Pleurisy dry cough

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Dry pleurisy - causes, symptoms and treatment of the disease

Dry pleurisy is a pathology characterized by the presence of an inflammatory process in the serous membrane of the lung. As a result, fibrinous edema forms on the surface of the pleural layers.

Table of contents:

Symptoms of dry pleurisy are characterized by pain in the chest, aggravated by breathing, dry cough, low-grade fever, and malaise.

Compared to other respiratory diseases, this pathology has a relatively benign course, but its clinical manifestations can significantly affect the quality of life and performance of patients. Given its widespread distribution, you should know everything about the symptoms and treatment of this disease.

Reasons for the development of the disease

Dry (fibrinous) pleurisy has no independent meaning. Most cases of fibrinous pleurisy are etiologically associated with pulmonary tuberculosis or tuberculosis of the intrathoracic lymph nodes. Dry pleurisy of tuberculous etiology occurs when the lesions are located subpleurally, break through into the pleural cavity with contamination of the latter, or as a result of hematogenous introduction of pathogens.

The pleura is a serous membrane, consisting of 2 layers, lining the outer surface of the lungs and the inner wall of the chest. The leaves are respectively called visceral, or the pulmonary pleura itself, and parietal, or parietal pleura.

In dry pleurisy, due to increased vascular permeability under the influence of pro-inflammatory substances, the liquid component of the plasma and some proteins begin to leak into the pleural cavity, among which fibrin is of greatest importance. Under the influence of the environment in the inflammatory focus, fibrin molecules begin to unite and form strong and adhesive threads that are deposited on the surface of the serous membrane.

The causes of the development of dry pleurisy are also often nonspecific lung lesions:

Often the disease is a complication of rheumatism, which occurs in the active phase, and other systemic pathologies of connective tissue. Such pathologies include rheumatic and lupus pleurisy.

This is an inflammatory disease, most often a complication of various lung diseases. You can cure it and forget about all its unpleasant manifestations if you immediately go to the clinic and take all the necessary tests. Otherwise, the pathology will develop further and can lead to dire consequences in the form of tuberculosis.

Extrapulmonary processes associated with dry pleurisy should be noted. We can talk about complications of diseases of the digestive organs such as cholecystitis and pancreatitis.

Symptoms of dry pleurisy of the lungs

The main symptom of dry pleurisy should be considered acute painful sensations that have become stabbing in nature. They are localized in the side and are forced in the following cases:

  • when trying to take deep breaths;
  • short cough;
  • sneezing.

When the pleural layers become inflamed, symptoms such as:

  • chills;
  • increased sweating at night;
  • severe weakness;
  • painful sensations.
  • rarely - increased body temperature;
  • swelling of the neck veins;
  • sometimes - swelling of the skin in the lower parts of the chest may be swollen, its fold is thicker than on the healthy half of the chest.

In addition to pain, there are other manifestations of the disease. These include a dry cough, which occurs due to fibrin irritation of the cough pleural nerve endings, as well as an increase in body temperature.

Cough occurs reflexively, due to irritation of the pleura. But the patient tries to restrain coughing movements, as they increase pain in the chest.

In 80% of cases, patients with dry pleurisy indicate pain and discomfort in the lower and lateral sternum. Depending on which location is affected, other processes may be involved in the algorithm for the irradiation of symptoms. We are talking about the brachial plexus, the nerve trunks of the upper limbs and the diaphragm.

Typically, dry pleurisy lasts 1-3 weeks and ends with recovery. The transition of dry pleurisy to exudative pleurisy is possible; then the pain decreases and the pleural friction noise disappears. A prolonged or recurrent course indicates active pulmonary tuberculosis.

Left-sided diaphragmatic pleurisy should be differentiated from myocardial infarction. Indeed, in this situation the following symptom complex arises.

  • pain in the chest, sometimes behind the sternum;
  • dyspepsia;
  • pain in the epigastric region;
  • rhythm disturbance such as extrasystole or tachyarrhythmia;
  • feeling of anxiety and fear.

There are a number of diseases that can occur with symptoms similar to pleurisy:

  • intercostal neuralgia;
  • intercostal neuromyositis;
  • rib fracture;
  • epidemic myalgia;
  • fibrinous pericarditis;
  • angina pectoris;
  • myocardial infarction;
  • spontaneous pneumothorax;
  • peptic ulcer of the stomach and duodenum;
  • acute cholecystitis;
  • acute appendicitis;
  • osteochondrosis of the intervertebral discs of the thoracic region.

A deep knowledge of their symptoms, as well as additional research methods, will help the doctor distinguish dry pleurisy from these diseases.

Diagnostics

Formal diagnosis of dry pleurisy is insufficient; it is always necessary to find out the cause of the disease. Therefore, if dry pleurisy is suspected, the patient should be consulted by a pulmonologist, phthisiatrician, rheumatologist, gastroenterologist, or infectious disease specialist.

When a doctor sees a patient, the first thing he will notice will be severe pain in the side on the affected side, which the patient himself will tell you about intensifying during coughing and breathing.

Diagnostic methods include:

  • Clinical blood test (increased erythrocyte sedimentation rate, neutrophilic leukocytosis with a shift to the left).
  • Biochemical blood test (increased amount of seromucoids, fibrin, sialic acids and other acute-phase indicators).
  • General urine analysis - no pathological changes.
  • X-ray examination of the thoracic organs (typical high location of the dome of the diaphragm on the affected side; decreased mobility of the lower edges of the organ during respiration and slight bulging of parts of the pulmonary field).
  • Ultrasound (reveals the presence of deposited fibrin layers and thickening of the membrane walls).

How is dry pleurisy treated?

Treatment of an uncomplicated form of dry pleurisy lasts several days or 2–3 weeks. With a prolonged recurrent course or transition to exudative pleurisy, one can assert the presence of a tuberculosis process. How is the disease treated?

The most common and effective treatment is the following drugs:

  • Clindamycin + III generation cephalosporins, for example, cefotaxime.
  • Amoxicillin + clavulanic acid.
  • Imipenem.

In addition to antibiotic therapy, treatment should include correction of protein metabolism. To do this, the patient is prescribed a diet that includes many foods rich in protein. If dysproteinemia is quite severe, administration of 150 ml of a 10% solution of albumin in blood plasma is prescribed.

To reduce inflammation, treatment includes taking steroid hormones. These include Metypred, Prednisolone, Hydrocortisone.

Non-hormonal anti-inflammatory drugs are prescribed, such as ibuprofen, voltaren, diclofenac, movalis.

After consulting with your doctor, you can use old, but quite effective methods of traditional medicine:

  • warm compress;
  • tight bandaging of the lower chest;
  • applying iodine strips to the skin of the chest

The use of invasive methods involves diagnosis using pleural puncture and thoracoscopy. In the first case, the chest is pierced along with the pleura. This procedure is complex, requiring serious preparation, sterile conditions and compliance with certain rules.

The puncture is taken between the seventh and eighth ribs. The liquid is slowly withdrawn with a syringe and transferred to a sterile container for further research.

In order to prevent the formation of adhesions in the pleural cavity, it is recommended:

  1. a complex of breathing exercises under the supervision of a physical therapy doctor;
  2. massage – classic or vibration;
  3. physiotherapeutic methods of treatment (primarily ultrasound).

These measures are carried out after acute manifestations have subsided.

Since dry pleurisy of unknown etiology can be caused by tuberculosis, patients are subject to dispensary observation by a phthisiatrician and preventive specific treatment in an anti-tuberculosis dispensary. The prognosis for dry pleurisy depends on the underlying cause of the disease. In case of transition to an exudative or recurrent form, the ability to work may be limited for a long time.

Prevention

The main preventive measure is prevention, timely diagnosis and comprehensive, adequate treatment of diseases complicated by pleurisy. To do this, you should regularly undergo preventive medical examinations (in particular, annual fluorography of the lungs), and if symptoms of disease arise, do not waste time, but immediately seek help from specialists.

With the presented approach and constant consultations with a specialist, it will be possible to restore the body and processes associated with life 100%.

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Dry pleurisy: symptoms, treatment, prevention

Dry pleurisy (hereinafter referred to as pleurisy) is an inflammatory process of the pleural layers, in which the pleural cavity remains dry. Compared to other respiratory diseases, this pathology has a relatively benign course, but its clinical manifestations can significantly affect the quality of life and performance of patients.

Causes and mechanisms of development

  • primary – develops independently, without reference to other diseases;
  • secondary - occurs as a result of diseases of organs (often those that are in close proximity to the pleural layers).

Secondary pleurisy develops:

  • more often – with lung diseases;
  • less often – with pathology of the chest wall, mediastinum, diaphragm and subphrenic space.

In most cases, “dry” lesions of the pleural layers are a secondary process. Almost all reactive or inflammatory changes in the pleura were preceded by a “push”—damage to other organs. Moreover, in a number of cases, it was only thanks to dry pleurisy that the diseases that provoked it were diagnosed, since they themselves passed without clearly defined symptoms.

Pleurisy is divided into 2 large groups:

  • non-infectious , or aseptic - initially inflammatory changes in the pleura occur without the participation of pathogens.
  • infectious.

The most common causes of aseptic pleurisy:

  • the entry of blood into the pleural cavity (for example, during injury or during surgery - this is the so-called traumatic pleurisy ). There may be little discharge, there is no hemothorax as such - but even a few milliliters of blood is enough to cause irritation of the pleura and trigger the inflammatory process;
  • irritation of the pleural layers of digestive pancreatic enzymes, which can enter the pleural cavity during the development of acute pancreatitis ( enzymatic pleurisy );
  • dispersion of tumor cells throughout the pleural layers ( carcinomatous pleurisy ).

Less commonly, dry pleurisy can occur with diseases such as:

  • infarction (death) of the lung;
  • rheumatism and other connective tissue lesions;
  • leukemia (malignant damage to blood cells);
  • granulomatosis (autoimmune inflammation of the walls of blood vessels);
  • hemorrhagic diathesis (increased bleeding);
  • some kidney and liver diseases (often autoimmune).

In some cases, the causes of pleurisy are not established - it is called idiopathic .

With the aseptic option, the infectious agent can join later - the pleural layers are compromised, the act of breathing is disrupted, the tissues do not receive enough oxygen, this aggravates the weakening of the body, as a result of which the infection becomes more active.

Most often, infectious pleurisy is caused by:

  • pneumococci;
  • staphylococci;
  • gram-negative rods;
  • less often - Koch bacilli (mycobacterium tuberculosis), which mainly provoke exudative pleurisy (inflammation of the pleural layers with the formation of fluid in the pleural cavity);
  • in some cases - pathogenic fungi that cause blastomycosis, coccidoidosis and other fungal diseases.

The infection can penetrate the pleural cavity in several ways:

  • hematogenous - with blood flow;
  • lymphogenous - with lymph flow;
  • contact - directly from organs affected by infection (including from the hilar lymph nodes - this most often occurs with tuberculosis);
  • direct - during medical procedures (operations, thoracoscopy, pleural puncture, if the rules of septic and antiseptic were violated) and in case of traumatic wounds.

Often, in order for infectious pleurisy to occur, infection on the pleural layers alone is not enough - specific sensitization (hypersensitivity) of the tissue is required. Its role is confirmed by the fact that in some patients infectious pleurisy was not observed even with massive invasion of the infectious agent (for example, with chest wounds with extensive contamination of the pleural layers), while in others it occurred when an insignificant amount of microorganisms entered the pleura. In this case, a separate form of this disease is distinguished - infectious-allergic pleurisy .

The mechanisms of development of aseptic pleurisy are not fully understood. Basically, it occurs as a reaction of the pleura to various non-infectious factors.

A separate form of damage to the pleural layers is described, which is observed in the presence of infectious foci in the body, but is non-infectious. These are so-called sympathetic (or sympathetic) pleurisy - they arise due to the fact that the pleura is affected not by the infectious pathogen itself (it is not in the pleural cavity, but remotely), but by the toxic products of its vital activity.

Dry pleurisy can transform into exudative - with the formation of fluid in the pleural cavity. This happens if the outflow of lymph is obstructed. Most often, this turn of the disease occurs in oncological diseases - tumor cells block the lymph outflow pathways in the chest (afferent vessels), lymph leaks into the pleural cavity.

The development of exudative pleurisy from dry is inhibited if the absorption capacity of the pleura is well developed, and the effusion does not have time to accumulate in the pleural cavity. This is a kind of borderline state between two types of pleurisy, which is difficult to identify based on clinical data - they are simply not observed.

Less commonly, the opposite clinical situation is observed: dry lesions of the pleural layers can develop after an exudative process, when the absorption capacity of the pleura is activated, and fibrin precipitates in a thick layer on the surface of the pleural leaves from the exudate, which is actively absorbed by the pleura. This is how adhesions form in the pleural cavity: the fibrin that has fallen out of the exudate becomes denser, so-called moorings appear. This explains the paradoxical phenomenon when, after fairly harmless pleurisy, severe respiratory failure occurs - adhesions prevent the lungs from fully expanding. Sometimes the adhesive process is so pronounced that partial or complete overgrowth of the pleural cavity occurs.

Symptoms of pleurisy

The most typical symptoms of pleurisy are:

  • chest pain;
  • shallow rapid breathing;
  • less often – cough;
  • signs of impaired ventilation (ventilation) of the lungs;
  • deterioration of general condition;
  • rarely - increased body temperature;
  • swelling of the neck veins;
  • sometimes - swelling of the skin in the lower parts of the chest may be swollen, its fold is thicker than on the healthy half of the chest.

The parietal pleura (the layer that lines the inside of the chest wall) is characterized by a large number of nerve receptors. During chest excursion (movements associated with the act of breathing), the layers of the pleura rub against each other, which leads to quite sharp painful sensations.

The more fibrinous deposits on the pleura, the more pronounced the friction and pain. Unpleasant sensations intensify when tilted to the healthy side - the affected pleura is stretched, nerve receptors are irritated. To relieve pain, the patient can lie on the affected side, thereby limiting its movement.

Due to pain, breathing becomes more shallow. The patient begins to breathe more often to compensate for the lack of oxygen.

Cough occurs reflexively, due to irritation of the pleura. But the patient tries to restrain coughing movements, as they increase pain in the chest.

Restriction of respiratory movements of the chest leads to deterioration of ventilation of the lungs - they do not release carbon dioxide well and are poorly saturated with oxygen. As a result, at later stages of the development of pleurisy, signs of hypoxia may appear - cyanosis of the skin and visible mucous membranes. Hypoxia during pleurisy is moderate and can lead to critical consequences only in chronic untreated advanced pleurisy.

Deterioration in general condition (weakness, decreased performance, lethargy) occurs due to oxygen starvation, which is explained by deterioration in lung function due to pain and adhesions in the pleural cavity.

Depending on how severe the symptoms are, pleurisy is:

  • acute – peak severity of symptoms is noted;
  • subacute – with moderate manifestations of symptoms;
  • chronic is a sluggish process that can last for weeks and does not cause any special subjective sensations, but is resistant to treatment.

Dry pleurisy is not so often total - usually some part of the pleura is affected: apical, parietal, diaphragmatic or interlobar. If the apical segments are affected, the trapezius and pectoral muscles may be tender. With extensive damage to the pleura in the patient’s chest, a noise similar to the creaking of snow or new leather goods is heard from the side (Schukarev’s symptom). This clinical effect is observed in patients with asthenic physique.

If the patient does not seek help, with prolonged chronic, constantly recurrent pleurisy, gradual depletion of the body occurs. Half of the chest on the affected side decreases in size, the intercostal spaces become narrower. Due to chronic respiratory failure, the functioning of all organs and systems deteriorates. In extremely advanced cases, the so-called pleurogenic cirrhosis of the lung will develop - irreversible growths of connective tissue in the lung, the occurrence of which is provoked by a chronic inflammatory process in the pleura and which, in turn, critically impairs the respiratory function of the lungs.

Diagnosis of dry pleurisy

The diagnosis of dry pleurisy in most cases is made based on clinical manifestations. Warning should be caused by sharp pain and deterioration of lung excursion against the background of a more or less satisfactory general condition.

Additional diagnostic methods provide rather meager information and are used in doubtful cases in order to exclude other diseases - in particular, pathologies with severe chest pain. X-ray examination, which is one of the most popular in pulmonology, for pleurisy is not informative: even with a pronounced clinical picture, the x-ray picture can be like that of a healthy person. Some information is present if pronounced, significantly thickened moorings (adhesions) are formed - they appear mainly in the lower part of the x-ray image, when the diaphragmatic pockets are filled with them. In other localizations, adhesions are difficult to identify.

On the blood side, typical signs characteristic of an inflammatory process of completely different localization may appear:

A distinctive diagnosis should be made between inflammation of the pleura in the lower parts and pathological damage to the subdiaphragmatic space. In the second case, the following symptoms are possible:

  • pain radiates to the neck or anterior abdominal wall;
  • Tension of the anterior abdominal wall develops;
  • in some cases, painful hiccups appear.

With pleurisy, such effects are not observed.

If the lower parts of the pleura are affected, pleurisy can be confused with diseases of the abdominal organs.

The absence of other signs from the abdominal organs and the constant alertness of surgeons regarding the condition of an acute abdomen can lead to unjustified laparotomy (opening the abdominal cavity, which is often performed for diagnostic purposes in complicated diagnostics).

Prolonged pleurisy can cause confusion in diagnosis. Normally, it lasts from several days to several weeks. If it lasts for quite a long time, does not respond to nonspecific treatment, periods of remission alternate with relapses, tuberculosis should be suspected.

Also, a distinctive diagnosis should be carried out if the patient notices a sudden decrease in chest pain and the associated relief of the condition - but they can occur not because pleurisy has been properly treated, but when it passes from a dry form to an exudative one, when the liquid lubricates pleural layers and eliminates painful friction between them. Discomfort in the chest does not go away - it acquires other characteristics: instead of sharp, sharp, sometimes unbearable pain, the patient begins to feel a peculiar feeling of heaviness in the chest and its fullness.

If pleurisy remains dry due to the increased absorption capacity of the pleura, diuresis (daily urine output) may be increased. In this case, differential diagnosis with kidney diseases should be done - the following will help you navigate:

  • Analysis of urine;
  • blood test - in addition to leukocytosis and increased ESR, there will be an increase in the number of certain blood cells - neutrophils, monocytes and eosinophils;
  • instrumental methods of kidney research (ultrasound and others).

If a pleural puncture was performed for diagnostic purposes, but no effusion was obtained, the pleural cavity can be washed, and the liquid obtained after washing can be inoculated onto nutrient media - this makes it possible to clarify:

  • is it infectious pleurisy or aseptic;
  • if pleurisy is infectious, the infectious agent is determined using culture; this is important for the choice of antibiotics.
  • the washings are also sent for cytological analysis - in case of tumor damage to the pleura, tumor cells and red blood cells are found in it.

In doubtful cases, thoracoscopy is used to confirm the diagnosis of dry pleurisy. In addition to examining the pleural layers, during it a pleurobiopsy is performed (a fragment of the pleural layers is pinched off in different places), followed by a cytological examination of the biopsy under a microscope.

The diagnosis of dry pleurisy of tuberculous origin is made based on the combination of the following data:

  • relatively young age of patients;
  • contacts with tuberculosis patients;
  • chest pain;
  • mild cough;
  • moderate increase in temperature;
  • prolonged course with the formation of adhesions in the pleural cavity;
  • positive tuberculin tests;
  • pathological changes in the lungs and hilar lymph nodes, characteristic of the tuberculosis process.

Treatment of dry pleurisy

Regardless of the origin of pleurisy, patients must adhere to medical prescriptions such as:

  • bed or semi-bed rest;
  • a balanced diet (it is especially important to consume enough proteins, but the consumption of carbohydrates, salts and liquids should be limited);
  • anti-inflammatory drugs (in the acute period - intramuscular and intravenous, for residual effects - tablets);
  • desensitizing agents;
  • in case of severe pain, use painkillers;
  • to increase the body's resistance - hyperimmune plasma, polyglobulin and their analogues.

Treatment for secondary pleurisy should be primarily aimed at eliminating the cause of inflammatory changes in the pleura - these are:

  • cytostatics for cancer;
  • anti-tuberculosis drugs for tuberculosis;
  • antibiotics for pneumonia, taking into account the sensitivity of microorganisms;

After consulting with your doctor, you can use old, but quite effective methods of traditional medicine:

  • warm compress;
  • tight bandaging of the lower chest;
  • applying iodine strips to the skin of the chest

In complex or advanced cases with a pronounced inflammatory process, as well as disturbances in protein and water-salt balance, the following is used:

  • hormonal drugs;
  • protein preparations;
  • electrolyte solutions.

The introduction of antibacterial drugs into the pleural cavity is theoretically possible, but as a method for dry pleurisy it has not taken root.

Prevention

Preventing the occurrence of pleurisy is, first of all, the prevention and treatment of diseases and conditions that provoke their occurrence - in particular, those that can lead to inflammatory changes in the pleura:

  • timely cure of tuberculosis, pneumonia and other diseases, competent medical tactics for oncological diseases;
  • compliance with the rules of asepsis and antisepsis during pleural punctures, thoracoscopy and chest surgery;
  • high-quality sanitation for injuries of the chest organs.

In order to prevent the formation of adhesions in the pleural cavity, it is recommended:

  • a complex of breathing exercises under the supervision of a physical therapy doctor;
  • massage – classic or vibration;
  • physiotherapeutic methods of treatment (primarily ultrasound).

These measures are carried out after acute manifestations have subsided.

Prognosis for pleurisy

The prognosis for dry (fibrinous) pleurisy for life and health is generally favorable. Irreversible changes in the pleura that worsen breathing occur in cases of neglected or improperly treated pleurisy.

Kovtonyuk Oksana Vladimirovna, medical observer, surgeon, consultant doctor

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Pulmonary pleurisy: symptoms, diagnosis and treatment

The pleura is the membrane that lines the lungs, protecting them from external influences. It adheres quite tightly to the tissue of the organ, therefore almost any serious lung disease can lead to the development of an inflammatory process in the pleura. This pathology is called “pleurisy”.

Causes

In most cases, inflammation of the pleura is a secondary process. It occurs as a result of some other disease as a complication. Depending on the cause of its occurrence, the diagnosis of pleurisy is divided into infectious and non-infectious.

Infections that can act as a cause of pathology include:

  • Tuberculosis
  • Typhoid (typhoid or typhus)
  • Pneumococcal or staphylococcal infection (bronchitis or pneumonia)
  • Syphilitic lung lesions
  • Candidiasis (fungal infections)
  • Mycoplasma infection.

The most common causes of infectious pleurisy are pneumonia and bronchitis. If necessary, this form of the disease can be treated with both tablets and folk remedies.

But pleurisy is not always associated with exposure to bacterial waste products. Once on the pleura, some other toxins lead to its irritation and the occurrence of an inflammatory process. Other causes of pleurisy:

  • Malignant neoplasms in the pleura and metastasis from other organs
  • Autoimmune pathologies
  • Pulmonary infarction
  • Leukemia
  • Pancreatitis.

There are dry and exudative pleurisy, the symptoms of which (shortness of breath, cough, chest pain) vary greatly. With dry inflammation, a simple inflammation of the pleura develops, and a specific protein, fibrin, is deposited on its surface.

Exudative pleurisy in adults is characterized by the accumulation of fluid in the pleural cavity, signs of which can be seen on x-ray. Purulent pleurisy is distinguished separately. It is considered the most severe form of the disease, since over time it is possible to develop pleural empyema - a serious complication with possible death, especially in older people.

Symptoms of pleurisy

The manifestations of the disease depend on its type. Dry pleurisy is characterized by the following symptoms:

  • Discomfort or even severe chest pain
  • Dry cough without sputum
  • Slight increase in temperature
  • Increased breathing rate
  • A typical “forced” position is half-sitting, leaning forward (in this position pain is felt less).

It is often accompanied by severe complicated bronchitis, the symptoms of which are similar to those of pleurisy.

The diagnosis of “exudative pleurisy” in adults is characterized by the appearance of a feeling of heaviness in the chest. The patient feels short of breath. Breathing is noisy and rapid. A slight dull pain and cough may appear.

Purulent pleurisy, complicating bronchitis, has all the same symptoms (chest pain, shortness of breath) as exudative pleurisy, but its progression is accompanied by the appearance of signs of general intoxication:

  • Heat
  • Chills
  • Excessive sweating
  • General weakness.

This is due to the fact that pus that accumulates in the pleural cavity eventually begins to enter the bloodstream. The toxins contained in it cause poisoning of the patient’s body, as a result of which signs of intoxication appear, worsening the diagnosis.

Diagnostics

In order to detect inflammation of the pleura in adults, a number of special techniques are used. The clinical picture is taken into account - cough, shortness of breath, chest pain. The doctor begins diagnosing the disease with a general examination of the patient.

Exudative pleurisy is characterized by protrusion of the diseased area of ​​the chest forward. At the same time, the intercostal spaces are smoothed out, which are easily palpable on the healthy half of the body.

Percussion (tapping) over the area of ​​fluid accumulation will reveal signs of dullness of sound. Normally, the sound above the lungs is very clear, since they contain air. Bronchitis and pleurisy can be identified by a decrease in the clarity of sound, a noticeable increase in breathing (shortness of breath).

Fluid in the lungs will also be visible on an x-ray, where a darkening will be visible. A pleural puncture will help diagnose purulent pleurisy. If just lymph is found in the pleural cavity, the prognosis for the patient will be much better than if pus comes out.

In addition, the resulting liquid can be examined in a bacteriological laboratory, determining the correct diagnosis (find the microorganism that caused inflammation of the pleura).

Dry pleurisy in adult patients is diagnosed based on complaints (severe dry cough, constant shortness of breath) and listening to the chest. If during the examination the doctor hears a very characteristic noise that occurs due to friction of the inflamed layers of the pleura from each other, this will confirm the diagnosis of pleurisy.

The X-ray method is also more informative. A sign of dry pleurisy in the image is a higher level of the diaphragm on the affected side. It is quite difficult to detect bronchitis on an x-ray.

Treatment of pleurisy

Doctors offer many methods to treat pleurisy. Each patient requires an individual approach, since the treatment regimen depends on the course of the disease, the shape, side and degree of damage to the pleura, and the extent of the process. You can also treat with folk remedies.

The basis of treatment for pleurisy is antibiotic therapy. Initially, the patient is prescribed broad-spectrum drugs that can inhibit the development of many microorganisms from different groups and effectively reduce tissue inflammation.

If a pleural puncture was performed, the analysis data will show how to treat pleurisy. They will allow you to determine the exact type of bacteria that caused the disease and select a narrow-spectrum antibiotic that acts more efficiently and faster than broad-spectrum drugs. The prescription for them is written by the attending physician.

Severe purulent pleurisy must be treated with pleural puncture. This research will help:

  • Remove excess fluid from the pleural cavity
  • Prevent the appearance of purulent melting (empyema) of the pleura
  • Reduce the pressure of exudate on internal organs (heart, lungs).

During puncture, pus is pumped out of the pleural cavity. Then a dissolved antibiotic is injected into it. This action of the drug will speed up recovery.

Exudative pleurisy can also be treated with folk remedies.

Horseradish treatment

At home, an effective remedy made from horseradish and lemon will help get rid of pleurisy. You need to crush 150 grams of horseradish root well and squeeze 3 lemons into it. If you drink the resulting composition daily, half a tablespoon in the morning and evening, the disease syndromes (cough, shortness of breath) will quickly disappear.

Honey and aloe

A simple recipe will help reduce the activity of inflammation and cure the disease with folk remedies. You need to take 100 grams of honey and dissolve in it a little pork fat, crushed aloe leaves (2-3 pieces) and a spoonful of cocoa. If you heat the mixture in a water bath, it will become homogeneous. Take a tablespoon 3 times a day.

A slightly modified recipe will help cure bronchitis complicated by pleurisy using folk remedies. To the same amount of honey you need to add pork fat and the yolk of a chicken egg. Place all this in a glass of milk and stir thoroughly. Drink daily before bed.

Badger fat

badger fat for pleurisy

Treatment of pulmonary pleurisy with badger fat is one of the best methods that can be used at home. The recipe is simple: mix badger fat, several aloe leaves and a glass of honey. Melt in a water bath and strain. This remedy should be taken one spoonful three times a day.

You can treat purulent pleurisy at home using regular onions. You need to chop one small onion, cover your head with a towel, lean over the plate and breathe this air for about 15 minutes. This remedy is also very effective in treating bronchitis and laryngitis.

It is worth noting that treating pleurisy with folk remedies is not a reason not to go to the doctor. Only an experienced specialist will be able to correctly diagnose the disease based on the clinical picture (cough, shortness of breath, chest pain) and select methods for its treatment.

Prevention of pleurisy

To prevent inflammation of the pleura, it is recommended to follow a number of simple rules. These include:

  • Avoid hypothermia
  • Treat colds, ARVI, bronchitis in a timely manner
  • Consult a doctor promptly when the first symptoms appear (shortness of breath, cough, chest pain, heart pain).

Following these simple rules will allow you to never suffer from pleurisy.

Source: http://lekhar.ru/bolesni/pulmonologija/plevrit-legkih/

Dry pleurisy

Dry pleurisy is an inflammation of the serous membrane of the lung with the formation of fibrinous plaque on the surface of the pleural layers.

The lungs are covered on the outside with a thin, smooth serous membrane - the visceral layer of the pleura. The walls of the chest, where the lungs are located, are also lined from the inside with a smooth serous layer of the parietal pleura. A pleural cavity is formed between the walls of the chest and the lungs - a closed, slit-like space with a small amount of fluid inside it. These few milliliters of fluid normally ensure the sliding movements of the lungs during breathing.

Causes of development of dry pleurisy

Dry pleurisy is usually a complication of painful processes in the lungs or other organs located near the pleural cavity, or serves as a symptom of general (systemic) diseases. Infectious pleurisy is divided according to the type of pathogen, aseptic (non-infectious) - according to the nature of the disease of which it is a manifestation.

Most often, the causes of serous and serous-fibrinous pleurisy are infectious inflammatory diseases of the lungs: tuberculosis, pneumonia (parapneumonic, metapneumonic pleurisy), a limited focus of suppuration of the lung (abscess).

Sometimes dry pleurisy develops as a complication of the active phase of rheumatism or other systemic connective tissue lesions (rheumatic, lupus pleurisy).

Uremia is the final stage of chronic renal failure, also accompanied by inflammation of the lung lining. Uremic dry pleurisy occurs as a result of irritation of the pleural layers by nitrogenous wastes, which are released through the serous membranes during renal failure.

Pathogenesis – mechanism of development of dry pleurisy

Penetration of pathogenic microbes into the pleural cavity during infectious pleurisy occurs directly from foci of inflammation located under the membrane of the lung.

Painful changes in the pleura are represented by inflammatory edema of the pleural layers and the accumulation of white blood cells there - leukocytes. A small amount of inflammatory fluid – effusion or exudate – appears inside the pleural cavity.

As the disease progresses, a small amount of serous effusion resolves. If the inflammatory exudate is rich in protein, then fibrinous plaque settles on the pleural layers. Subsequently, these fibrinous deposits grow with elements of connective tissue. As a result, fibrous scars form on the pleural sheets, and the sheets grow together. As a result, the pleural cavity completely or partially closes. This outcome of inflammation of the pleura is called adhesive pleurisy.

Clinical manifestations of dry pleurisy

Signs of pleurisy complement the symptoms of the underlying lung disease (tuberculosis, pneumonia, abscess) or become leading in the clinical picture of the disease. The general condition of the patient with dry pleurisy suffers slightly. Body temperature can be normal, low-grade or elevated, depending on the activity of the underlying inflammatory process in the lung tissue. Chills, night sweats, and general severe weakness accompany inflammation of the pleural layers.

The patient experiences acute chest pain when breathing. This pain intensifies when coughing, taking a deep breath, or bending the body to the healthy side. The patient's breathing becomes rapid and shallow. Sometimes the patient is forced to take a horizontal position on the sore side. This position relieves pain by limiting the respiratory movements of the chest.

The mobility of the diseased half of the chest during breathing is noticeably limited. In the absence of massive inflammation of the lung tissue, the percussion sound over the affected area is not changed. Due to the patient sparing the affected side, breathing during auscultation may be weakened. Also above the source of inflammation, a pleural friction noise is detected, which in timbre resembles the creaking of snow or new skin.

Symptoms of diaphragmatic dry pleurisy

With fibrinous inflammation of the pleura lining the diaphragm, diaphragmatic dry pleurisy develops. In this case, the friction noise of the inflamed pleura cannot be heard. The pain that arises can be carried along the phrenic nerve to the neck, along the intercostal nerves to the abdominal area. Sometimes, with dry diaphragmatic pleurisy, abdominal tension is detected, simulating an acute disease of the abdominal organs. Painful hiccups and pain when swallowing may occur.

In patients with dry diaphragmatic pleurisy, the thoracic type of breathing predominates with the participation of the upper part of the chest and increased pain in the lower part with deep inspiration. When pressing between the legs of the sternocleidomastoid muscle, in the first intercostal spaces near the sternum, at the place of attachment of the diaphragm to the ribs, on the spinous processes of the first cervical vertebrae, pain points are revealed.

Additional examination methods

X-ray examination reveals symptoms of dysfunction of the diaphragm: high standing of the dome, limitation of its mobility on the affected side. In the absence of pronounced inflammation in the lung tissue, changes in the general blood test are minimal.

How is dry pleurisy treated?

Treatment of pleurisy should be comprehensive and include active action on the underlying disease. The patient must remain in semi-bed rest or bed rest. Treatment is carried out with anti-inflammatory drugs and antibiotics. Antitussives are used for dry coughs that worsen chest pain.

To reduce inflammation in autoimmune connective tissue diseases, steroid hormones (metipred, dexamethasone, prednisolone, hydrocortisone) are used.

Severe pain can also be reduced by intramuscular injection of painkillers. Traditional methods of treatment have retained their importance: warm compresses, medical cups, application of iodine mesh to the skin. In the absence of a massive focus of inflammation in the lung tissue, treatment of the patient with dry pleurisy at home is allowed. Symptomatic treatment consists of immobilization (immobilization) of the diseased half of the chest by tight bandaging.

Patients need a diet rich in vitamins and complete proteins

During the recovery period, treatment is supplemented with physiotherapeutic procedures and therapeutic breathing exercises.

Treatment of uncomplicated dry pleurisy lasts from several days to 2-3 weeks. A long recurrent course, as well as a transition to exudative pleurisy, can be observed with the tuberculous nature of the process.

Forecast and prevention of pleurisy

The prognosis for dry pleurisy is generally favorable and depends on the course of the underlying disease.

Prevention of pleural inflammation involves the prevention and effective treatment of diseases complicated by pleurisy.

For early diagnosis of pneumonia and lung abscesses, it is necessary to promptly seek medical help when the first symptoms of respiratory tract inflammation appear. A simple and accessible method for diagnosing these diseases is x-rays of the lungs. Patients should not refuse diagnostic radiography prescribed by a doctor to exclude severe complications.

An effective and affordable method for early diagnosis of tuberculosis is preventive annual fluorography.

Symptoms and treatment of dry pleurisy

The term pleurisy in pulmonology refers to diseases of an inflammatory nature that can occur either independently or as complications of other pathological processes. Dry pleurisy differs from other varieties in that it does not produce a large amount of fluid. This variety is often called fibrinous.

Causes of pathology

Dry pleurisy can only be a complication of diseases localized in the lungs or outside them. Most often its causes are the following pathologies:

  1. In most cases, tuberculosis leads to pleurisy. Moreover, it can affect not only the lungs, but also the intrathoracic lymph nodes. If foci of tuberculosis are located near the pleura, then there is a high risk that it will be infested with bacteria. In some cases, pathogens are delivered to the pleura through the bloodstream from a focus of tuberculosis that is not located subpleurally.
  2. Another common cause may be brochiectasis.
  3. Inflammation of the pleura, which is caused by complicated pneumonia, is not uncommon.
  4. The pathology can also be caused by more severe diseases: a lung abscess, its infarction, or a malignant neoplasm that has appeared on this organ.
  5. Separately, it is worth noting pathologies of extrapulmonary localization: influenza, measles, whooping cough, typhus or typhoid fever. They are not uncommon in people, and many people treat such infections extremely carelessly.
  6. Inflammatory processes in other organs can also cause damage to the pleura. These include: pancreatitis, cholecystitis and subphrenic abscess. All these organs are located in the diaphragm or near the pleura.
  7. Systemic pathologies can also cause inflammation of the pleura. For example, lupus erythematosus, rheumatoid arthritis, scleroderma or vasculitis.
  8. Chronic renal failure in the terminal stage can also cause pleurisy that occurs without fluid secretion. The exudative process in this case is sluggish.
  9. The rarest cause of inflammation is a lack of vitamin C.

Complications of these diseases lead to the development of an inflammatory process in the pleural area, which has its own characteristics. The main one is the small amount of exudate, most of it is absorbed back into the pleura. In this case, threads of fibrin, which is part of this fluid, are deposited on the surface of the pleura and make it difficult for its leaves to slide. Later they are replaced by connective tissue. In such places, the leaves grow together and form adhesions.

In some cases, the infectious agent may not be present. For example, if the cause was rheumatoid arthritis and similar diseases. In renal failure, inflammation is caused by nitrogen compounds that irritate the serous membranes of the lungs.

Symptoms

Often, signs of pleurisy only complement the clinical picture of a disease. The most common complaints of patients:

  • weakness, fatigue, loss of appetite, headache;
  • the increase in temperature can vary from low-grade (up to 37.9 degrees) to more serious (above 38);
  • chest pain in the area of ​​the pleura;
  • cough;
  • increased discomfort when breathing deeply, coughing and sneezing.

Instinctively, every patient tries to spare the affected area. He lies more on the side in which inflammation has developed, holds it, limiting breathing, which becomes shallow and frequent. This is especially visible if fibrinous pleurisy is one-sided.

The intensity of pain increases over time. At an advanced stage, it can disturb the patient during a calm conversation. Signs of pleurisy may be more pronounced or, on the contrary, appear almost imperceptibly.

Why are differential diagnostic methods used?

There are several diseases with which dry pleurisy has similar symptoms. If it is unilateral and developed on the left, then the patient needs to be examined for the presence of cardiovascular diseases. This pathology is often confused with rib fractures, appendicitis and osteochondrosis. It is precisely because the clinical symptoms of several diseases are similar that doctors use differential diagnostic methods. The patient is prescribed a comprehensive examination, including:

  • biochemical and general blood test;
  • urine test;
  • Ultrasound of the pleural area;
  • X-ray of the chest area.

In addition, the doctor examines the patient by palpating the painful area. Based on the condition of the muscles and tissues, he can make a preliminary diagnosis. Dry pleurisy is most quickly diagnosed in people who received treatment in a hospital. Doctors are aware of the possibility of such a complication and quickly adjust the course of treatment to make it as effective as possible.

How to treat this pathology

Since dry pleurisy occurs against the background of serious illnesses, its treatment is carried out in a hospital. Patients are prescribed bed rest, which can occasionally be supplemented with short walks. It is important to establish proper nutrition for the patient. You need to include protein foods and vitamins in your diet.

The course of treatment for pleurisy is quite specific. First of all, you need to get rid of the underlying pathological process. If the pathogen is known, then antibiotics to which it is most sensitive can be used. If the causes of pleurisy are unknown, then broad-spectrum drugs are used.

If the cause of inflammation of the pleura is tuberculosis, then it is treated with medication. For diseases of rheumatic origin, cytostatics and glucocorticosteroids are necessarily added to the course of treatment.

Additionally, symptomatic treatment may be prescribed:

  • tightly bandaging the chest to relieve pain;
  • non-steroidal anti-inflammatory drugs in the form of suppositories or intramuscular injections;
  • antitussives (butamirate or codeine);
  • in the absence of temperature, warming measures are carried out (compresses, mustard plasters or cups).

After recovery, physical therapy is performed for speedy rehabilitation. At this stage, the patient may be advised to regularly do breathing exercises to restore lung function.

Complications from pleurisy are extremely rare, and it goes away almost without leaving a trace. However, the diseases that cause it may be incurable or require longer therapy. Symptoms of pleurisy torment the patient for 1-3 weeks.

The best prevention of fibrinous inflammation of the pleura is timely diagnosis and treatment of any diseases. If you experience alarming symptoms, you should immediately consult a doctor. You also need to undergo regular medical examinations, including fluorography. It is with its help that pulmonary tuberculosis can be detected at an early stage.

Source: http://kashelsovet.ru/zabolevaniya/simptomy-i-lechenie-suhogo-plevrita.html