What causes pleurisy and how to treat it. Pleurisy of the lungs - what is it and how to deal with it? Folk ways to deal with the disease

Pleurisy is one of the most common pathological conditions of the 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 can prevent dangerous complications. Diagnosis of pleurisy for a professional doctor is not difficult. The task of the patient is to seek medical help in a timely manner. Let us consider in more detail what signs indicate developing pleurisy and what forms of treatment for this pathological condition exist.

Characteristics of the disease and types of pleurisy

Pleurisy is called inflammation of the pleura - the serous membrane that envelops the lungs. The pleura looks like translucent sheets of connective tissue. One of them is adjacent to the lungs, the other lines the chest cavity from the inside. A 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 frequently. Pleurisy can also be dry - in this case, fibrin protein is deposited on the surface of the pleura, the membrane thickens. However, as a rule, dry (fibrinous) pleurisy is only the first stage of the disease, which precedes the further formation of exudate. In addition, when the pleural cavity is infected, the exudate can also 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. According to 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 respiratory disease.

So, depending on the state of the pleural fluid, there are:

• purulent pleurisy;
• serous pleurisy;
• serous-purulent pleurisy.

The purulent form is the most dangerous, since it is accompanied by intoxication of the whole organism 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 of the chest or appear only on one side;
• development often provokes an infection, in which case it is called infectious.

The list of non-infectious causes of pleurisy of the lungs is also wide:

• connective tissue diseases;
• vasculitis;
• pulmonary embolism;
• chest trauma;
• 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 seeps into the pleural cavity. It is possible to close the lumen of the large bronchus, which lowers the pressure in the pleural cavity, which means it provokes the accumulation of exudate.

With non-small cell lung cancer (NSCLC), pleurisy is diagnosed in more than half of the cases. With adenocarcinoma, the frequency of metastatic pleurisy reaches 47%. At squamous cell carcinoma lung - 10%. Bronchiolo-alveolar cancer leads to pleural effusion already at an early stage, and in this case, pleurisy may be the only signal of the presence of a malignant tumor.

Varies depending on the shape clinical manifestations pleurisy. However, as a rule, it is not difficult to determine pleurisy of the lungs. 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 pleurisy of the lungs are pain in the chest, especially when inhaling, a cough that does not bring relief, shortness of breath, a feeling of tightness in the chest. Depending on the nature of inflammation of the pleura and localization, 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 not excluded. The temperature remains normal or rises slightly - no more than 37 ° C.

With exudative pleurisy, weakness and poor health are more pronounced. Fluid accumulates in the pleural cavity, compresses the lungs, prevents them from expanding. The patient cannot take a full breath. 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 increase. The skin becomes pale. A large accumulation of fluid prevents the outflow of blood from the cervical 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 signs: up to 39–40 ° in the evening and 36.6–37 ° in the morning. This indicates the need for urgent medical attention, since the purulent form is fraught with serious consequences.

Diagnosis of pleurisy takes place in several stages:

1. Examination and questioning of the patient. The doctor finds out the clinical manifestations, the duration of occurrence and the level of well-being of the patient.
2. Clinical examination. Different methods are used: auscultation (listening with a stethoscope), percussion (tapping with special instruments for the presence of fluid), palpation (palpation to determine painful areas).
3. X-ray examination and CT. X-ray allows you to visualize pleurisy, assess the volume of fluid, and in some cases - to identify metastases in the pleura and lymph nodes. Computed tomography helps to establish the degree of prevalence more accurately.
4. Blood analysis. With an inflammatory process in the body, the ESR, the number of leukocytes or lymphocytes increases. This study is necessary for the diagnosis of infectious pleurisy.
5. Pleural puncture. This is the collection of fluid from the pleural cavity for laboratory testing. The procedure is carried out in the case when there is no threat to the life of the patient. If too much fluid has accumulated, a pleurocentesis (thoracocentesis) is immediately performed - removal of exudate through a puncture using a long needle and electric suction, or a port system is installed, which is an advantageous solution. The patient's condition improves, and part of the fluid is sent for analysis.

If after all the stages the exact picture remains unclear, the doctor may prescribe a videothoracoscopy. A thorascope 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 are talking about oncology, it is necessary to take 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 pleurisy of the lungs should be comprehensive, aimed at eliminating the disease that caused it. Therapy of pleurisy itself, as a rule, is symptomatic, designed to accelerate the resorption of fibrin, prevent the formation of adhesions in the pleural cavity and liquid "bags", and alleviate the patient's condition. The first step is to remove the pleural edema. At a high temperature, the patient is prescribed antipyretics, with pain - analgesic NSAIDs. All these actions allow to stabilize the patient's condition, normalize the respiratory function and effectively treat the underlying disease.

Treatment of pleurisy in a mild form is possible at home, in a complex one - exclusively in a hospital. It may include different methods and techniques.

1. Thoracocentesis . This is a procedure in which accumulated fluid is removed from the pleural cavity. Assign in all cases of effusion pleurisy in the absence of contraindications. Thoracocentesis is performed with caution in the presence of a 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 control and exudate is taken. Compression of the lung tissue decreases, the patient becomes easier to breathe.
2. Often, the procedure needs to be repeated; for this, modern and completely safe interpleural port systems , providing constant access to the pleural cavity both for the evacuation of exudate and for the administration of drugs, including as part of 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 placed in the soft tissues of the chest wall, under the skin. In the future, it does not cause any inconvenience to the patient. Manipulation takes no more than an hour. The very next day after the installation of the port, the patient can go home. When it is necessary to evacuate the exudate again, it is enough to pierce the skin and the silicone membrane under it. It's fast, safe and painless. With a sudden need and lack of access to medical care, with a certain skill and knowledge of the rules for the procedure, even relatives are able to independently release the patient's pleural cavity from fluid through the port.
3. Another type of intervention pleurodesis . This is an operation to artificially create adhesions between the sheets of the pleura and destroy the pleural cavity so that there is nowhere for fluid to accumulate. The procedure is prescribed, as a rule, for oncological patients with the ineffectiveness of chemotherapy. 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 can be immunomodulators (for example, interleukins), glucocorticosteroids, antimicrobials, radioisotopes and alkylating cytostatics (derivatives of oxazaphosphorine and bis-β-chloroethylamine, nitrosourea or ethylenediamine, platinum preparations, alkylsulfonates, triazines or tetrazines), which depends solely on the specific clinical case. .
4. If the above methods fail, the pleura removal and shunt placement . After shunting, the fluid from the pleural cavity passes into the abdominal cavity. However, these methods are classified as radical, capable of causing serious complications, so they are resorted to last.
5. Medical treatment . In the case when pleurisy has an infectious nature or is complicated by an infection, apply antibacterial drugs, the choice of which depends entirely on the type of pathogen and its sensitivity to a particular antibiotic. Medicines, depending on the nature of the pathogenic flora, can be:

• natural, synthetic, semi-synthetic and combined penicillins (benzylpenicillin, phenoxymethylpenicillin, methicillin, oxacillin, nafcillin, ticarcillin, carbpenicillin, Sultasin, Oxamp, Amoxiclav, mezlocillin, azlocillin, mecillam);
• cephalosporins ("Mefoxin", "Ceftriaxone", "Katen", "Latamoccef", "Cefpir", "Cefepim", "Zeftera", "Ceftolosan");
• fluoroquinolones ("Microflox", lomefloxacin, norfloxacin, levofloxacin, sparfloxacin, moxifloxacin, gemifloxacin, gatifloxacin, sitafloxacin, trovafloxacin);
• carbapenems ("Tienam", doripenem, meropenem);
• glycopeptides ("Vancomycin", "Vero-Bleomycin", "Targocid", "Vibativ", ramoplanin, decaplanin);
• macrolides ("Sumamed", "Utacid", "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, "Minoleksin");
• amphenicols ("Levomycetin");
• other synthetic antibacterial agents (hydroxymethylquinoxaline dioxide, fosfomycin, dioxidine).

For the treatment of inflammation of the pleura, anti-inflammatory and desensitizing drugs are also prescribed. medicines(electrophoresis of 5% solution of novocaine, analgin, diphenhydramine, 10% solution of calcium chloride, 0.2% solution of platyfillin hydrotartrate, indomethacin, etc.), regulators of water and electrolyte balance (saline and glucose solution), diuretics ("Furosemide" ), lidase electrophoresis (64 IU every 3 days, 10–15 procedures per course of treatment). They can prescribe agents for expanding the bronchi and cardiac glycosides that enhance myocardial contraction (Eufillin, Korglikon). Pleurisy of the lungs with oncology lends itself well to chemotherapy - after it is carried out, the swelling and symptoms usually go away. Medications administered systemically - by injection or intrapleurally through the membrane valve of the port system.

According to statistics, courses of chemotherapy in combination with other methods of treatment help to eliminate pleurisy in about 60% of patients who are sensitive to chemotherapy drugs.

During the course of treatment, the patient must be constantly under the supervision of a physician and receive supportive therapy. After the end of the course, it is necessary to conduct an examination, and after a few weeks, appoint it again.

Disease prognosis

Advanced forms of pleurisy of the lungs can have severe complications: the occurrence of adhesions of the pleura, bronchopleural fistulas, circulatory disorders due to squeezing of blood vessels.

In the process of developing pleurisy under fluid pressure, the arteries, veins and even the heart can move in the opposite direction, which leads to an increase in intrathoracic pressure and a violation of blood flow to the heart. In this regard, the prevention of pulmonary heart failure is the central task of all therapeutic measures for pleurisy. If a displacement is detected, the patient is shown an emergency pleurocentesis.

A dangerous complication is empyema - the formation of a "pocket" with pus, which ultimately can lead to scarring of the cavity and the final blockage of the lung. A breakthrough of purulent exudate into the lung tissue is fatal. Finally, pleurisy can cause amyloidosis of parenchymal organs or kidney damage.

Special attention is paid to pleurisy in its diagnosis in cancer patients. Pleural effusion aggravates lung cancer, increases weakness, gives additional shortness of breath, provokes pain. When the vessels are squeezed, the ventilation of the tissue is disrupted. Given immune disorders, this creates a 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 advanced stages of cancer. This makes treatment difficult and the prognosis is often poor. In other cases, if the fluid from the pleural cavity was removed in time and adequate treatment was prescribed, there is no threat to the life of the patient. However, patients need regular monitoring in order to diagnose a relapse in time when it occurs.

Content

Pleurisy is called inflammation of the pleura, which is accompanied by the formation of effusion or fibrinous plaque. 10% of all therapeutic diseases are pleurisy. More often this disease occurs in young children after pneumonia.

Forms of the disease

To achieve the effect of therapeutic measures as soon as possible, it is necessary to find out the form of the disease before starting therapy. Classification of pleurisy:

1. By etiology:

• metapneumonic;
• parapneumonic;
• tuberculosis;
• rheumatic;
• hypostatic;
• carcinomatous;
• aseptic.

1. By pathogenesis:

• hematogenous;
• lymphogenous.

1. According to the nature of the lesion of the pleura:

• Dry or fibrinous - is divided into adhesive (adhesive, productive, fibrous) and armored (pachypleuritis).
• Effusive or exudative.

1. By localization:

• apical (apical);
• basal (diaphragmatic);
• mediastinal (paramediastinal);
• costal (paracostal);
• interlobar (interlobar).

1. According to the prevalence of exudate:

• cloak-like;
• bagged.

1. According to the composition of the effusion:

• serous;
• hemorrhagic;
• serous-hemorrhagic;
• putrefactive;
• purulent.

Symptoms of pleurisy in adults

Since the signs of pleurisy of the lungs depend on its form and may be similar to other diseases of the respiratory system, differential diagnosis is very important. Clinically, there are three main syndromes characteristic of the disease. These syndromes can sequentially change one after another or be observed in isolation:

Clinical picture	Dry pleurisy syndrome	effusion pleurisy syndrome	Syndrome of purulent pleurisy
Common features	Pain when breathing, aggravated by bending to the healthy side and taking a deep breath. Rapid and labored breathing. Lag of the diseased half of the chest in the act of breathing. Position of the patient on the affected side.
Features	Prolonged subfebrile fever. Palpation of the chest on the side of the lesion on inspiration. Rubbing noise of the pleura on auscultation.	Heaviness in the chest. Prolonged dry reflex cough. Swelling of the neck veins. Hepatic dullness with superior border on percussion. The absence of auscultatory noises in the area of ​​percussion dullness, bronchial breathing and fine bubbling rales above it. Pleural friction rub or crepitus at the upper limit of dullness on auscultation.	Hectic fever. Severe intoxication. Hepatic dullness on percussion. Absence of auscultatory noises.

Sukhoi

The duration of the course varies from 10 days to 2 weeks.

Symptoms of dry pleurisy can simulate the clinic of not only diseases of the respiratory system, but also acute appendicitis, cholecystitis or pancreatitis with involvement of the diaphragmatic pleura.

Differential diagnosis of diaphragmatic dry pleurisy is based on indirect x-ray symptoms: high standing and limitation of diaphragm mobility. Also, in the clinical picture, the identification of the following pain points is important:

• between the legs of the sternocleidomastoid muscle;
• near the sternum in the first intercostal space;
• spinous processes of the first cervical vertebrae;
• attachment points of the diaphragm to the ribs.

Purulent

In the diagnosis of purulent pleurisy, the age of the patient plays an important role. Clinical symptoms in newborns are reduced to manifestations of pneumonia or umbilical sepsis, and in adults, the signs of the disease become more pronounced. Typical symptoms are respiratory failure, functional disorders of the liver, kidneys, endocrine and autonomic systems. Chest x-ray and pleural puncture are used to confirm the diagnosis.

Exudative

Signs of exudative pleurisy are characterized by the presence of common symptoms, but may differ. Radiologically, an intense darkening of the lower lobe of the lung is determined, which merges with the shadow of the diaphragm and mediastinum and has an upper oblique border. Due to the accumulation of a large amount of exudate, this form is often accompanied by symptoms from the cardiovascular system:

• mediastinal displacement;
• tachycardia;
• hypotension;
• decrease in minute volume of blood;
• decrease in stroke volume of the heart.

tuberculosis

The clinical picture of tuberculous pleurisy varies depending on its clinical variant. There are 3 types:

• allergic;
• perifocal;
• tuberculosis of the pleura with exudative pleurisy.

The allergic variant begins acutely, accompanied by pain, shortness of breath, cough and fever. The nature of the exudate is serous or serous-hemorrhagic with large quantity eosinophils. Mycobacterium tuberculosis (MBT) is not found in the exudate. In the blood, leukocytosis, eosinophilia and an increase in the erythrocyte sedimentation rate (ESR) are detected. Tuberculin reactions are positive. Radiographically, it is often characterized by intralobular and costal localization options.

Perifocal tuberculous pleurisy is characterized by a protracted or recurrent course. The disease begins acutely or subacutely and is accompanied by fever, fever, symptoms of intoxication. The pleural effusion has a lymphocytic character, MBT are not detected. Tuberculin tests are normergic in nature.

Tuberculosis of the pleura with exudative pleurisy has a subacute or asymptomatic course with a predominance of symptoms of intoxication and fever. In the early period and during the resorption of the exudate, a pleural friction noise occurs, which may be accompanied by dry and moist small bubbling rales. The nature of the effusion may vary. A blood test reveals leukocytosis with a shift to the left, lymphopenia and an increase in ESR. Features of the course of the disease in old age

In elderly patients, pleurisy is predominantly infectious in nature and sluggish. The course of the disease is aggravated by comorbidities, such as diabetes, kidney and liver diseases. If the patient has cerebral circulation disorders, the clinic is erased - there is no cough, no changes are detected in blood tests.

Signs of complications

Pleurisy, like any disease, has many serious complications that occur when the initial symptoms are ignored and non-compliance with medical prescriptions. Possible Complications diseases:

Complications	Symptoms
Liver abscesses	Febrile temperature. Constant aching pains of a dull nature in the right hypochondrium. dyspepsia. Weight loss. Jaundice of the skin and sclera.
Lung atelectasis	Chest pain. Dullness of percussion sound. Lag in the act of breathing half of the chest on the side of the lesion. triangular shadow on x-ray.
Respiratory failure	Hypotension. Tachycardia. Headache.
	Weakness. Dizziness Hypothermia. Bluish pallor. Cold sweat. Weak pulse. Tachycardia. Hypotension. Sluggish pupillary reaction to light.
Acute cardiopulmonary failure	Severe hypotension. Rapid labored shallow breathing. Swelling of the neck veins. Chest pain. Sticky sweat.
Pulmonary edema	Chest pain. Tachypnea. Tachycardia. Increasing pressure. Sweating. Anxiety. Distant bubbling rales.
	Fever. Febrile or hectic temperature. Tachycardia. Tachypnea. Hypotension. Limit dysfunction.
	Chest pain. Tachycardia. Pallor. Hyperthermia. Respiratory failure.
Decreased diaphragm movement	Violation of breathing at rest, when bending, entering the water. Respiratory failure. Limitation of physical activity. It is often an incidental finding on x-ray.
Seal of the pleura	Shortness of breath that worsens with exertion. Forced position on the affected side. Lag of half of the chest in the act of breathing. Pain in the chest on palpation
	Hypotension. Tachycardia or bradycardia. Tachypnea. Lack of response to pain. Loss of consciousness.
Pleural empyema	Fever. Chest pain. Sweating.

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Turning to human anatomy, the mechanism of the disease becomes clear.

Pleura- consists of outer and inner sheets with an intermediate gap or pleural cavity. Under the influence of any causes (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 sheets - at the same time they thicken. In this way, it is formed fibrinous or dry pleurisy. With a larger volume of fluid in the pleural cavity develops exudative pleurisy.

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Classmates

What is this disease?

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, as well as against the background of oncology. Men under 40 are more susceptible to the disease. contribute to its emergence:

• excessive cooling or vice versa, overheating;
• untreated acute respiratory infections;
• trauma;
• poor nutrition with poor intake of vitamin C;
• heavy physical exertion without recovery.

Reasons for the appearance

In general, allocate three main reasons or ways of formation of inflammation:

Aseptic etiology:

• malignant oncology of the pleura (mesothelioma), one or multiple metastases in the pleural cavity in oncological diseases of other organs, for example, mammary glands, ovaries, lungs, and so on;
• autoimmune cause: local damage to connective tissues (lupus erythematosus, arthritis, systemic vasculitis, rheumatism, etc.);
• heart attacks (myocardium, lung);
• other (pancreatitis, leukemia, renal failure).

Mixed ancestry:

• Infectious-allergic;
• toxic-allergic;
• autoimmune-toxic.

• Allergy to chemical substances or the plant is accompanied by a runny nose - this is not as harmless as it seems. Learn more about and fight allergies.
• Suffering from a cough? Pay attention to the health of children, as a predisposition to bronchospasm may be hereditary. you can read about the causes of bronchitis.

Symptoms

The clinical picture of pleurisy is divided into dry and exudative.

Symptoms of dry pleurisy:

• chest pain;
• General unhealthy condition;
• dry cough;
• subfebrile body temperature;
• local pain (depending on the location of the lesion);
• with palpation of the ribs, deep breathing, coughing, pain intensifies.

In the acute course of the disease, the doctor diagnoses pleural murmur by auscultation, which does not stop after pressing with a stethoscope or coughing. Dry pleurisy, as a rule, passes without any negative consequences- of course, with an adequate treatment algorithm.

Symptoms of exudative pleurisy:

• general malaise, lethargy, subfebrile fever;
• chest pain, shortness of breath increase, gradual increase in heat - this is due to the collapse of the lung, the mediastinal organs are squeezed.

Acute serous pleurisy is usually tuberculous in origin.

characterized by three stages:

• exudation;
• stabilization;
• effusion resorption.

In the initial period (exudative) smoothing or even bulging of the intercostal space is noted. The mediastinal organs are displaced to the healthy side under the influence of a large amount of fluid in the pleural space.

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 on a vertical x-ray. In this case, it is necessary to conduct a study in a position on the side. Free fluid moves easily in accordance with the position of the patient's torso. Often, its accumulations are concentrated in the gaps between the lobes, as well as in the area of ​​the dome of the diaphragm.

Clinical manifestations of inflammation of the pleura are divided into:

• acute (the disease is pronounced, it develops rapidly);
• subacute (moderate course of inflammation);
• chronic (weak symptoms, periods of exacerbation).

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 noted that non-tuberculous empyema is relatively well treatable, however, with an inadequate algorithm of actions, it can turn into a more complex form. Tuberculous empyema is severe and may be chronic. The patient significantly loses weight, suffocates, experiences constant chills, suffers from coughing fits. In addition, the chronic form of this type of pleurisy causes amyloidosis of the internal organs.

In case of not providing optimal assistance, complications arise:

• Stop breathing;
• spread of infection throughout the body with blood flow;
• development of purulent mediastinitis.

Prevention

Very simple: it is necessary to adequately treat the primary infectious disease, monitor nutrition, alternate physical activity with quality rest, do not overheat and do not succumb to excessive cooling.

Pleurisy perifocal- in patients with pulmonary forms of tuberculosis, it has a chronic stagnant character. Relapses are possible. The exudate is serous, also without mycobacteria.

If you find in yourself or people close to you the described signs of pleural inflammation, you must urgently contact a local therapist.

After the initial examination of the clinical picture, which can tell the specialist a lot, take a series of tests, act on the further prescription of the doctor. Most likely, a referral to a pulmonologist will follow.

It is important to remember that with an early diagnosis of the disease, the doctor will prescribe adequate therapy, following which, you can count on the final full recovery.

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Pleurisy - inflammation of the pleura with the formation of fibrous plaque on its surface or effusion inside it. Appears as an accompanying pathology or as a result of various diseases.

Pleurisy is an independent disease (primary pleurisy), but most often it is the consequences of acute and chronic inflammatory processes in the lungs (secondary pleurisy). They are divided into dry, otherwise called fibrinous, and effusion (serous, serous-fibrinous, purulent, hemorrhagic) pleurisy.

Often pleurisy is one of the symptoms of systemic diseases (oncology, rheumatism, tuberculosis). However, the vivid clinical manifestations of the disease often force doctors to put the manifestations of pleurisy in the forefront, and already by its presence to find out the true diagnosis. Pleurisy can occur at any age, many of them remain unrecognized.

The reasons

Why does pleurisy of the lungs occur, what is it, and how to treat it? Pleurisy is a disease of the respiratory system, with its development, the visceral (pulmonary) and parietal (parietal) sheets of the pleura, the connective tissue membrane that covers the lungs and the inner surface of the chest, become inflamed.

Also, with pleurisy, fluids can be deposited between the sheets of the pleura (in the pleural cavity), such as blood, pus, serous or putrefactive exudate. The causes of pleurisy can be conditionally divided into infectious and aseptic or inflammatory (non-infectious).

infectious causes Pleurisy of the lungs include:

• bacterial infections (pneumococcus, staphylococcus),
• fungal infections (blastomycosis, candidiasis),
• typhoid fever,
• tularemia
• chest injury,
• surgical interventions.

Causes of non-infectious pleurisy of the lungs are as follows:

• malignant tumors of the pleura,
• metastasis to the pleura (with cancer of the breast, lung, etc.),
• connective tissue lesions of a diffuse nature (, scleroderma,), lung infarction,
• TELA.

Factors that increase the risk of developing pleurisy:

• stress and overwork;
• hypothermia;
• unbalanced, nutrient-poor nutrition;
• hypokinesia;
• drug allergies.

The course of pleurisy may be:

• acute up to 2-4 weeks,
• subacute from 4 weeks to 4-6 months,
• chronic, more than 4-6 months.

Microorganisms enter the pleural cavity in different ways. The causative agents of infection can penetrate by contact, through the blood or lymph. Their direct hit occurs with injuries and wounds, during operations.

Dry pleurisy

With dry pleurisy, there is no fluid in the pleura, fibrin appears on its surface. Basically, this form of pleurisy precedes the development of exudative.

Dry pleurisy is often a secondary disease in many diseases of the lower respiratory tract and intrathoracic lymph nodes, malignant neoplasms, rheumatism, collagenosis and some viral infections.

Tuberculous pleurisy

Recently, the incidence of tuberculous pleurisy has increased, which occurs in all forms: fibrous, exudative and purulent.

In almost half of the cases, the presence of dry pleurisy indicates that the tuberculous process occurs in the body in a latent form. By itself, tuberculosis of the pleura is quite rare, for the most part, fibrous pleurisy is a response to tuberculosis of the lymph nodes or lungs.

Tuberculous pleurisy, depending on the course of the disease and its characteristics, is divided into three varieties: perifocal, allergic and proper pleural tuberculosis.

Purulent pleurisy

Purulent pleurisy is caused by such microorganisms as pathogenic staphylococci, pneumococci, streptococci. In rare cases, these are Proteus, Escherichia sticks. As a rule, purulent pleurisy develops after exposure to one type of microorganism, but it happens that a whole association of microbes causes the disease.

Symptoms of purulent pleurisy. The course of the disease varies with age. In infants of the first three months of life, purulent pleurisy is very difficult to recognize, as it masks itself under the general symptoms characteristic of umbilical sepsis, pneumonia caused by staphylococci.

On the part of the disease, the chest becomes convex. There is also a drooping of the shoulder, insufficient mobility of the arm. Older children have standard symptoms of total pleurisy. You can also note a dry cough with sputum, sometimes even with pus - when a pleural abscess breaks into the bronchi.

Encapsulated pleurisy

Encapsulated pleurisy is one of the most severe forms of pleurisy, in which the fusion of the pleural sheets leads to the accumulation of pleural extrudate.

This form develops as a result of prolonged inflammatory processes in the lungs and pleura, which lead to numerous adhesions and delimit the exudate from the pleural cavity. Thus, the effusion accumulates in one place.

Exudative pleurisy

Exudative pleurisy is distinguished by the presence of fluid in the pleural cavity. It can be formed as a result of a chest injury with bleeding or hemorrhage, outpouring of lymph.

By the nature of this fluid, pleurisy is divided into serous-fibrinous, hemorrhagic, chylous and mixed. This fluid, often of obscure origin, is called effusion, which can also restrict the movement of the lungs and make it difficult to breathe.

Symptoms of pleurisy

In the case of pleurisy, the symptoms may vary depending on how the pathological process proceeds - with or without exudate.

Dry pleurisy is characterized by the following features:

• stabbing pain in the chest, especially with coughing, deep breathing and sudden movements,
• forced position on the sore side,
• shallow and gentle breathing, while the affected side visually lags behind in breathing,
• when listening - pleural friction noise, weakening of breathing in the area of ​​fibrin deposits,
• fever, chills and profuse sweating.

With exudative pleurisy, the clinical manifestations are somewhat different:

• dull pain in the affected area,
• a strong lag of the affected area of ​​the chest in breathing,
• feeling of heaviness, shortness of breath, bulging of the spaces between the ribs,
• weakness, fever, severe chills and profuse sweat.

The most severe course is observed with purulent pleurisy:

• high body temperature;
• severe chest pain;
• chills, aches all over the body;
• earthy skin tone;
• weight loss.

If the course of pleurisy becomes chronic, then cicatricial changes in the form of pleural adhesions are formed in the lung, which prevent the lung from completely expanding. Massive pneumofibrosis is accompanied by a decrease in the perfusion volume of the lung tissue, thereby exacerbating the symptoms of respiratory failure.

Complications

The outcome of pleurisy largely depends on its etiology. In cases of persistent pleurisy, in the future, the development of an adhesive process in the pleural cavity, fusion of interlobar fissures and pleural cavities, the formation of massive moorings, thickening of the pleural sheets, the development of pleurosclerosis and respiratory failure, and limitation of the mobility of the dome of the diaphragm are not excluded.

Diagnostics

Before determining how to treat pleurisy of the lungs, it is worth undergoing an examination and determining the causes of its occurrence. In the clinic, the following examinations are used to diagnose pleurisy:

• examination and questioning of the patient;
• clinical examination of the patient;
• x-ray examination;
• blood analysis;
• analysis of pleural effusion;
• microbiological research.

Diagnosis of pleurisy as a clinical condition usually does not present any particular difficulties. The main diagnostic difficulty in this pathology is to determine the cause that caused inflammation of the pleura and the formation of pleural effusion.

How to treat pleurisy?

When symptoms of pleurisy appear, treatment should be comprehensive and aimed primarily at eliminating the main process that led to its development. Symptomatic treatment aims to anesthetize and accelerate the resorption of fibrin, to prevent the formation of extensive moorings and adhesions in the pleural cavity.

At home, only patients with diagnosed dry (fibrinous) pleurisy are subject to treatment, all other patients should be hospitalized for examination and selection of an individual treatment regimen for pleurisy of the lungs.

The specialized department for this category of patients is the therapeutic department, and patients with purulent pleurisy and pleural empyema need specialized treatment in a surgical hospital. Each of the forms of pleurisy has its own characteristics of therapy, but for any type of pleurisy, an etiotropic and pathogenetic direction in treatment is indicated.

So, with dry pleurisy, the patient is prescribed:

1. To stop the pain syndrome, they are prescribed: analgin, ketanov, tramadol, with the ineffectiveness of these drugs, in a hospital, the introduction of narcotic painkillers is possible.
2. Warming semi-alcohol or camphor compresses, mustard plasters, iodine mesh are effective.
3. Prescribe drugs that suppress cough - sinekod, codelac, libexin.
4. Since the root cause is most often tuberculosis, after confirming the diagnosis of tuberculous pleurisy, a specific treatment is carried out in the anti-tuberculosis dispensary.

If pleurisy is exudative with a large amount of effusion, a pleural puncture is done to evacuate it or drain it. No more than 1.5 liters of exudate are pumped out at a time, so as not to provoke cardiac complications. With purulent pleurisy, the cavity is washed with antiseptics. If the process has become chronic, they resort to pleurectomy - the surgical removal of part of the pleura in order to prevent relapse. After resorption of the exudate, patients are prescribed physiotherapy, physiotherapy exercises, and breathing exercises.

In acute tuberculous pleurisy, drugs such as isoniazid, streptomycin, ethambutol, or rifampicin may be included in the complex. The course of tuberculosis treatment itself takes about a year. With parapneumonic pleurisy, the success of treatment depends on the selection of antibiotics based on the sensitivity of the pathological microflora to them. In parallel, immunostimulating therapy is prescribed.

Update: December 2018

Each lung is enclosed in a two-layer bag (pleura), between the sheets of which, as a result of various diseases, blood, edematous or inflammatory fluid can accumulate. This condition in medicine is called pleurisy, which is extremely rare in the form of an independent disease, usually this process is a complication of such diseases and conditions as:

• pulmonary tuberculosis
• connective tissue diseases - autoimmune (rheumatism, systemic lupus erythematosus)
• allergic reactions (pleurisy)
• hemorrhage in injuries and operations on the chest
• acute bacterial pneumonia (usually pneumococcal)
• cardiovascular, renal,
• oncological processes, leukemia
• infectious diseases (brucellosis, syphilis)
• fungal diseases of the lungs
• dystrophy from prolonged starvation
• with acute pancreatitis, the development of enzymatic pleurisy is possible

Each of these conditions reduces defensive forces organism, disrupts the normal course metabolic processes, changes the composition of blood and lymph. In the pleura there is a fairly developed capillary network of lymphatic and blood vessels, which are the source of fibrin or fluid in its cavity.

However, the most common causes of fluid accumulation in the pleural cavity and the development of pleurisy today are tuberculosis and oncology. An independent and very dangerous disease is pleural empyema - purulent pleurisy. Our article is about pleurisy, symptoms and treatment of this insidious disease.

Types of pleurisy

Dry pleurisy

Symptoms of dry pleurisy

Pleurisy has a number of specific symptoms. At the same time, the clinic of dry pleurisy differs significantly from pleurisy with effusion. The clinical picture is complemented by the symptoms of the underlying disease.

The onset of the disease is sudden, patients can accurately indicate the time of onset of the disease. The infectious process may be accompanied high temperature. Fibrinous pleurisy is characterized by a sharp pain syndrome on the affected side of the lung. Breathing is superficial, a painful cough appears, all this is accompanied by severe pain that arises from the contact of the inflamed pleura. Pain is aggravated by tilting the body in the opposite direction, with a deep breath or coughing.

The patient tries to lie on a healthy side, which slightly alleviates his suffering. With the localization of the inflammatory process near the diaphragm, pain can occur in the upper abdomen, in the heart, in the neck, which creates the basis for erroneous diagnoses.

Diagnostics

On examination, the diseased half of the chest lags behind in the act of breathing, this can be seen from the movement of the shoulder blades. When listening to the lungs, a very characteristic sound of pleural friction is determined.
Radiography in acute dry pleurisy does not provide sufficient information. Laboratory tests will characterize the underlying disease.

Treatment of dry pleurisy

• To stop the pain syndrome, painkillers are prescribed analgin, ketanov (see the list of NSAIDs in the article), tramadol, if these drugs are ineffective, in a hospital, narcotic painkillers may be administered.
• Effective warming semi-alcohol or camphor compresses, iodine mesh.
• Prescribe drugs that suppress cough - sinekod, codelac, libexin (see).
• Since the root cause is most often tuberculosis, after confirming the diagnosis of tuberculous pleurisy, a specific treatment is carried out in the anti-tuberculosis dispensary.

For reference:

• According to WHO, the mortality rate from tuberculosis and the number of patients with tuberculosis (including tuberculous pleurisy) in Russia are 8 times higher than in European countries.
• Prisoners ill with tuberculosis, when leaving prison, as a rule, do not go to doctors and are not registered, infecting 10-20 people a year.
• Every year in Russia 25,000 people die of tuberculosis, 120,000 people fall ill.
• The worst thing is that every 10 patients have multiple drug resistance, that is, a practically incurable form of pulmonary tuberculosis and its extrapulmonary forms (kidneys, joints, spine, genitals, eyes).

Exudative pleurisy and hydrothorax

Symptoms of exudative pleurisy

Unlike fibrous pleurisy, pain in pleurisy with various types effusion is not a leading symptom, except for chest injuries, so signs of fluid accumulation do not appear until a few days after the onset of the disease.

Exudative pleurisy begins gradually, the symptoms grow slowly, the person complains of headache, fever, weakness, a feeling of heaviness in the affected side of the chest, with gradually increasing shortness of breath, which worries the patient even at rest (see).

Shortness of breath is caused by a decrease in lung volume, due to compression of their enlarged pleural cavity. The pulse quickens, the face turns pale, the nasolabial triangle takes on a bluish tint, the veins of the neck swell. In the place of accumulation of effusion, intercostal spaces may swell. There is a lag of the affected half during breathing.

In severe conditions caused by insufficiency of the heart, liver, kidneys, the process can develop symmetrically, pleurisy is noted on both sides. Then there will be no bright symptoms characteristic of pleurisy, although the general condition of the patient will worsen.

most common cause exudative pleurisy in adults remains tuberculosis, and in 70% of cases it begins as lobar pneumonia, with fever 39C, pain, general weakness, chills.

Diagnostics

The leading criterion will be radiography, radiological signs of pleurisy or hydrothorax are quite eloquent. On auscultation of the lungs, in contrast to dry pleurisy, the affected side of the chest is "silent". Laboratory indicators will correspond to the underlying disease. Only with hemorrhagic pleurisy can there be signs of anemia (anemia).

Treatment

Exudative pleurisy is treated in a hospital. In the edematous form of the underlying disease, an unloading diet is prescribed that restricts fluid and salt. With purulent pleurisy, antibiotic therapy (broad-spectrum antibiotics), NSAIDs, painkillers and antihistamines are required, which reduce swelling and have an antiallergic effect (see).

If the volume of the effusion is large enough, resulting in marked violations of the respiratory and cardiovascular functions, the pleural cavity is urgently punctured and the contents are evacuated. The obtained material must be examined to clarify its nature and the main diagnosis. Perhaps the introduction of antibiotics, prednisolone or hydrocortisone into the pleural cavity, to reduce the phenomena of exudation. A drainage system is installed for several days.

When in the postoperative period, the accumulation of fluid in the chest should not be considered a complication?

If an operation was performed to remove the lung or part of it, an empty space is formed in the chest cavity, which is filled with fluid. “Nature abhors emptiness”, this is a kind of protective-compensatory reaction to maintain stable pressure in the chest cavity, which ensures the normal arrangement of the remaining organs.

Neither the heart nor the remaining lungs are displaced, which allows them to function normally. In the process of recovery, part of the fluid is absorbed, part is replaced by fibrin, forming adhesions. In this case, pleurisy is not a complication. In other operations, the appearance of pleurisy is considered a complication, the resulting fluid is removed and appropriate treatment is carried out.

Forecast

The prognosis of pleurisy is favorable, although it directly depends on the leading disease. Inflammatory, infectious, post-traumatic pleurisy is successfully cured and does not affect the quality of later life. Unless, during later life, pleural adhesions will be noted on radiographs.

The exception is dry tuberculous pleurisy, as a result of which fibrous deposits can calcify over time, the so-called armored pleurisy is formed. The lung is enclosed in a "stone shell", which interferes with its full functioning and leads to chronic respiratory failure.

To prevent the formation of adhesions that form after the removal of fluid from the pleural cavity, after treatment, when the acute period subsides, the patient should undergo rehabilitation procedures - this is physiotherapy, manual and vibration massage, it is necessary to carry out daily, using the Frolov breathing simulator).