient needs to give up complex, hard-to-digest foods so as not to create additional stress on the stomach. The basis of nutrition should be food high in vitamins - cereals, vegetables, fruits, herbs, broths. Also worth avoiding stressful situations and anxiety, sometimes it is necessary to take sedatives.
If you have pleurisy, you must consult a doctor who will prescribe antibiotics. Drug treatment depends on the cause of pleurisy, namely:
- if the disease is caused or acute, then it must be treated with antibiotics;
- pleurisy caused by other chronic inflammatory processes and not accompanied by febrile fever is treated with non-steroidal anti-inflammatory drugs;
- Treatment of tuberculous pleurisy is carried out with the help of special medications and lasts up to six months.
In all cases, patients are prescribed expectorants, painkillers and diuretics. If the fluid puts pressure on the heart, then the attending physician will prescribe medications to support the heart muscle and blood vessels.
If the above therapy does not lead to a decrease in exudate in the lung, or its volume is critically high (sometimes it can reach several liters), then the patient is pumped out the fluid. To do this, the doctor inserts a needle into the inflamed area and pumps out the effusion or pus, after which he injects a small amount of anti-inflammatory drugs into the interpleural area. In rare cases and with chronic tuberculous pleurisy, the patient needs regular drainage, and sometimes it is necessary to excise part of the lung.
Treatment with folk remedies
Folk remedies cannot cure the disease on their own, but they will be a good addition medications. Patients are prescribed a pulmonary collection that promotes expectoration and restoration of the alveoli, as well as a decoction of herbs such as wild rosemary, licorice root, and plantain leaves. Patients are advised to drink fresh beet juice and eat it regularly boiled beets. Reduce swelling and remove excess liquid can be removed from the body using a decoction of horsetail and chamomile. You can take these medications only after consulting a doctor and only if there are no contraindications.
Important! If a child has pleurisy, it cannot be treated with folk remedies. His lung capacity is still very small, and even a slight accumulation of fluid can lead to a sharp deterioration in his condition and suffocation.
After curing pleurisy of the lungs, you need to do it regularly. breathing exercises and spend more time on fresh air Recovery after pleurisy and disease prevention
After discharge from the hospital, patients must perform breathing exercises prescribed by the doctor to restore full lung function. Moderate shown physical exercise, long walks in the fresh air, yoga is very useful. Being in a coniferous forest is especially useful for those recovering.
Strengthening your health, taking care of your health and giving up bad habits, especially smoking, will help you avoid the disease. During the cold season, it is necessary to regularly humidify the air that has been dried out by heating devices and ventilate the room.
This article is posted solely for the general educational purposes of visitors and does not constitute scientific material, universal instructions or professional medical advice, and does not replace a consultation with a doctor. For diagnosis and treatment, consult only qualified physicians.
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I am a general practitioner, a general specialist. My competence includes issues of early diagnosis of patients and treatment of many diseases of the gastrointestinal tract, lungs and respiratory tract, liver, kidneys, cardiovascular and genitourinary systems, skin diseases, metabolic disorders, etc. 15 years of experience as a general practitioner in Moscow clinics, 5 of which worked in one hospital in St. Petersburg.. I will be happy to answer questions from readers of my blog.
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Pleurisy in adults is a common inflammatory disease. In most cases, this is a syndrome, a complication of another pathology. Usually the secondary form of the disease is the consequences of chronic or acute pathological processes in the lungs. Symptoms of primary pleurisy as an independent disease develop very rarely. Treating a disease is a very difficult task.
This is a two-layer smooth serous membrane in the form of two sheets. They surround the lung and line the inside of the chest, forming the pleural sac. There are internal and external mucous membranes of the lungs, which actively participate in gas exchange.
Its thin shell keeps the lungs in an expanded state.
Air enters the lungs through respiratory tract adults. The blood is enriched with oxygen, which enters every cell of the body.
During breathing, pulmonary pressure becomes negative. Normally, this cavity always contains serous fluid in moderate quantities. Thin translucent layers of the pleura ensure free movement of the lungs during inhalation and exhalation inside the rigid frame of the chest.
Causes of pleurisy
Against the background of various diseases, signs of this severe symptom complex develop.
The most common causes of the disease:
Symptoms
Two groups of symptoms appear with any pleurisy. The underlying disease that caused pleurisy determines the specific features of the symptoms of the first group of syndromes. Symptoms of the second group are a direct manifestation of pulmonary pleurisy. Typically, the symptoms of this disease are consequences of pathology of the respiratory system. Manifestations of the syndrome depend on the type of pleurisy and the causative factors of the disease.
Fibrinous pleurisy
This is a dry form of pathology:
Typical manifestations of dry pleurisy:
- There are a lot of pain receptors in the pleura, so pain is the main symptom of dry pleurisy. The intensity depends on the localization of the process painful sensations. When coughing, with every breath, pleurisy of the lungs causes sharp pain.
- To immobilize the pleural layers as much as possible and relieve fluid pressure on the mediastinum, patients try to lie on the painful side and breathe shallowly. It is not possible to get rid of a severe sore throat using traditional methods.
- Pain is usually detected in the lateral and lower segments of the chest. When tilted to the side painful symptoms become more intense. Patients complain of sweating.
- The patient feels fatigue, lethargy, and weakness. Persistent loss of appetite and periodic headaches reduce the quality of life. Folk remedies can relieve attacks of pain only temporarily.
- Usually the body temperature rises by no more than 1-1.5 degrees. Low-grade fever persists long time. If purulent pleurisy develops, a high temperature is characteristic. A dry cough most often brings little or no relief. It occurs in paroxysms, periodically.
Exudative pleurisy
The permeability of the pleural surface during non-infectious effusion of the lungs increases. Later, lymphatic circulation becomes difficult if large amounts of pleural fluid cannot be reabsorbed. The layers of the pleura are separated by the resulting pleural effusion, which accumulates in the pleural cavity.
It appears in the form of an infectious exudate or a transudate of non-inflammatory origin. If the amount of fluid in the pleural cavity increases, the symptoms of pleurisy become more severe. The natural breathing process is disrupted. Systemic venous and pulmonary pressure increases after organ dysfunction. Chest drainage deteriorates. Symptoms of respiratory failure are pronounced.
Exudate of inflammatory etiology accumulates in the pleura. The doctor reveals swelling of the neck veins. Skin changes color. Its surface acquires a bluish tint. A pronounced bulging of the intercostal spaces of the patient's chest is characteristic. Its affected half is visually more voluminous than the healthy one. The patient suffers from a feeling of heaviness in the chest. A feeling of lack of air and shortness of breath are constant signs of pathology. Her Negative influence the body is constantly felt.
Painful symptoms in this form of pleurisy bother the patient only in the initial stages. As the effusion accumulates, the intensity of pain decreases. A dry cough is reflexive in nature. Sometimes scant sputum is produced. Treatment with folk remedies must begin immediately.
Diagnostics
A dangerous disease often threatens a person’s life and brings unbearable suffering. Treatment must be carried out in a timely manner. However, often the symptoms of this serious illness are mild. Crucial in diagnosis is a chest x-ray, which reliably confirms the presence of pathology.
If there are pleural adhesions or persistent changes in the pleura, a diagnosis is made. It is impossible to treat such an ailment only with folk remedies. Pleural puncture plays important role in the diagnosis of serious illness. Experts determine consistency and color pathological fluid. Its biochemical study is being carried out. These are specific signs of the disease.
Treatment
Based on the results of the diagnostic study, therapy for the disease is carried out. Complex treatment pleurisy, in order to eliminate the main pathological process against which the illness arose, is prescribed only by a doctor. This is the main condition for the healing process. At home, treatment with folk remedies is prescribed by a doctor.
If necessary, antibacterial agents are started. Symptomatic treatment is carried out to prevent pleural adhesions and the formation of light connective tissue areas in the thin membrane. Medicines help remove fibrin and provide the necessary pain relief. It is quite possible to treat pleurisy at home. Correct selection of adequate treatment tactics, treatment of the disease on early stages pathology gives good results.
