Pleurisy of the lungs on the right side. Pleurisy of the lungs: symptoms and treatment

Against the background of painful processes in the lungs and other organs, it may occur. This pathology is not uncommon in medical practice, sometimes the symptoms of pleurisy come to the fore, masking the underlying disease.

Between the chest and lungs is a narrow space lined with a thin serous membrane - the pleura. The cavity contains about 2 ml of thick fluid, which ensures smooth movement of the lungs. This moisture is constantly filtered out of the blood vessels of the pleura. Fluid is absorbed through the lymphatic system and excreted to the lymph nodes.

Inflammatory processes are accompanied by the accumulation of effusion in the pleural cavity - an exudate rich in protein. The lymphatic vessels of the pleural sheets manage to remove a small amount of inflammatory fluid from the cavity, but fibrin clots settle on the surface of the serous membrane.

Fibrinous pleurisy develops, also called dry. With the accumulation of a significant amount of exudative fluid, the disease passes into an exudative form. When pathogens enter the pleural cavity, the inflammatory exudate becomes purulent. In addition to bacteria, the development of pleurisy can cause:

• fungal microorganisms;
• viruses;
• rickettsia;
• helminths;
• protozoa.

The infection reaches the pleural cavity through the circulatory and lymphatic system, or penetrates directly from the focus of the disease in the lungs. Infection can occur with open trauma chest, surgical intervention. The most common cause of infectious pleurisy is pneumonia.

Pleurisy, not associated with an infection, can provoke a lot of reasons, including:

• tumors (most often mesothelioma);
• vascular diseases;
• myocardial infarction;
• pancreatitis;
• kidney failure;
• radiation therapy;
• chest injury.

Dry pleurisy

The main symptoms that the patient complains of with fibrinous pleurisy are fever and pain in the lesion of the pleura. The pain tends to increase during deep breaths, coughing, movement. In this case, a person puts his hand to a sore spot, as if protecting him.

Breathing becomes frequent, at times there is pain in the joints, muscles. Body temperature rarely reaches high values, accompanied by chills and excessive sweating.

When listening, the decisive diagnostic sign is the characteristic friction noise, which is produced by rough pleural sheets with layers of fibrin.
At the end of inhalation and the beginning of exhalation, a grinding sound is clearly defined, similar to the rustling of paper. At the site of the lesion, weakened, muffled breathing in the lungs is heard.

In a laboratory blood test, symptoms of inflammation are revealed: an increase in the number of leukocytes, an acceleration of the erythrocyte sedimentation rate, a shift in the white blood formula to the left. An X-ray examination shows a decrease in lung mobility, and an ultrasound shows deposits of fibrin flakes.

exudative form

On the early stages exudative pleurisy may experience dry cough, soreness in the affected area of ​​the pleura. As fluid accumulates in the pleural cavity, the pain disappears, but a feeling of fullness or heaviness in the chest appears. Body temperature often reaches 40˚, symptoms of intoxication are expressed:

• weakness;
• increased sweating;
• dizziness.

Inflammatory effusion displaces the organs of the chest cavity and disrupts the activity of the cardiovascular system. At the same time, the heart rate increases, arterial pressure. Due to the infringement of lung function, shortness of breath develops, the patient's skin becomes cyanotic.

On examination, it is possible to detect an increase in the volume of the chest on the side of the lesion. Intercostal spaces over the area of ​​inflammation are smoothed out, sometimes even protrude. The patient with pleurisy lies mainly on the affected side, as this relieves the pain a little. When tapping the place of accumulation of inflammatory exudate, a dull sound is heard. The fluid absorbs sounds, so breathing sounds in the lungs do not sound over the affected area.
are heard.

Purulent form

It can be quite difficult to recognize purulent inflammation of the pleural sheets. At the onset of the disease, symptoms of the underlying disease, such as pneumonia or acute pancreatitis, predominate. Increasing symptoms of intoxication indicate the attachment of infection to the inflammatory process:

• weakness;
• lack of appetite;
• emaciation;
• trembling of the limbs;
• frequent pulse;
• exhausting fever.

Body temperature during the day can fluctuate significantly, falling sharply from higher to normal numbers. Temperature stabilization at the level of 37-37.5˚ is considered to be an extremely unfavorable sign. This indicates the depletion of the body's defenses. A cough develops with sputum production. The functions of the lungs, liver, kidneys and circulatory system are sharply disturbed. The skin of patients, especially on the face, becomes edematous.

The disease can be complicated by a breakthrough of the purulent contents of the pleural cavity into the bronchi. This is accompanied by the appearance of a large amount of sputum with an unpleasant odor. Much less often, a purulent effusion impregnates the soft tissues of the chest, subcutaneous tissue, thins the skin and breaks out.

In the blood test, there is a sharp increase in the number of leukocytes, a shift of the leukocyte formula to the left, neutrophils are affected by toxic granularity. Biochemical studies register an increase in the level of C-reactive protein, haptoglobin, sialic acids and other markers of acute inflammation.

Diagnostic studies

To confirm the diagnosis with exudative pleurisy, apply:

• radiograph;
• pleural puncture.

The initial stage of purulent pleurisy is best detected by x-ray examination of the chest in direct and lateral projections. With the accumulation of a large amount of inflammatory effusion, the radiograph is carried out in the position of the patient lying down. The fluid is evenly distributed along the chest and becomes visible in the picture.

The most difficult thing is to identify changes if the inflammation is accompanied by an adhesive process and the formation of a closed cavity with pus. It is possible to accurately establish the pathological accumulation of pleural fluid and determine the place for puncture using ultrasound.
Pleural puncture for exudative pleurisy is performed under local anesthesia. In the patient's sitting position, a puncture of the intercostal space is made with a long and thick needle. The liquid obtained during the puncture is subjected to:

• microscopy;
• bacteriological analysis;
• cytological examination (to exclude a tumor).

Medical appointments

If any form of pleurisy is detected, treatment of the underlying pathology is necessary. With fibrinous pleurisy, treatment is supplemented with cough medicines (codeine, dionin) and painkillers. Symptoms of inflammation are relieved by Voltaren, Indomethacin or Acetylsalicylic acid.

At the first signs of fibrinous pleurisy, alcohol-containing compresses are effective. The prognosis for dry pleurisy is favorable, adequate treatment after 10-15 days leads to recovery, only sometimes there are relapses of the disease.

If the cause of exudative pleurisy cannot be established, then treatment is prescribed antibacterial agents like pneumonia. When selecting drugs, only those that have not been used in the treatment of the patient before should be used.

Antibiotics from the penicillin group can be combined with cephalosporins, aminoglycosides or metronidazole to enhance the action. The drugs are best administered intravenously by drip.

Intravenous administration of hemodez, glucose, Ringer's solution with exudative pleurisy helps to reduce intoxication and correct protein metabolism. To enhance the reactivity of the body, treatment is supplemented with immunomodulatory agents that activate phagocytosis and cause the production of interferon. Apply:

• Levamisole;
• T-activin;
• Sodium nucleinate;
• Timalin.

In the stage of resorption of the inflammatory effusion, paraffin therapy and chest massage are used. With the help of electrophoresis calcium chloride, heparin is introduced.

Treatment of pleurisy with drainage is carried out if:

• displacement of the heart with inflammatory fluid;
• symptoms of collapsed lungs (low blood pressure, severe shortness of breath);
• large amount of exudate.

A puncture is made and a tube with a valve is inserted along the needle. To avoid complications, no more than 1-1.5 liters of fluid is pumped out of the cavity at a time. Through the drainage, antibiotics are injected directly into the site of infection. If the treatment does not bring results, the affected areas of the pleural sheets and scar layers are surgically removed.

Each patient who has had pleurisy should be regularly examined by a general practitioner or pulmonologist within two years after the illness. Well restores the health of the respiratory system treatment in specialized sanatoriums.

Pleurisy, what is it? Causes and Treatments

An interesting fact is that women are most often diagnosed with the so-called tumor pleurisy. It develops against the background of various neoplasms of the genital organs and breasts. As for men, effusion pleurisy often occurs with pathology of the pancreas and rheumatoid arthritis. In most cases, bilateral or unilateral pleurisy is secondary.

What it is?

Pleurisy - inflammation of the pleural sheets, with the loss of fibrin on their surface (dry pleurisy) or the accumulation of exudate of a different nature in the pleural cavity (exudative pleurisy).

The same term denotes processes in the pleural cavity, accompanied by an accumulation of pathological effusion, when the inflammatory nature of pleural changes does not seem indisputable. Among its causes are infections, chest injuries, tumors.

Causes

The causes of pleurisy can be conditionally divided into infectious and aseptic or inflammatory (non-infectious).

Noninfectious pleurisy usually occurs

• at ,
• with (vascular damage),
• with rheumatism,
• at ,
• at ,
• as a result of pulmonary embolism and pulmonary edema,
• with pulmonary infarction
• when lung cancer mathestasis into the pleural cavity,
• with a primary malignant tumor of the pleura - mesothelioma,
• lymphoma,
• during hemorrhagic diathesis (coagulation disorders),
• during leukemia,
• in the tumor process of the ovaries, breast cancer as a result of cancer cachexia (terminal stage of cancer),
• with myocardial infarction due to congestion in the pulmonary circulation.
• with acute.

Infectious diseases include:

In clinical practice, it is customary to distinguish several types of pleurisy, which differ in the nature of the effusion formed in the pleural cavity, and, accordingly, in the main clinical manifestations.

1. Dry (fibrinous) pleurisy. Develops on initial stage inflammatory lesions of the pleura. Often, at this stage of the pathology, there are still no infectious agents in the lung cavity, and the resulting changes are due to the reactive involvement of blood and lymphatic vessels, as well as an allergic component. Due to the increase in vascular permeability under the action of pro-inflammatory substances, the liquid component of the plasma and some of the proteins, among which fibrin is of the greatest importance, begin to seep into the pleural cavity. Under the influence of the environment in the inflammatory focus, fibrin molecules begin to combine and form strong and sticky threads that are deposited on the surface of the serous membrane.
2. Purulent pleurisy. Purulent exudate accumulates between the sheets of the serous membrane of the lung. This pathology is extremely severe and is associated with intoxication of the body. Without proper treatment, it poses a threat to the life of the patient. Purulent pleurisy can form both with direct damage to the pleura by infectious agents, and with the independent opening of an abscess (or other accumulation of pus) of the lung into the pleural cavity. Empyema usually develops in malnourished patients who have serious damage to other organs or systems, as well as in people with reduced immunity.
3. Exudative (effusion) pleurisy. It is the next phase of the development of the disease after dry pleurisy. At this stage, the inflammatory reaction progresses, the area of ​​the affected serous membrane increases. The activity of enzymes that break down fibrin threads decreases, pleural pockets begin to form, in which pus can accumulate in the future. The outflow of lymph is disturbed, which, against the background of increased secretion of fluid (filtration from dilated blood vessels in the focus of inflammation), leads to an increase in the volume of intrapleural effusion. This effusion compresses the lower lung segments from the affected side, which leads to a decrease in its vital volume. As a result, with massive exudative pleurisy, respiratory failure may develop - a condition that poses an immediate threat to the life of the patient. Since the fluid accumulated in the pleural cavity to some extent reduces the friction between the pleural layers, at this stage, the irritation of the serous membranes and, accordingly, the intensity of the pain sensation is somewhat reduced.
4. Tuberculous pleurisy. Often it is distinguished into a separate category due to the fact that this ailment is quite common in medical practice. Tuberculous pleurisy is characterized by a slow, chronic course with the development of a syndrome of general intoxication and signs of lung damage (in rare cases, other organs). The effusion in tuberculous pleurisy contains a large number of lymphocytes. In some cases, this disease is accompanied by the formation of fibrinous pleurisy. When the bronchi are melted by an infectious focus in the lungs, a specific curdled pus, characteristic of this pathology, can enter the pleural cavity.

This division in most cases is rather arbitrary, since one type of pleurisy can often turn into another. Moreover, dry and exudative (effusion) pleurisy are considered by most pulmonologists as different stages of the same pathological process. It is believed that dry pleurisy is initially formed, and effusion develops only with further progression of the inflammatory reaction.

Symptoms

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

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 usually has a tuberculous origin, is characterized by three stages:

1. In the initial period (exudative) smoothing or even swelling 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.
2. The stabilization period is characterized by a decrease acute signs: temperature drops, chest pains 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.
3. 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.

Symptoms of dry pleurisy:

• chest pain;
• general unhealthy condition;
• subfebrile body temperature;
• local pain (depending on the location of the lesion);
• on palpation of the ribs, deep breathing, coughing pain intensify.

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.

TO 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 is caused by pus entering the pleural cavity, where it tends to accumulate. It should be taken into account that non-tuberculous empyema responds relatively well to treatment, 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.

Diagnostics

The first task in diagnosing pleurisy is finding out the location and cause of inflammation or swelling. To make a diagnosis, the doctor examines the medical history in detail and conducts an initial examination of the patient.

The main methods for diagnosing pleurisy of the lungs:

1. Blood tests can help determine if you have an infection, which could be the cause of pleurisy. In addition, blood tests will show the state of the immune system.
2. A chest x-ray will determine if there is any pneumonia. A chest x-ray may also be taken while lying down to allow free fluid in the lungs to form a layer. A recumbent chest x-ray should confirm if there is any fluid buildup.
3. Computed tomography is already performed if any abnormalities are found on the chest x-ray. This analysis presents a series of detailed, transverse sectional images of the chest. The images produced by a CT scan create a detailed picture of the inside of the breast, allowing the attending physician to obtain a more detailed analysis of the irritated tissue.
4. During a thoracentesis, your doctor will insert a needle into your chest area to test for fluid. The fluid is then removed and analyzed for infections. Due to its aggressive nature and associated risks, this test is rarely done for a typical case of pleurisy.
5. During a thoracoscopy, a small incision is made in the chest wall and then a tiny camera attached to a tube is inserted into the chest cavity. The camera locates the irritated area, allowing a tissue sample to be taken for analysis.
6. A biopsy is useful in the development of pleurisy in oncology. In this case, sterile procedures are used and small incisions are made in the skin of the chest wall. X-ray or CT scan can confirm the exact location of the biopsy. The doctor may use these procedures to insert the lung biopsy needle between the ribs and into the lung. Then a small sample of lung tissue is taken and the needle is removed. The tissue is sent to a laboratory where it will be analyzed for infections and abnormal cells compatible with cancer.
7. Using ultrasound, high-frequency sound waves create an image of the inside of the chest cavity, which will allow you to see if there is any inflammation or fluid buildup.

As soon as the symptoms of pleurisy are identified, treatment is prescribed immediately. In the first place in the treatment are antibiotics against infection. In addition, anti-inflammatory drugs or other pain medications are prescribed. Sometimes cough medicine is prescribed.

Pleurisy treatment

Effective treatment of pleurisy depends entirely on the cause of its occurrence and consists mainly in eliminating the unpleasant symptoms of the disease and improving the patient's well-being. In the case of a combination of pneumonia and pleurisy, antibiotic treatment is indicated. Pleurisy accompanying systemic vasculitis, rheumatism, scleroderma is treated with glucocorticoid drugs.

Pleurisy, which arose against the background of the disease, is treated with isoniazid, rifampicin, streptomycin. Typically, this treatment lasts for several months. In all cases of the disease, diuretic, analgesic and cardiovascular drugs are prescribed. Patients with no specific contraindications should physiotherapy and physiotherapy. Often, in the treatment of pleurisy, in order to prevent recurrence of the disease, obliteration of the pleural cavity or pleurodesis is performed - the introduction of special preparations that “glue” it into the pleural cavity.

The patient is prescribed analgesics, anti-inflammatory drugs, antibiotics, cough suppressants and allergic manifestations. With tuberculous pleurisy, specific therapy with anti-tuberculosis drugs is carried out. With pleurisy resulting from a tumor of the lung or intrathoracic lymph nodes prescribed chemotherapy. Glucocorticosteroids are used in collagen diseases. With a large amount of fluid in the pleural cavity, a puncture is indicated to aspirate the contents and introduce medicines directly into the cavity.

During the rehabilitation period, respiratory gymnastics, physiotherapy, general strengthening therapy are prescribed.

Prevention

Of course, it is impossible to predict how the body will react to the action of a particular factor. However, any person is able to follow simple recommendations for the prevention of pleurisy:

1. First of all, complications should not be allowed in the development of acute respiratory infections. So that pathogenic microflora does not penetrate the mucous membrane of the respiratory tract, and then into the pleural cavity, colds should not be left to chance!
2. With frequent infections of the respiratory tract, it is good to change the climate for a while. Sea air is excellent tool prevention of respiratory tract infections, including pleurisy.
3. If pneumonia is suspected, it is better to take a chest x-ray in a timely manner and begin adequate therapy. Improper treatment of the disease increases the risk of complications in the form of inflammation of the pleura.
4. Try to strengthen your immune system. In the warm season, harden, spend more time in the fresh air.
5. Quit smoking. Nicotine becomes the first cause of the development of pulmonary tuberculosis, which in turn can provoke inflammation of the pleura.
6. Do breathing exercises. A couple of deep breaths after waking up will serve as an excellent prevention of the development of inflammatory diseases of the respiratory system.

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 conduct daily breathing exercises(according to Strelnikova, with the help of Frolov's breathing simulator).

Fibrous pleurisy is a disease whose name speaks for itself. It manifests itself in the form of an inflammatory process in the pleura. Usually the disease is a consequence of the lobar. During this disease, a specific plaque appears on the surface of the pleural sheets. Another reason for pleurisy can be a number of other diseases, such as rheumatism, lung injury, cancer or tuberculosis.

Dry fibrinous pleurisy

It is a dangerous disease, since there is no light exudate in the pleural cavity, which contains a certain amount of fibrin. As a result, the accumulated fluid washes the pleural sheets, after which fibrinous plaque accumulates, which increases the thickness of the pleural wall. In the future, there is a process of replacing the walls of the pleura itself with fibrinous tissues. Dry pleurisy is detected during the onset of the disease, when the tissue is just beginning to become inflamed. It covers cough receptors, as a result of which an infected person begins to cough.

Etiology of the phenomenon

If any inflammatory process occurs in the body, then there is a risk of pleurisy, especially patients whose inflammatory processes occur directly in the lungs or in organs located near the pleura are susceptible to this disease. Based on what is the impetus for the development of this disease, all causes can be divided into aseptic and septic. The first category is characterized by many chronic or pathological diseases. A prime example lupus erythematosus or uremia, which developed as a result of kidney failure. As a rule, with uremia, nitrogenous scales accumulate on the pleural sheets, and those, in turn, irritate the walls of the pleura.

Septic diseases, that is, infectious, include: SARS, lung abscess, tuberculosis and pneumonia of all types.

People are susceptible to this disease if:

1. They are constantly in a nervous state.
2. They tolerate frequent cooling due to their profession.
3. Overtired.
4. Have a tendency to severe tolerance chemicals.
5. They do not support a healthy lifestyle.

Symptomatic manifestations

A reliable auscultatory sign of fibrinous pleurisy is friction in the pleura, characteristic of this disease. Sometimes this sound resembles the crunch of dry snow. In addition, its brightest signs are: a painful, dry, severe cough, pain in the chest or even hiccups. Moreover, patients suffer from high temperature or chills, there is shallow breathing, weakness and sweating. On an x-ray with fibrinous pleurisy, a bright lag in breathing is tracked from the affected side. In medical practice, the most difficult and main task is to timely distinguish pleurisy from a fracture of the ribs or from intercostal neuralgia.

Stages of pathology

Fibrinous pleurisy is a response of the body to foreign bodies (microbes), which develops in three stages:

1. In the first stage, the blood vessels of an infected person dilate. They are easily permeable and prone to various damages. As a result, the amount of accumulated fluid increases dramatically.
2. The second stage is characterized by the formation of a purulent mass, so the pathology gradually develops. Certain deposits, which are known as fibrin deposits, create friction on the sheets of the pleura during the patient's breathing. The pleural cavity is filled with pockets and adhesions. All this violates the decrease in exudate. In general, the outcome of all of the above is a purulent formation.
3. The third stage includes the patient's recovery process, all disorders that have occurred in the body gradually return to normal thanks to medications and various procedures. However, the disease does not leave the patient's body - it goes into a chronic stage and hides in the body, but often does not manifest itself in any way in the future. A person becomes much better, although the infection cannot be called completely defeated.

Parapneumonic left-sided fibrinous pleurisy

A striking feature of this disease is intrapulmonary left-sided unusual inflammation, which was confirmed by X-ray. This inflammation is characterized by a sharp regression during antibiotic therapy. Treatment does not take long early stages the disease is easily treatable.

Serous

Serous-fibrinous pleurisy is detected in the course of damage to the nodes of the mediastinum and lymph nodes. Tuberculosis is the main cause, the source for the manifestation of this disease. Allergic process, perifocal inflammation and tuberculous lesion of the pleura - three the most important factors for the development of pathology. In its signs, it resembles ordinary pleurisy. This is a consequence of the fact that the initial stage of this type of disease is dry fibrinous pleurisy. Two types of pleurisy, serous and serous-fibrinous, have their similarities and differences. The causative agents of such ailments include a number of viral diseases, as well as the infamous typhoid fever, syphilis, diphtheria and periarteritis nodosa.

Based on the location of the tumor itself, diaphragmatic, mediastinal (posterior, anterior, left lateral, right, etc.), parietal (cloak-like, interlobar) types are distinguished.

Purulent pleurisy

It develops subject to the presence of Pseudomonas aeruginosa and pathogenic bacteria in the body. This stage of the disease is the most severe. Pathogens can provoke pleurisy in the aggregate and singly. The basis for this disease is staphylococcal destruction of the lungs. Moreover, another focus of this disease are ruptures of the esophagus. With such a pathology, scarring of the pleura is detected, which becomes the result of the accumulation of a large amount of pus in the pocket, that is, in the free cavity. In the initial stage, the disease is an acute purulent pleurisy, and later it develops to a chronic form. The outcome may be favorable provided that the patient recovers and the tumor heals.

In the modern world, there are seventy-four causative agents of this disease. Residents of rural areas are at particular risk of infection, as there are the most optimal conditions for the reproduction and survival of viruses. When the causative agents of tuberculosis enter an uninfected area (in addition to the lungs, there are also skin, bones, lymph nodes, etc.), they begin to multiply, which leads to serious consequences. Soon, in the zone of development of inflammation, tubercles are formed, which have the property of self-resorption or increase.

Unfortunately, fibro-purulent pleurisy is contagious, respectively, it is transmitted by airborne droplets.

Diagnostic measures

One of the most important and difficult tasks on the way to recovery is the correct diagnosis of the disease. The most common way to detect pleurisy is considered to be an x-ray.

A complete blood count reveals leukocytosis, increased ESR, or anemia. In addition, urinalysis shows the presence of epithelium or red blood cells. The content of total protein, as well as foreign bodies (fibrinogen or sialic acids) is determined by biochemical analysis blood.

Fibrinous-purulent pleurisy can be detected using a micropreparation. A micropreparation is a glass slide on which the unit under study is placed. Using a microscope, objects of infected zones are examined. Below is shown on a demonstration micropreparation fibrinous-purulent pleurisy.

Principles of treatment

Given that pleurisy is a secondary disease, it should be treated in parallel with the underlying cause. Therapy needs to be comprehensive. The goal of treating fibrinous pleurisy is to relieve the patient's pain and eliminate the tumor as soon as possible. And in the future, all measures are taken to eliminate complications.

The treatment itself includes medication, often strong antibiotics. In no case should ancillary procedures such as physiotherapy or pleural puncture be avoided or abandoned. The general course of treatment includes:

1. Drugs that reduce pain.
2. Medicines with warming properties.
3. Cough suppressants.

It must be borne in mind that the placement of a patient in a hospital is an essential condition for recovery, since all procedures will be carried out directly by experienced physicians on an ongoing basis until the patient is completely cured.

Experts also advise not to use any folk remedies and avoid self-treatment at home, since such activities lead to irreversible consequences that seriously affect the patient's well-being.

In the course of the disease, the attending physician prescribes a special diet, which is characterized by a high protein content and an almost complete absence of liquid.

Another necessary condition for the recovery of the patient are the usual walks in the fresh air and massages. To avoid spread pathogenic microorganisms such measures should be taken during the rehabilitation period.

Possible Complications

Despite the fact that fibrinous pleurisy is itself a complication after other pulmonary diseases, certain complications may arise in conditions of illiterate or unstable treatment. These include:

1. The development of adhesions in the pleural cavity.
2. Pleurosclerosis.
3. Enlargement of pleural sheets.
4. Enlarged seams.
5. Immobility of the diaphragmatic dome.
6. Respiratory failure.

Another important point may be the property of the inflamed pleura to fuse with other organs, such as the heart, which sometimes even during surgery causes serious damage to health and causes serious consequences.

Rehabilitation

Even after completely getting rid of this disease, you should visit sanatoriums for the first 2-3 years. If the treatment was carried out correctly and all the necessary procedures were performed, then complications should not arise. In case of delayed initiation of therapy or weak immunity, however, its treatment is not difficult, and it manifests itself extremely rarely.

In conclusion, one cannot fail to recall that fibrinous pleurisy is a serious disease. It cannot resolve itself, so attempts to treat it on your own, without experienced specialists, only worsen the patient's well-being. As a result, sooner or later he ends up in the hospital anyway, but the disease is already too advanced by this time. Unfortunately, in medical practice, cases of death are known, but they occurred decades earlier, and even then very rarely. You should pay more attention to your health and contact specialists with the slightest change in well-being.

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For the implementation of respiratory movements, the lungs and chest cavity are covered with sheets of a special membrane called the pleura.

When inhaling and exhaling, the pleura provides unhindered sliding of the lungs along the inner wall of the chest cavity, as it consists of two sheets: the visceral pleura covers the lungs, the parietal pleura lines the chest cavity from the inside.

Between these sheets there is a slit-like cavity, which normally contains a small amount of fluid that minimizes the friction of the pleura during respiratory movements.

Pleurisy is an inflammatory reaction of the pleura to a pathological process or disease of the lungs, as well as other organs.

Dry and exudative pleurisy

Depending on the presence of inflammatory fluid in the pleural cavity, dry and exudative pleurisy are isolated. In their course, they can pass into each other.

Dry or fibrinous pleurisy occurs at the beginning of the disease, when the inflammatory process leads to the drying of the pleura and the appearance of fibrin protein on its surface.

The pleura sheets become sticky and lose their ability to easily slide relative to each other. Pleurisy may remain dry if a large amount of fluid is not secreted from the inflamed pleura. Otherwise, an inflammatory fluid, called exudate, begins to enter the pleural cavity.

With the accumulation of a large amount of exudate, pleurisy becomes exudative or effusion. In the future, when the fluid is resorbed, the pleura sheets become sticky again, which can lead to adhesions and adhesions between them.

With exudative pleurisy a complication is pleural empyema or purulent pleurisy. Purulent pleurisy occurs when suppuration of the exudate. It is caused by the appearance of microorganisms in the exudative fluid.

To eliminate them, leukocytes begin to enter the exudate and active substances, which leads to the formation of a purulent effusion. If left untreated, fibrin plaque appears on the pleural sheets, which leads to adhesions of the sheets and "encapsulation" of the purulent focus.

Purulent inflammation can also occur with chest trauma and direct entry of microorganisms into the pleural cavity, without previous exudative pleurisy.

By site location inflamed pleura, the following types of pleurisy are distinguished:

• Apical or apical;
• Costal, that is, located at the ribs;
• Costo-diaphragmatic, which are formed at the junction of the ribs with the diaphragm;
• Diaphragmatic;
• Located in the mediastinum - behind the sternum;
• Interlobar;
• Unilateral: left-sided or right-sided pleurisy;
• Bilateral.

Main reasons occurrence of both types of pleurisy:

Pleurisy is characterized by the appearance of pain, shortness of breath and dry cough.

1. Dry pleurisy most often has a sudden, acute onset. It is manifested by point stabbing pain in the area of ​​​​the location of the inflammatory process, which occurs during respiratory movements due to friction of the pleura sheets against each other.

Therefore, the patient tries to limit these movements: in a sitting position, he leans towards the side of pleurisy, lies on his sore side, and reduces the depth of inspiration. When examining the chest, the lagging of the diseased half during breathing is noticeable.

If pleurisy is localized at the apex of the lung, then muscle tension in the neck and above the collarbone on the side of the lesion can be detected. When listening to the lungs, a pleural friction noise is detected, which is characteristic of dry pleurisy. With the appearance of exudate in the pleural cavity, this noise disappears.

• Body temperature with dry pleurisy usually does not exceed 37.5 -380C, that is, it is subfebrile.

Lungs - the symptoms of this type of pleurisy are expressed in an increase in shortness of breath, respectively, an increase in the volume of fluid in the pleural cavity. Gradually, the volume of respiratory movements on the side of the lesion decreases.

If the pleural effusion is significant, then compression of the lung tissue by fluid occurs, which leads to atelectasis: the lung cannot carry out respiratory movements and loses its airiness.

The development of atelectasis causes aggravation of shortness of breath and the appearance of a cough without sputum, which does not bring relief. Pain with effusion pleurisy may be absent, the accumulation of fluid often gives a feeling of heaviness and stiffness when breathing.

• The development of effusion pleurisy is gradual. The temperature reaches febrile numbers, especially with an increase in the severity of inflammation, and can be above 390C.

The transition of exudative pleurisy to purulent pleurisy is manifested either by an increase in symptoms and a worsening of the condition with exudative pleurisy, or by a resumption of the missing symptoms against the background of an improvement in the condition and subsidence of the manifestations of the disease. The patient has an aggravation of intoxication and respiratory dysfunction: body temperature and shortness of breath increase, chills appear, cough becomes more frequent, sputum appears.

The onset of pain is usually uncharacteristic or minor. The appearance of sharp pain, cold sweat, chills, fainting indicates the development of pleural shock.

Tuberculous pleurisy is not isolated from other symptoms of this infectious disease, but appears against the background of an active tuberculous process. There are the following options for inflammation of the pleura in tuberculosis:

• Tuberculosis of the pleura leads to the appearance of the classic picture of exudative pleurisy with a large amount of fluid. It is manifested by shortness of breath and symptoms of atelectasis. Often complicated by pleural empyema. Identification of mycobacteria in a pleural exudate is characteristic;
• Allergic pleurisy has a quick onset with pain and fever, but the same quick cure within a month. Occurs in patients with fresh infection with mycobacterium tuberculosis, with a chronic course of the primary form of tuberculosis. It is accompanied by such manifestations as polyarthritis, conflicts, the appearance of erythema nodosum, characteristic of primary tuberculosis. Tuberculosis pathogens are not found in the exudate;
• Perifocal pleurisy occurs on the pleura, located next to the tuberculous focus. Manifested sluggish, chronic course. Its detection is sometimes possible only with the help of x-rays. The nature of the inflammatory fluid is serous, the tubercle bacillus is usually absent;

With fluoroscopy, dry pleurisy is manifested by a high standing dome of the diaphragm, lagging behind the diseased half of the chest during breathing, and a decrease in the mobility of the lower edges of the lungs.

Exudative pleurisy in the picture has a well-defined fluid boundary. With limited pleurisy, a small amount of effusion is best determined using ultrasound. This method can detect as little as 5 ml of exudate, unlike X-ray, which will only show volumes over 200 ml.

Purulent pleurisy has the appearance of limited dark areas with a characteristic upper level of fluid in the form of a crescent.

Tuberculous pleurisy is combined with the identification of caverns, areas of compaction and foci of tuberculosis.

Pleurisy treatment - methods and preparations

1. The main treatment of pleurisy is the therapeutic effect on the underlying disease that caused inflammation of the pulmonary membranes. Against the background of proper therapy, the severity of symptoms of pleurisy decreases. For example, after radiation therapy, the number of tumor pleurisy is reduced by 40%.

2. With dry pleurisy, to reduce pain, the chest is tightly wrapped with an elastic bandage, which is bandaged 1-2 times a day.

An increase in the immobility of the chest can be achieved if a semi-rigid pillow is attached to the sore side. A painful and unproductive dry cough is eliminated by prescribing drugs that suppress the cough reflex: codeine, codterpine, libexin, etc.

3. If X-ray signs characteristic of fluid accumulation and symptoms accompanying exudative pleurisy of the lungs are identified, treatment should begin with a pleural puncture. This procedure is also diagnostic, clarifying the nature and cause of pleurisy.

4. The appointment of antibiotic therapy is carried out if the cause of the effusion is an infectious disease. The best is the appointment of a specific antibiotic after identifying the type of pathogen in the pleural fluid.

A modern laboratory has such a type of research as PCR diagnostics. This method allows you to determine the pathogen on the day of the study (as opposed to bak. sowing on a nutrient medium) and immediately prescribe the desired drug.

5. Additional treatment for exudative pleurisy includes diuretics and anti-inflammatory drugs. Of the diuretics, furosemide and veroshpiron are usually used. Anti-inflammatory therapy is presented as nonsteroidal drugs(ibuprofen) and steroid hormones (prednisolone).

6. Treatment of pleural empyema consists in the mandatory establishment of drainage through chest wall in combination with active antibiotic therapy. Through the drainage, pus is evacuated and the pleural cavity is washed. When an encysted empyema occurs, an operation is performed: an empyemectomy, in which the entire purulent sac is removed.

7. In the treatment of pleurisy of a tuberculous nature, 2-3 anti-tuberculosis drugs are prescribed simultaneously.

8. Physiotherapy treatment has a resolving effect and accelerates recovery. Dry pleurisy with moderate temperature is treated with compresses with vodka, electrophoresis is performed with calcium chloride.

When the exudate is resorbed, to prevent the formation of adhesions, electrophoresis with heparin, paraffin treatment, and decimeter waves are used. After the elimination of inflammation, general and vibrational massage is recommended, as well as sanatorium treatment in forest and sea climatic zones.

Forecast

With timely evacuation of the contents and the appointment of an effective antibiotic, pleurisy is completely cured.

Without treatment, encysted purulent pleurisy can spontaneously break through to the surface of the chest or through the bronchus, which leads to a sharp appearance of a large amount of purulent sputum.

With pleurisy, a complication can be the appearance of adhesions between the layers of the pleura, which lead to restriction of respiratory movements and the appearance of respiratory failure.

If the treatment of purulent pleurisy is absent or ineffective, acute pleurisy may turn into chronic form. This happens within 2-3 months with a sluggish course of the process, poor functioning of the immune system.

The lungs are the main organ of the human respiratory system. They have anatomical structure allowing them to perform their function of providing oxygen.

The serous membrane of the lungs is called the pleura, which can be visceral (pulmonary) or parietal (parietal):

1. Visceral pleura - covers the lungs from all sides and is tightly connected with them. It enters the space between the pulmonary lobes, passing into the parietal at the surface of the lung root.
2. Parietal pleura - lines the nearby walls of the chest region, protecting the lungs from the mediastinum. Fusion with the inner surface of the sternum. Forms a bag, in each of the halves of the chest cavity, which contain the lungs covered with a visceral pleura.

The lungs are a paired organ divided into a right lung and a left lung. Located in the chest cavity, they occupy up to 80% of its total volume. Lung tissue looks like a sponge with pink pores. Gradually, it darkens due to smoking, pathologies in the respiratory system, aging.

What is pleurisy of the lungs?

Pleurisy of the lungs is a complex inflammatory pathology, especially dangerous for children and the elderly. The disease begins as a result of inflammation (infectious or not) of the pleura. It rarely happens on its own, more often it is a consequence of painful processes in the lungs.

Inflammation of the pleural membranes of the lungs is accompanied by the release of exudate:

1. With dry pleurisy, fibrin falls on the surface of the pleura.
2. With exudative pleurisy, the secret accumulates in the pleural cavity.

Exudative pleurisy of the lungs are also called processes accompanied by pathological effusion without inflammation - tumors, injuries, infections.

Species and general taxonomy

Depending on the reasons that served as the beginning of pleurisy of the lungs, its development and forms of manifestation, it happens:

1. Purulent.
   • Occurs due to the filling of the pleural cavity with purulent effusion. Pulmonary and parietal membranes become inflamed.
2. Exudative.
   • The pleura is affected by infections, tumors, injuries.
3. Dry.
   • Complications of diseases of the lungs and other organs located near the pleural cavity. It can manifest itself as a symptom of systemic diseases.
4. tuberculosis.
   • The serous membranes that create the pleural cavity and envelop the human lungs are affected. The disease is diagnosed by a large volume of secreted fluid.

The symptoms of each type are typical and depend on the nature of the course of the disease.

Stages of the disease

By the nature of the course, pleurisy of the lungs has three stages.

1. The first stage is the stage of exudation.
   • There is an increased production of pleural fluid - a consequence of the expansion of blood vessels and an increase in their permeability. This happens when immune cells activate biological processes against the background of infection. Excess fluid has time to be excreted by the lymphatic system, since its volume in the pleura does not exceed normal.
2. The second stage is the stage of formation of purulent exudate.
   • Sticky, saturated with fibrin, exudate begins to be deposited on the pleural sheets. The friction between them increases, gradually the sheets are soldered (fused together). "Pockets" are formed, which significantly complicate the release of exudate from the pleural cavity. Bacteria that died from contact with immune cells accumulate in places where the secret is accumulated. Which, combined with protein activity, leads to putrefaction and decay. Inflammatory processes begin to develop in adjacent tissues, the outflow of fluids through the vessels is disturbed lymphatic system. In the pleural cavity, even more liquid purulent mass is collected.
3. The third stage is the stage of chronicity or recovery.
   • The stage of resorption of pathological formations or their transition to a chronic form. Chronology appears:
     • a significant decrease in lung mobility;
     • an increase in the thickness of the pleura;
     • decreased outflow of pleural fluid;
     • the formation of pleural adhesions;
     • sometimes, the pleura is completely overgrown with fibrous tissue.

Causes

It is rare to meet the disease in its pure form. You can get pleurisy with a chest injury or hypothermia, but more often this is a consequence of a complication of another disease. It depends on the nature of the symptoms.

Infectious pleurisy is the most common form. For its development, the general sensitivity of the patient is important. The reactivity of the disease changes significantly when, due to microbes or toxins, allergization of the pleural cavity begins. The immune system directs produced antibodies to the affected area, which, when combined with antigens, affect the production of histamines.

Approximately three-quarters of infectious problems are caused by exposure to bacterial agents:

• tubercle bacillus;
• fungal infection;
• streptococci;
• staphylococci;
• anaerobic bacteria;
• legionella.

The non-infectious form may occur for the following reasons:

• the formation of malignant tumors on the pleural sheets;
• spread of metastases in the pleural cavity;
• lung infarction;
• connective tissue injuries against the background of:
  • scleroderma;
  • systemic vasculitis;
  • lupus erythematosus.

Pleurisy of the lungs contribute to the following diseases:

• angina;

Symptoms of pleurisy of the lungs

The symptomatology of pleurisy depends on the specific form of the disease and the nature of its course. Often the onset of the development of the disease is missed by patients, because it is confused with the common cold. However, the main symptoms of the disease still differ from other respiratory pathologies.

Exudative, encysted pleurisy: symptoms

Significant differences possible clinical picture this form of the disease, depending on the place of localization and the statute of limitations of the pathology. The nature of the secretions and their volume also matter.

Pleurisy of this type includes:

1. Interlobar:
   • do not have severe symptoms.
2. Bagged wall:
   • intensifying (when sneezing and coughing) pain in the chest;
   • encapsulation of exudate in the sinus of the diaphragm leads to the spread of pain impulses in the upper abdomen, it becomes difficult to swallow;
   • pain can spread to the area of ​​the scapula, neck. By nature, it resembles pain in Pancoast cancer or plexitis.
3. Encapsulated purulent:
   • gives a typical picture of pleural empyema:
     • the temperature rises;
     • the patient feels severe chills,
     • there is clear toxicity.
   • Of the not pronounced symptoms:
     • the patient feels general weakness;
     • malaise;
     • purulent encysted effusion can break through into the bronchi and tissues of the chest cavity, forming pleuro-cutaneous or pleural-bronchial fistulas.

Signs of dry (fibrinous), adhesive pleurisy

Adhesive pleurisy - a form of fibrinous pleurisy - the most common chronic illness affecting the lining of the lungs. From the fibrinous plaque on the pleura, adhesions are formed, which lead to the immobilization of tissues, reducing the volume of the lungs.

The disease corresponds to the symptoms characteristic of all types of dry pleurisy:

• a dry cough appears, manifested by seizures;
• body temperature rises, chills begin;
• rapid and difficult breathing;
• pleural sheets, when rubbing against each other, cause wheezing;
• shortness of breath occurs;
• the patient feels a general malaise;
• in the evening the fever increases with a sharp increase in perspiration.

Against the backdrop of these symptoms, severe pain in the affected lung, aggravated by deep breaths or sharp bends / turns of the body. Sometimes there are pains in the region of the heart, in the upper abdomen and neck.

A characteristic feature is the suddenness of the onset of symptoms. The patient can accurately name the time of onset of the development of pathology.

Manifestations of effusion (purulent, serous) pleurisy of the lungs

Purulent, effusion pleurisy of the lungs is the most severe form of pathology. Diagnosed in all categories of citizens, does not depend on gender and age. Causes damage to the lining of the lung, the formation of arrays of liquid pus inside the organ.

The disease is characterized by the following symptoms:

• heaviness or pain in the chest;
• general weakness, loss of strength is felt;
• an annoying strong cough begins;
• shortness of breath appears;
• body temperature rises sharply;
• in the side there is a constant feeling of fullness
• breathing is disturbed, it becomes difficult for a person to breathe in and out.

With purulent pleurisy, pain is the main symptom. Gradually, as pus accumulates in the pleural cavity, this symptom disappears. Cough is rarely accompanied by sputum production, manifesting itself mainly at night. If this is a complication after an infection, exudate may be released.

Differences of tuberculous, viral pleurisy

Tuberculous pleurisy is a pulmonary pathology with active release of exudate (into the pleural cavity and onto the surface of the lung). The disease is characteristic childhood although it also occurs in adults. It can be either a separate form of tuberculosis, or an independent disease.

1. allergic form.
   • Occurs in tuberculosis patients, with sensitivity to tuberculin, prone to hyperergic reaction. Symptoms appear sharply: a rapid increase in temperature that persists for 10-14 days. Due to serous effusion, there are problems with breathing, pain in the side, increased heart rate.
2. perifocal form.
   • It starts gradually. Often the symptoms are associated with hypothermia or a viral infection. There is a dry cough, borderline temperature (37-38 0 C), tingling, burning in the chest. When pressing on the intercostal zones, painful sensations. Pain is similar to myositis or intercostal neuralgia, with irradiation into the abdominal cavity - to an attack of cholecystitis.

Cough with pleurisy

With pleurisy, the pleura becomes inflamed, it can be dry and exudative. When dry, a dry, often reflex, cough is manifested. Patients try to restrain him, because the shudder of the chest causes severe pain.

As fluid accumulates in the pleural plane, the intensity of cough gradually decreases. There is heaviness and shortness of breath in the side. Weak vesicular breathing can be expressed, sometimes you can feel the noise from the friction of the pleura.

Exudative pleurisy passes without obvious activation of the cough center. Accompanied by a sharp weakening of breathing, the voice trembles and the percussion sound is shortened.

Possible Complications

Treatment of pleurisy must be carried out on time, the only way to avoid possible complications. And the disease has a lot of them:

• adhesions form in the pleural cavity;
• general respiratory failure of organs and systems;
• adhesive form of pleurisy;
• obliteration of interlobar fissures;
• the pleural cavity is scarred;
• decreased diaphragm mobility;
• pleurosclerosis.

The appearance of complications depends on the causes of the pathology, the course of its development. To avoid complications, you should not hesitate to visit a doctor.

Diagnostics

Diagnosing pleurisy itself is easy, defining it as clinical condition presents no problem. It is difficult to determine the causes that caused the painful condition. Diagnostics will require the following methods:

• examination and questioning;
• examination of the patient in a clinical setting;
• blood test;
• collection and analysis of pleural effusion;
• microbiological examination.

Based on the results of the diagnostic examination, the necessary treatment is prescribed.

Treatment

In the treatment of pleurisy, two main tasks are pursued: to stabilize the patient's condition and to normalize it. respiratory function. But first, it is required to eliminate the cause that caused the disease. For this, both methods of traditional and alternative medicine are suitable.

traditional medicine

The basis of medical treatment of pleurisy is antibacterial drugs, since the nature of the disease is infectious. The pleura itself is treated with desensitizing and anti-inflammatory drugs.

The selection of drugs depends on the data obtained after the diagnosis. The choice of antibiotics is based on the sensitivity of pathogenic microflora, which is detected during laboratory examination. Dosage rates - according to the current condition of the patient.

1. Antibiotics:
   • Clindamycin;
   • Ceftriaxone;
   • Ampicillin.
2. Non-steroidal anti-inflammatory drugs:
   • Meloxicam;
   • ibuprofen;
   • Diclofenac.
3. Glucocorticosteroid:
   • Prednisolone.

Folk remedies

You can treat pleurisy based on recipes traditional medicine. The most common home remedies include:

Prevention of pleurisy, coupled with measures to strengthen the immune system, reduces the risk of inflammatory lung diseases.