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Lung pleurisy, what is it? - forms, symptoms and treatment

In the pulmonary section of medicine, among many pathologies of the pleural cavity, the most common disease is pleurisy (pleurisy).

What it is? Pleurisy is a term that summarizes several diseases that cause inflammation of the serous membrane of the lung, the pleura. As a rule, it develops when pathologies already exist, accompanied by effusion of exudate or fibrin clots in the pulmonary pleural cavity.

Pleurisy development process

The pleura is a two-layer (in the form of two sheets) serous membrane surrounding the lungs - the inner (visceral) leaf and the outer (parietal). The pleural inner leaf covers directly the lung tissue itself and its structures (nerve tissue, vascular network and bronchial branches) and isolates them from other organs.

Pleurisy of the lungs The outer pleural sheet lines the intracavitary chest walls. It ensures the safety of the lungs, and the slip of the leaves, preventing their friction in the process of breathing.

In a healthy, normal state, the distance between the pleural leaf membranes does not exceed 2.5 cm and is filled with serous (serum) fluid.

The fluid enters between the sheets of pleura from the vessels of the upper zone of the lung, as a result of plasma filtration of the blood. Under the influence of any injuries, serious diseases or infections, its rapid accumulation occurs between the pleural membranes, causing the development of inflammatory reactions in the pleura - pleuresia.

The normal work of the vascular functions provides for the absorption of excess exudate, leaving a sediment in the form of fibrin proteins on the pleural sheet, so a dry (fibrinous) form of pleurisy appears.

The failure of vascular functions provokes the formation of bloody, purulent, or lymphoid fluid in the cavity of the pleura - an exudative pleurisy.


Causes of pleurisy, etiology

The reason for the development of pleurisy is due to two extensive groups of provocative factors - infectious and non-infectious.

Infection often becomes a causal factor in the initiation of inflammatory reactions with the formation of a purulent fluid (effusion) between the membranes of the pleura. Penetration into the pathogen can occur as a result of direct contact with an infectious focus (usually in the lung itself), through the blood and lymph, or through direct contact (surgery, injury, trauma). As the causative agent are:

  1. Mycobacterium tuberculosis (tuberculous pleurisy);
  2. Cocci bacteria;
  3. Parasites , protozoa and fungal infections.

The most common non-infectious factors are due to the influence of:

  • Malignant neoplasms on the pleura or metastases of tumors located outside of it. The tumor process damages the pleural membrane, contributes to a significant increase in exudate secretion and the development of exudative pathology.
  • Systemic diseases causing vascular and tissue lesions;
  • Pulmonary emboli when inflammation passes to the membranes of the pleura;
  • Acute pathology of the heart muscle, due to a decrease in the immune factor;
  • Uremic toxins in renal pathology;
  • Blood diseases and gastrointestinal tract.

The manifestation of the clinical forms of the disease are classified:

  • in form or type;
  • by the nature of the exudate and its quantity;
  • in the place of inflammatory reactions;
  • according to clinical signs, as manifested - acute pleurisy, subacute or chronic, with bilateral pleural inflammation or left-sided and right-sided pleurisy.

Symptoms of pulmonary pleurisy

Symptoms of pulmonary pleurisy

The disease develops, as a rule, with a dry (fibrinous) form of pleurisy, lasting from 1 to 3 weeks. The absence of positive dynamics of treatment contributes to its overflow into exudative pleuresia, or chronic.

Dry (fibrinous) pleresia is characterized by suddenness and severity of manifestation. The first symptoms of pleurisy manifest themselves especially sharp chest pain in the development of inflammatory reactions. Coughing, sneezing and oscillating movements cause an increase in pain.

Deep breathing is accompanied by a dry, hot cough. The temperature is absent, or rises slightly.

Marked by:

  • migraine, soreness and weakness;
  • joint pain and occasional muscle pain;
  • heard hoarseness and noise - evidence of pleural friction caused by fibrin sediment.

Symptoms of dry pleurisy of various types of manifestation are distinguished by special signs.

  1. Parietal form of inflammation, the most common disease. Its main feature is a constant increase in painful symptoms when reflex coughing and sneezing.
  2. The diaphragmatic process of inflammation is characterized by signs of pain radiating to the shoulder and the anterior area of ​​the peritoneum. Hiccup and swallowing cause unpleasant sensations.
  3. Apical pleurisy (dry) is recognized by painful signs in the shoulder-shoulder area and neuralgic pathologies in the hands. This form develops in tuberculous lesions of the lungs, which subsequently transforms into sacculated pleuresia.

Exudative, effusion pleurisy. The symptoms of pulmonary pulmonary effusion, in its various forms, in the initial development stage are similar to dry pleurisy. After a certain time, they become “blurred”, since the voids between the sheets are filled with effusion and the contact is terminated.

It happens that the exudative type develops without prior fibrous pleurisy.

For some time, patients may not feel changes in the thoracic region, the characteristic symptoms manifest themselves after a while:

  • fever with very high temperatures;
  • tachypnea and dyspnea;
  • swelling and cyanosis of the facial and cervical area;
  • swelling of the veins and venous pulsation on the neck;
  • expansion of the sternum in the area of ​​inflammation;
  • bulging or smoothing intermuscular rib crevices;
  • swelling in the lower skin folds in the area of ​​pain.

Patients try to avoid unnecessary movements, lie only on the non-damaged side. Perhaps expectoration of bloody sputum.

Purulent pleuresia. In rare cases, a very severe pathology with serious consequences, which, for the most part, end in death, is formed. Very dangerous in childhood and old age. Purulent pleurisy begins its development on the background of inflammation or lung abscess. Appears:

  • pains of a pricking character in the sternum, subsiding with purulent filling of the pleural cavity;
  • podrebernymi rubber and weight;
  • insolvency of deep breath and a sense of lack of air;
  • gradual enhancement of dry cough;
  • critical temperature and purulent expectoration.

If the disease is a consequence of an abscess of the lungs, then as a result of its rupture, a painful prolonged cough appears, causing severe pain symptoms in the side.

Purulent exudate causes intoxication in the form of blanching of the skin and cold sweat. May increase pressure and increase shortness of breath, making it difficult to breathe fully. With these symptoms of pleurisy of the lungs, both treatment and subsequent monitoring of its effectiveness must take place within the hospital walls.

Tuberculosis form. It is characterized by the highest frequency of development in children and young age. It manifests itself in three main forms - para-specific (allergic), perifocal (local) and tuberculous pleurisy.

Para-specific begins with fever, tachycardia, shortness of breath and painful symptoms in the side. Symptoms disappear immediately after filling the pleural cavity with fluid.

The perifocal form is manifested already in the presence of tuberculous lesions of the lung tissue, which takes a long time with periods of exacerbation and spontaneous remissions.

Symptoms in the dry form of tuberculous lesions are caused by signs of friction of the pleural sheets, causing noise during breathing and pain in the sternum. The presence of effusion is accompanied by distinct symptoms:

  • fever and sweating;
  • rapid heartbeat and suffocation;
  • lateral and sternal painful muscle spasms;
  • hoarse breathing and fever;
  • a lumpy bulge and a lump in the chest in the area of ​​the inflammatory response ..

Treatment methods for pleurisy

Treatment methods for pleurisy

There is no single treatment for pleurisy. The basis of the therapeutic process is the physical diagnosis of the doctor, after which appropriate methods of instrumental diagnostics are assigned, according to the results of which individual therapy is selected taking into account all the parameters of the pathology (form, type, localization, severity of the process, etc.).

As a conservative treatment is carried out drug therapy.

  1. Antibacterial drugs, even before bacteriological results are obtained, are drugs and analogues of Bigflon, Levofloxacin, Cefepime, or Ceftriaxone, and then replacing them with drugs for a specific pathogen.
  2. Painkillers and anti-inflammatory drugs used in inflammatory and degenerative diseases (Mefenamic acid, Indomethacin or Nurofen);
  3. Antifungal therapy for fungal causes of pathology.
  4. When pleuresia, as a consequence of tumor processes, natural hormone preparations and anticancer drugs are prescribed.
  5. In the treatment of exudative pleurisy, the use of diuretics is justified. And vascular drugs (if indicated).
  6. When the dry form of pleuresia is prescribed, drugs of a cough of an overwhelming nature (Codeine or Dionin), thermal methods of physiotherapy, and methods of tight bandaging of the sternum are prescribed.
  7. To prevent the development of pleural empyema, as a consequence of exudative pleurisy complications, puncture removal of purulent exudate is performed, followed by washing the cavity of the pleural sheets with antibiotic solutions.

Possible complications and consequences

The neglect of inflammatory processes in the pulmonary pleura leads to dangerous pleurisy complications - adhesion of pleural sheets by adhesions, local disturbances of blood circulation caused by compression of blood vessels, effusion, development of single and multiple pulmonary pleural messages (fistulas).

The most dangerous complication is pleural empyema (pyothorax) in which, the lack of adequate drainage of pus, causes the development of multi-chamber empyema.

With the processes of scarring and thickening of the pleural membrane, the development of sepsis in the adjacent tissues (septicopyemia), pathological changes in the bronchi (bronchiectasis), amyloid dystrophy.

All this, in more than 50% of cases, may end in death. Much higher mortality rate in children and elderly patients.


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