What is the pleura of the lungs?

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Dry and effusion pleurisy of the lungs: what is it and how does the disease manifest itself?

Not everyone knows why pulmonary pleurisy is dangerous, what it is and how to treat it. The human lungs are located in the chest cavity. On the outside they are covered with pleura.

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The pleura is a serous membrane that lines the inner layer of the chest cavity and envelops both lungs. The basis of the pleura is made up of mesothelial cells.

Directly between the parietal and visceral layers there is a space in which the fluid is located. The latter makes breathing easier by reducing friction between the leaves. When the pleura becomes inflamed, the production of this fluid is disrupted, which subsequently provokes the appearance of a cough. What is the etiology, clinical picture and treatment of pleurisy?

Features of pleurisy

Pleurisy is an inflammation of the serous membranes that cover the outside of the lungs. This disease occurs very often. This is the most commonly diagnosed lung pathology. In the general structure of population morbidity, pleurisy accounts for 5-15%. The incidence rate varies from 300 to 320 cases per 100 thousand people. Men and women suffer from this disease equally often. Pleurisy in children is diagnosed less frequently than in adults.

An interesting fact is that women are most often diagnosed with 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.

There are different types of this pathology. There are infectious and non-infectious pleurisy. If the causes of inflammation of the pleura are unknown, idiopathic pleurisy occurs. Depending on the presence of exudate, effusion and dry pleurisy are distinguished. In the first case, the exudate can be serous, hemorrhagic, eosinophilic, serous-fibrinous, purulent, putrefactive, chylous or mixed. According to the nature of the course, acute, subacute and chronic inflammation of the pleura is distinguished. Depending on the location of the effusion, diffuse and limited pleurisy are distinguished. One of the most dangerous is metastatic pleurisy, as it is formed due to the spread of cancer cells from the site in diseases such as lung, breast, ovarian, and lymphoma.

Etiological factors

Acute and chronic pleurisy occur for a variety of reasons. If the disease is infectious in nature, the etiological factors may be:

  • bacterial diseases (streptoccal and staphylococcal infections, tuberculosis, pneumonia);
  • fungal diseases (candidiasis);
  • helminthic infestation (echinococcosis);
  • protozoal infections (amoebiasis);
  • mycoplasmosis;
  • syphilis;
  • typhoid fever;
  • brucellosis;
  • tularemia;
  • infection of the lungs and pleura during surgical interventions.

Exudative pleurisy very often develops with tuberculosis. With an infectious form of inflammation of the pleura, the patient is contagious, since pathogenic microorganisms can be released with a cough. As for the non-infectious form of the disease, in this situation the possible causes are:

  • the presence of malignant tumors;
  • systemic autoimmune diseases (lupus erythematosus, rheumatoid arthritis, vasculitis, scleroderma);
  • myocardial infarction;
  • blockage of the lumen of the pulmonary artery by a thrombus;
  • pulmonary infarction;
  • leukemia;
  • pancreatitis;
  • allergic diseases (diathesis);
  • traumatic injury;
  • chronic renal failure;
  • exposure to ionizing radiation;
  • intoxication of the body.

Recently, the detection of carcinomatous pleurisy has often been observed. The main causes of its occurrence are pleural mesothelioma and cancer of other organs. Bilateral inflammatory process is rarely diagnosed. In most cases, the cause is tuberculosis infection. The development of left-sided pleurisy is often caused by heart disease (myocardial infarction). How does the causative agent of an infectious form of inflammation of the pleura penetrate the tissue? The following routes of penetration of pathogenic microbes are distinguished:

  • through lymphatic vessels;
  • through blood;
  • contact;
  • straight (for open chest injury).

Predisposing factors for the development of this pathology are: alcohol abuse (can provoke pancreatitis and reactive pleurisy), decreased immunity, poor nutrition (is a trigger for the development of atherosclerosis and coronary artery disease, including myocardial infarction), smoking.

Pathogenesis of the disease

It is necessary to know not only what pleurisy is, but also the mechanism of its development. In the case of infectious inflammation, pathogenic microbes penetrate into the pleural tissue. The latter cause inflammation. Exudate begins to accumulate in the pleural cavity. This occurs against the background of increased vascular permeability. The effusion contains the protein fibrin. It accumulates on the layers of the pleura. If the fluid is sucked back out, dry pleurisy is formed. Synpneumonic pleurisy is often diagnosed. It develops when the lung tissue becomes inflamed. The exudate can be hemorrhagic or fibrinous-purulent.

The mechanism of development of pleural inflammation of non-infectious origin depends on the underlying disease. Hemorrhagic pleurisy is formed when small vessels (capillaries) of the pleura are damaged. This occurs with vasculitis or systemic diseases (lupus erythematosus). Traumatic pleurisy is directly related to the body’s reaction to hemorrhage. If a person has developed kidney failure, then metabolic products and various toxic substances accumulate in the blood, which lead to inflammation of the pleura. In the case of acute pancreatitis, the pleura may be damaged by enzymes.

Clinical manifestations

Symptoms of pleural inflammation are largely determined by whether the pleurisy is dry or effusion. The fibrinous type of pleurisy (dry) occurs most often in an acute form. Its main features are:

The pain can be stabbing and intense. The pain tends to intensify when coughing, sneezing or taking a deep breath. The pain syndrome weakens when a person lies on the painful side. The pain in the vast majority of cases is localized on one side. Painful sensations appear due to irritation of the pleural layers by fibrin. Acute inflammation caused by an infectious factor always occurs with an increase in body temperature. Often it reaches 38º. Additional symptoms of the disease include chills, pain in the hypochondrium or abdomen, and increased sweating. In severe cases, shortness of breath and difficulty breathing may occur. Objective signs of dry pleurisy include pleural friction noise and decreased breathing when listening to the lungs.

Effluent interlobar pleurisy proceeds differently. Often it occurs in an erased form. Its peculiarity is that it is most often detected in adolescence. In this situation, exudate accumulates between the lobes of the lungs, without reaching the prenatal cavity. This form of the disease is more mild than the mediastinal one. Often it is detected only with the help of x-ray examination. With mediastinal pleurisy, when fluid accumulates in the pleural cavity, symptoms may include dull pain on the affected side, dry cough, shortness of breath, cyanosis of the skin, loss of appetite, and sweating. Over time, the pain syndrome is replaced by heaviness in the chest and shortness of breath. With primary exudative inflammation, pain is rare. With the serous type of inflammation against the background of lung cancer, hemoptysis is possible. In this situation, it is necessary to exclude tuberculosis.

Diagnostic measures

To identify left-sided or right-sided pleurisy, a thorough examination of the patient is required. Diagnostics includes:

  • patient interview;
  • visual inspection;
  • listening to the heart and lungs;
  • general and biochemical blood test;
  • Analysis of urine;
  • X-ray examination;
  • examination of pleural fluid;
  • sputum analysis.

During the examination, the following changes are possible: displacement of the trachea, change in skin color, smoothing of the spaces between the ribs on the affected side, tilt of the body to the affected side, uneven movement of the chest when breathing. Diseases of the lungs and pleura can be detected after X-ray examination. Elevation of the dome of the diaphragm and a decrease in the transparency of the lung tissue indicate dry pleurisy. If the angle in the diaphragm area is smoothed, there is a displacement of the mediastinal organs to the side that is not affected, and darkening, then this indicates exudative pleurisy. If adhesive pleurisy or any other was a complication of pneumonia or tuberculosis, then signs of these diseases are observed (shadows of various sizes). Identification of foci of calcification indicates an armored type of pleurisy.

The results of examination of fluid after pleural puncture are of great diagnostic value. Normally, pleural fluid is transparent, straw-yellow in color, odorless, and non-viscous. The reaction of the medium is 7.2. A decrease in glucose in it may indicate mesothelioma, tuberculosis or pneumonia. If blood is detected in it, then the cause may be hemothorax, trauma, embolism, or tumor. The analysis evaluates the content of formed elements, density, amount of protein and enzymes. In case of infectious inflammation, microbiological examination of sputum is required.

Treatment tactics

Treatment is determined by the form of pleurisy. Treatment of an infectious type of inflammation of the pleura involves the use of antibiotics and other antimicrobial agents, diuretics, and painkillers. In case of exudative inflammation, physiotherapy and exercise therapy can be used, but only after the effusion has resolved. If the cause of inflammation of the pleura is pulmonary tuberculosis, anti-tuberculosis drugs are prescribed (Streptomycin, Rifampicin, Ethambutol, Isoniazid). This therapy should last several months. Treatment of pleurisy against the background of community-acquired bacterial pneumonia is carried out with protected penicillins, cephalosporins or macrolides.

Treatment involves the use of symptomatic remedies. If there are pleural fibrinous deposits (dry pleurisy), the patient should be provided with complete rest. In case of cough, antitussives are prescribed. Treatment often includes cupping, mustard plasters, the use of anti-inflammatory drugs (Aspirin, Ibuprofen), and breathing exercises.

If a large volume of fluid accumulates, a pleural puncture may be required.

After the puncture, the patient needs close attention. Fibrinous pleurisy proceeds most favorably and ends with recovery (with the exception of tuberculosis). Surgical treatment may be required for chronic purulent pleurisy.

Nutrition for pleurisy should be complete and meet physiological needs. It is necessary to include more vitamin-rich foods in your diet. The diet for pleurisy involves limiting the consumption of carbohydrates and salt. It is also necessary to reduce the amount of liquid you drink. As for non-infectious pleurisy, its treatment involves eliminating the underlying disease. In the case of a tumor, chemotherapy may be given. For rheumatic diseases, Prednisolone is indicated. Prevention of pleurisy is aimed at preventing major diseases (tuberculosis, pneumonia, heart attack, systemic diseases). Thus, pleurisy in most cases is a complication of another pathology. This condition requires timely diagnosis and treatment.

Source: http://respiratoria.ru/plevrit/plevrit-legkix-chto-eto-takoe.html

Pulmonary pleurisy - what is it? Symptoms and treatment

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

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

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

Causes

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

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

Infectious causes of pulmonary pleurisy include:

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

The causes of non-infectious pulmonary pleurisy are as follows:

  • malignant tumors of the pleural layers,
  • metastasis to the pleura (in breast cancer, lung cancer, etc.),
  • diffuse connective tissue lesions (systemic vasculitis, scleroderma, systemic lupus erythematosus), pulmonary infarction,
  • TELA.

Factors that increase the risk of developing pleurisy:

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

The course of pleurisy can be:

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

Microorganisms enter the pleural cavity in different ways. Infectious agents can enter by contact, through blood or lymph. Their direct impact occurs during injuries and wounds, during operations.

Dry pleurisy

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

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

Tuberculous pleurisy

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

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

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

Purulent pleurisy

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

Symptoms of purulent pleurisy. The course of the disease varies depending on age. In infants in the first three months of life, purulent pleurisy is very difficult to recognize, since it is masked under the general symptoms characteristic of umbilical sepsis and pneumonia caused by staphylococci.

From the side of the disease, the chest becomes convex. Shoulder drooping and insufficient arm mobility also occur. In older children, standard symptoms of total pleurisy are observed. You can also note a dry cough with sputum, sometimes even with pus - when a pleural abscess breaks into the bronchi.

Encapsulated pleurisy

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

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

Exudative pleurisy

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

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

Symptoms of pleurisy

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

Dry pleurisy is characterized by the following symptoms:

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

With exudative pleurisy, the clinical manifestations are somewhat different:

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

The most severe course is observed with purulent pleurisy:

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

If the course of pleurisy becomes chronic, then scar changes form in the lung in the form of pleural adhesions, which prevent complete expansion of the lung. Massive pulmonary fibrosis is accompanied by a decrease in the perfusion volume of lung tissue, thereby aggravating the symptoms of respiratory failure.

Complications

The outcome of pleurisy largely depends on its etiology. In cases of persistent pleurisy, the development of adhesions in the pleural cavity, fusion of interlobar fissures and pleural cavities, the formation of massive moorings, thickening of the pleural layers, the development of pleurosclerosis and respiratory failure, and limited mobility of the dome of the diaphragm cannot be ruled out in the future.

Diagnostics

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

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

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

How to treat pleurisy?

When symptoms of pleurisy appear, treatment should be comprehensive and aimed primarily at eliminating the underlying process that led to its development. Symptomatic treatment is aimed at anesthetizing and accelerating the resorption of fibrin, preventing the formation of extensive adhesions and adhesions in the pleural cavity.

Only patients with diagnosed dry (fibrinous) pleurisy can be treated at home; all other patients should be hospitalized for examination and selection of an individual treatment regimen for pulmonary pleurisy.

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

So, with dry pleurisy, the patient is prescribed:

  1. To relieve pain, painkillers are prescribed: analgin, ketanov, tramadol; if these drugs are ineffective, narcotic painkillers can be administered in a hospital setting.
  2. Warming semi-alcohol or camphor compresses, mustard plasters, and iodide mesh are effective.
  3. Cough suppressants are prescribed - Sinecode, Codelac, Libexin.
  4. Since the root cause is most often tuberculosis, after confirming the diagnosis of tuberculous pleurisy, specific treatment is carried out at the anti-tuberculosis dispensary.

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

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

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If you pumped out 1.7 liters of fluid from the pleura

How difficult is it? 1.5 months have passed since the operation, breast cancer

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Source: http://simptomy-lechenie.net/plevrit-legkix-chto-eto-takoe/

What happens if the pleura becomes inflamed

Everyone knows what a cold, sore throat, bronchitis, and pneumonia are. These respiratory diseases are widespread and occur quite often. But their spectrum is much wider, and one of the most severe and dangerous is pleurisy of the lungs.

People do not always understand what pleurisy is, since it involves an organ that is quite inconspicuous and, at the same time, important - the pleura. It consists of two hermetically connected sheets, thin films, one of which envelops the lung tissue, and the other separates them from the chest. Between them there is a small space containing about two milliliters of lubricant.

This film plays an extremely important role. It not only separates and protects lung tissue, but also helps create the negative pressure necessary for normal breathing. When you inhale, the film stretches along with the chest, increasing the volume of the lungs. As a result, inhalation occurs easier and more fully. And if the pleura becomes inflamed, the consequences can be very severe.

Forms of manifestation

Despite the fact that this disease affects a relatively small organ, it has several forms that are quite different from each other. There are several groups based on a number of characteristics:

  • According to the pathogen. Pleurisy can be allergic, bacterial, viral, traumatic, or oncological. Today, pleurisy of unknown etiology is increasingly being recorded.
  • Because of. Like many other diseases, pleurisy can be primary or secondary. Primary, independent pleurisy is extremely rare; most often it becomes a consequence of some other disease.
  • According to the primary disease. There are tuberculous, rheumatic, hypostatic, traumatic pleurisy, as well as a number of other types of pleurisy.
  • According to the form. Like any inflammatory disease, pleurisy can be acute or chronic. The connection between them is standard: if not treated in time, the acute form becomes chronic, which can worsen at times.
  • According to the nature of the damage to the pleura. There are two types of pleurisy: fibrinous (dry pleurisy) and exudative. In the first case, lymph protein is deposited between the layers of the pleura, but there is no exudate or very little of it. Exudative pleurisy or effusion pleurisy is characterized by the accumulation of fluid between the layers of the pleura.
  • By type of exudate. Exudative pleurisy has several forms, which differ in the nature of the exudate. There are hemorrhagic, purulent, serous and putrefactive pleurisy.

Depending on the combination of these signs, the manifestations of this disease also depend.

Symptoms of pulmonary pleurisy

The signs of this disease can be quite varied, depending on the causes that caused it and the characteristics of its course. But a number of signs appear most often:

  • Cough. Most often, pleurisy is accompanied by a strong cough, dry or with a small amount of sputum. The cough can be very strong, up to reflex vomiting.
  • Labored breathing. This is one of the typical signs of pleurisy, most often exudative.
  • Pain. Severe pain in the right or left side of the chest forces a person to take a forced position to relieve it.
  • Pallor. Difficulty breathing leads to a lack of oxygen, which is manifested by pale or even bluish skin.
  • Increased body temperature. With pleurisy, body temperature may be slightly elevated - about 37-37.5 degrees.

If such signs appear, diagnosis and treatment should be started immediately.

Diagnosis of the disease

When a patient consults a doctor with similar symptoms, the primary diagnosis in most cases will be typical:

  • Inspection and survey. The doctor pays attention to the condition of the skin, the patient’s posture, and breathing patterns. Characteristic signs of pleurisy are bulging of the skin between the ribs, as well as a lag in the breathing of the lung on the affected side.
  • Listening. With the help of a stethoscope, the doctor can more accurately examine breathing, paying attention to the noises and wheezing typical for this disease.
  • X-ray. One of the most important and informative examinations is an x-ray. A characteristic sign is a darkened area on one of the lungs.
  • Tomography. A similar type, but more accurate examination is computed tomography or magnetic resonance imaging.
  • Bronchoscopy. In some cases, visual examination of the inner surface of the bronchi may be required.
  • Puncture. In the case of exudative pleurisy, the study of exudate is of great importance. To do this, a small amount of liquid is pumped out through the puncture, which is studied first visually, and then at the biochemical level.

In addition, a number of additional tests may be required to determine the underlying cause of the disease.

Treatment of pulmonary pleurisy

Treatment of this disease consists of several parts:

  • First of all, doctors need to relieve pain and restore normal breathing to a person. For this, a number of methods can be used, for example, pumping out exudate that interferes with normal breathing.
  • At the same time, symptomatic therapy is prescribed to make breathing easier. Depending on the type of disease, it can be anti-inflammatory, anesthetic, antipyretic, and so on.
  • But at the same time, it is necessary to find the primary disease that caused the inflammation of the pleura and eliminate it. For this purpose, targeted and highly specialized therapy is used: antiviral, antibacterial, a course of corticosteroids, radiation or chemotherapy.

It is worth noting that treatment of pleurisy in most cases is carried out in a hospital setting. And only the rehabilitation period can take place at home or in a sanatorium under the supervision of a doctor.

Without timely and adequate treatment, it can have quite serious consequences, greatly reducing a person’s quality of life. Therefore, you cannot ignore a prolonged cough, hoping that it will go away on its own after some time.

Source: http://www.internet-medicina.ru/stati/organov-dyxaniya/chto-byvaet-esli-vospalyaetsya-plevra.html

Pleurisy of the lungs - what is it, causes, types, symptoms and treatment in adults

The main respiratory organ in the human body is the lungs. The unique anatomical structure of the human lungs fully corresponds to the function they perform, which is difficult to overestimate. Pulmonary pleurisy is caused by inflammation of the pleural layers for infectious and non-infectious reasons. The disease does not belong to a number of independent nosological forms, as it is a complication of many pathological processes.

What is pulmonary pleurisy

Pulmonary pleurisy is one of the most complex inflammatory diseases, most severely occurring in children and the elderly. The pleura is the serous membrane of the lung. It is divided into visceral (pulmonary) and parietal (parietal).

Each lung is covered with pulmonary pleura, which along the surface of the root passes into the parietal pleura, lining the walls of the chest cavity adjacent to the lung and delimiting the lung from the mediastinum. The pleura that covers the lungs allows them to painlessly come into contact with the chest during breathing.

The lungs are a paired organ. Every person has two lungs - right and left. The lungs are located in the chest and occupy 4/5 of its volume. Each lung is covered with pleura, the outer edge of which is tightly fused with the chest. Lung tissue resembles a finely porous pink sponge. With age, as well as with pathological processes of the respiratory system, long-term smoking, the color of the pulmonary parenchyma changes and becomes darker.

Breathing is a largely uncontrolled process carried out at a reflex level. A certain zone is responsible for this – the medulla oblongata. It regulates the pace and depth of breathing, focusing on the percentage of carbon dioxide concentration in the blood. The rhythm of breathing is affected by the work of the whole organism. Depending on the breathing rate, the heart rate slows down or speeds up.

Classification of the disease

Depending on the cause of the disease, the forms of manifestation of the disease may also differ and are divided into:

  • Purulent pleurisy is a disease, the occurrence of which is provoked by the accumulation of purulent effusion in the pleural cavity. At the same time, the parietal and pulmonary membranes are damaged by the inflammatory process.
  • Exudative pleurisy is characterized by damage to the pleura of an infectious, tumor or other nature.
  • 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.
  • Tuberculous pleurisy affects the serous membranes that form the pleural cavity and cover the lungs. The main symptom of the disease is increased fluid secretion or fibrin deposits on the surface of the pleura.

By distribution area:

  • Diffuse pleurisy (exudate moves through the pleural cavity).
  • Enclosed pleurisy (fluid accumulates in one of the areas of the pleural cavity). It can be apical, parietal, basal, interlobar.

According to the nature of the lesion, pleurisy is divided into:

  • escudative – fluid is formed and retained between the layers of the pleura;
  • fibrous - fluid secretion is scanty, but the surface of the pleural walls itself is covered with a layer of fibrin (protein).

Pleurisy is also divided according to the nature of its spread:

  • it can only affect one lung
  • both lobes (unilateral and bilateral).

Causes

It must be said that the disease in its pure form is rare. For example, its development can be caused by trauma to the chest or hypothermia. In most cases, it accompanies any disease or occurs as a complication of it.

Pulmonary pleurisy is characterized by the formation of fibrinous deposits on the surface of the pleural layers and/or accumulation of exudate in the pleural cavity. Symptoms depend on the form of the disease.

Infectious pleurisy is the most common. Sensitization of the body also plays a major role in the mechanism of development of pathology. Microbes and their toxins lead to changes in the body's reactivity and allergization of the pleura. The immune system begins to “send” produced antibodies to the site of inflammation, which, when combined with antigens, affect the production of histamines.

About 70% of forms of pathology are caused by bacterial agents:

The causes of non-infectious pulmonary pleurisy are as follows:

  • malignant tumors of the pleural layers,
  • metastasis to the pleura (in breast cancer, lung cancer, etc.),
  • connective tissue lesions of a diffuse nature (systemic vasculitis, scleroderma, systemic lupus erythematosus),
  • pulmonary infarction.

Is pleurisy contagious? To answer this question unambiguously, you need to know the cause of pleurisy itself. If the suffering is associated with a chest injury, then, naturally, such pleurisy is not contagious. With a viral etiology, it can be quite contagious, although the degree of contagiousness is low.

Symptoms of pulmonary pleurisy

Patients often miss the onset of pleurisy because its symptoms are similar to the common cold. However, the signs of this pathology still differ from other respiratory diseases. You should know that the signs of different types of pleurisy are also different.

The very first and most obvious sign of pulmonary pleurisy is:

  • Severe, fleeting, sharp chest pain, often on only one side, when breathing deeply, coughing, moving, sneezing, or even talking.
  • When pleurisy appears in certain places on the lungs, pain may be felt in other parts of the body, such as the neck, shoulder, or abdomen.
  • Painful breathing often provokes a dry cough, which, in turn, increases pain.

The rate at which symptoms increase also plays a big role:

  • Acute periods of pleural damage are characterized by a rapid clinical rise;
  • for tumor and chronic forms – a calmer course of the disease

How does pulmonary pleurisy occur in older people? In old age, there is a sluggish course and slow resorption of the source of inflammation.

  • a clear connection between pain in the chest and the patient’s act of breathing: pain suddenly arises or significantly intensifies at the height of a deep breath. When the inflammatory process becomes less pronounced, the pain also decreases.
  • dry cough, which occurs due to fibrin irritation of the cough pleural nerve endings, as well as increased body temperature.

Patients with purulent pleurisy complain of:

  • pain, feeling of heaviness or fullness in the side,
  • cough,
  • difficulty breathing, inability to take a deep breath, shortness of breath,
  • increased body temperature, weakness.

Stages

Inflammation of the pleura develops in response to the introduction of pathogenic microbes and consists of 3 stages: exudation, formation of purulent discharge and recovery.

Exudate is a liquid coming out of microvessels, containing a large amount of protein and, as a rule, blood elements. Accumulates in tissues and/or body cavities during inflammation.

Stage 1

At the first stage, under the influence of the pathogen, the blood vessels dilate, the degree of their permeability increases, and the process of fluid production intensifies.

Stage 2

The exudation stage gradually turns into the stage of formation of purulent discharge. This occurs during the further development of the pathology. Fibrin deposits appear on the pleural layers, which create friction between them during breathing. This leads to the formation of adhesions and pockets in the pleural cavity, complicating the normal outflow of exudate, which becomes purulent in nature. Purulent discharge consists of bacteria and their waste products.

Stage 3 pleurisy

At the third stage, the symptoms gradually subside, the patient either recovers, or the disease becomes chronic. Despite the fact that the external symptoms of the disease subside and cease to annoy the patient, internal pathological processes gradually develop further.

Complications

Why is pulmonary pleurisy dangerous? As a result of the formation of scars (moorings), individual blocks of the lung are blocked, which contributes to less air intake during inhalation, resulting in increased breathing.

Advanced forms of pleurisy can lead to the development of health and life-threatening complications - pleural adhesions, local circulatory disorders due to compression of blood vessels by exudate, bronchopleural fistulas.

The main complications of pleurisy:

  • Purulent melting of the pleura (empyema);
  • Adhesions of the pleural cavity are a consequence of exudative pleurisy;
  • Thickening of leaves, fibrosis;
  • Decreased respiratory excursion of the lungs;
  • Respiratory, cardiovascular failure.

The prognosis for such complications is very serious: mortality reaches 50%. The percentage of dying patients is even higher among elderly and frail people and young children.

Diagnostics

If symptoms are detected, you should immediately consult a doctor: if there is no temperature, contact your local general practitioner; in case of unstable health or associated infectious disease - go to the emergency department

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

After the patient has been diagnosed, fluid is collected from the pleura to determine what fluid is accumulating in it. Most often it is exudate or pus, in rare cases it is blood. It is noteworthy that the purulent form of the disease is more common in children.

The following examinations are used to diagnose pleurisy:

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

Treatment of pulmonary pleurisy

If you have been diagnosed with “pulmonary pleurisy,” your doctor will explain what it is and how to treat the disease. If pleurisy is suspected, the symptoms and all previous treatments are analyzed and the patient is hospitalized.

Depending on the type of disease, certain medications are prescribed that help eliminate inflammation and reduce symptoms. But it is necessary not only to take pills: you will need proper nutrition and exercise to restore the organs completely.

Drug treatment depends on the cause of pleurisy, namely:

  • If the disease is caused by pneumonia or acute bronchitis, then it must be treated with antibiotics;
  • Tuberculosis requires a special regime.
  • For the pain of pleurisy, medications containing acetaminophen or anti-inflammatory drugs such as ibuprofen are used.

The type of drug depends on the cause of the disease. If it is infectious in nature, antibiotics are used, if it is allergic, anti-allergenic drugs are used.

In the early stage of fibrinous pleurisy of the lungs, semi-alcoholic warming compresses and electrophoresis with calcium chloride are recommended.

When treating exudative pleurisy of the lungs, physiotherapy is carried out in the resolution phase (resorption of exudate) in order to accelerate the disappearance of exudate and reduce pleural adhesions.

In cases of exacerbation of dry pleurisy, patients are prescribed warming of the chest with infrared rays, ultraviolet irradiation of the chest, and daily paraffin applications. After acute inflammation subsides, calcium and iodine electrophoresis is performed. A month after recovery, water procedures, exercise therapy, manual and vibration massage are indicated.

Patients need to eat a balanced diet and drink plenty of fluids. The patient is also prescribed a special diet, which is based on a lot of vitamins and proteins.

After discharge from the hospital, patients must perform breathing exercises prescribed by the doctor to restore full lung function. Moderate physical activity, long walks in the fresh air are recommended, and yoga is very useful. Being in a coniferous forest is especially useful for those recovering.

How to treat pleurisy with folk remedies

It is important to understand that it is impossible to treat pleurisy with folk remedies alone, since the disease can quickly progress and lead to respiratory failure and suppuration of the effusion.

Treatment of pulmonary pleurisy with folk remedies involves the use of compresses and the use of infusions, decoctions, and tinctures.

  1. Beetroot juice helps with pleurisy. It is squeezed from fresh root vegetables and mixed with honey. For 100 g of juice, 2 tablespoons of honey are required. Take the product 2 times a day after meals. Each time you need to prepare a fresh portion, the composition does not need to be stored.
  2. Try to treat pleurisy with an infusion of herbs such as: mint, cudweed, coltsfoot, take a glass three times a day.
  3. Boil the roots (0.5 tsp) and rhizomes (0.5 tsp) of the Caucasian hellebore in 0.5 liters of water so that after evaporation you get a glass of liquid. Take 0.5 tsp. three times a day. The decoction is useful for the treatment of pleurisy, pneumonia, tuberculosis, and heart failure.
  4. Mix honey and onion juice in equal portions (you can take black radish juice instead of onions) - one tablespoon twice a day to treat pleurisy.
  5. Infusion of plantain leaf or common plantain. For half a liter of boiling water add 2 tbsp. l. dried plant. The liquid is filtered and drunk warmly 4 times a day. The drink is harmless, has a healing and antibacterial character.

Prevention

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

Remember that pleurisy is a consequence of another disease. Never stop treatment halfway due to laziness or lack of time, and always try to avoid situations that could provoke an infection.

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Pleurisy

Pleurisy is an etiologically different inflammatory lesion of the serous membrane surrounding the lungs. Pleurisy is accompanied by chest pain, shortness of breath, cough, weakness, fever, and auscultatory phenomena (pleural friction noise, decreased breathing). Diagnosis of pleurisy is carried out using radiography (scopy) of the chest, ultrasound of the pleural cavity, pleural puncture, and diagnostic thoracoscopy. Treatment may include conservative therapy (antibiotics, NSAIDs, exercise therapy, physiotherapy), a series of therapeutic punctures or drainage of the pleural cavity, surgical tactics (pleurodesis, pleurectomy).

Pleurisy

Pleurisy is inflammation of the visceral (pulmonary) and parietal (parietal) layers of the pleura. Pleurisy can be accompanied by the accumulation of effusion in the pleural cavity (exudative pleurisy) or occur with the formation of fibrinous deposits on the surface of the inflamed pleural layers (fibrinous or dry pleurisy). The diagnosis of “pleurisy” is made in 5-10% of all patients undergoing treatment in therapeutic hospitals. Pleurisy can aggravate the course of various diseases in pulmonology, phthisiology, cardiology, rheumatology, and oncology. Statistically, pleurisy is diagnosed more often in middle-aged and elderly men.

Causes and mechanism of development of pleurisy

Often, pleurisy is not an independent pathology, but accompanies a number of diseases of the lungs and other organs. Based on the causes of occurrence, pleurisy is divided into infectious and non-infectious (aseptic).

The causes of pleurisy of infectious etiology are:

Pleurisy of non-infectious etiology causes:

The mechanism of development of pleurisy of various etiologies has its own specifics. The causative agents of infectious pleurisy directly affect the pleural cavity, penetrating into it in various ways. Contact, lymphogenous or hematogenous routes of penetration are possible from subpleurally located sources of infection (abscess, pneumonia, bronchiectasis, festering cyst, tuberculosis). Direct entry of microorganisms into the pleural cavity occurs when the integrity of the chest is violated (in case of wounds, injuries, surgical interventions).

Pleurisy can develop as a result of increased permeability of lymphatic and blood vessels during systemic vasculitis, tumor processes, acute pancreatitis; violations of lymph outflow; reducing general and local reactivity of the body.

A small amount of exudate can be reabsorbed by the pleura, leaving a fibrin layer on its surface. This is how dry (fibrinous) pleurisy forms. If the formation and accumulation of effusion in the pleural cavity exceeds the speed and possibility of its outflow, then exudative pleurisy develops.

The acute phase of pleurisy is characterized by inflammatory edema and cellular infiltration of the pleura, accumulation of exudate in the pleural cavity. When the liquid part of the exudate is absorbed, moorings can form on the surface of the pleura - fibrinous pleural deposits, leading to partial or complete pleurosclerosis (obliteration of the pleural cavity).

Classification of pleurisy

The classification of pleurisy proposed in 1984 by St. Petersburg State Medical University professor N.V. is most often used in clinical practice. Putov.

  • infectious (by infectious agent - pneumococcal, staphylococcal, tuberculous and other pleurisy)
  • non-infectious (indicating a disease leading to the development of pleurisy - lung cancer, rheumatism, etc.)
  • idiopathic (of unclear etiology)

According to the presence and nature of the exudate:

  • exudative (pleurisy with serous, serous-fibrinous, purulent, putrefactive, hemorrhagic, cholesterol, eosinophilic, chylous, mixed effusion)
  • fibrinous (dry)

According to the course of inflammation:

According to the location of the effusion:

  • diffuse
  • encysted or limited (parietal, apical, diaphragmatic, costodiaphragmatic, interlobar, paramediastinal).

Symptoms of pleurisy

  • Dry pleurisy

As a rule, being a secondary process, complication or syndrome of other diseases, the symptoms of pleurisy can prevail, masking the underlying pathology. The clinical picture of dry pleurisy is characterized by stabbing pain in the chest, aggravated by coughing, breathing and movement. The patient is forced to take a position, lying on the painful side, to limit the mobility of the chest. Breathing is shallow, gentle, the affected half of the chest noticeably lags behind during respiratory movements. A characteristic symptom of dry pleurisy is a pleural friction noise heard during auscultation, weakened breathing in the area of ​​fibrinous pleural overlays. Body temperature sometimes rises to subfebrile levels, and pleurisy may be accompanied by chills, night sweats, and weakness.

Diaphragmatic dry pleurisy has a specific clinical picture: pain in the hypochondrium, chest and abdominal cavity, flatulence, hiccups, tension in the abdominal muscles.

The development of fibrinous pleurisy depends on the underlying disease. In a number of patients, manifestations of dry pleurisy disappear after 2-3 weeks, however, relapses are possible. In tuberculosis, the course of pleurisy is long, often accompanied by exudation of exudate into the pleural cavity.

The onset of pleural exudation is accompanied by a dull pain in the affected side, a reflexively occurring painful dry cough, a lag in breathing of the corresponding half of the chest, and a pleural friction noise. As the exudate accumulates, the pain is replaced by a feeling of heaviness in the side, increasing shortness of breath, moderate cyanosis, and smoothing of the intercostal spaces. Exudative pleurisy is characterized by general symptoms: weakness, febrile body temperature (with pleural empyema - with chills), loss of appetite, sweating. With encysted paramediastinal pleurisy, dysphagia, hoarseness, swelling of the face and neck are observed. With serous pleurisy caused by a bronchogenic form of cancer, hemoptysis is often observed. Pleurisy caused by systemic lupus erythematosus is often combined with pericarditis, kidney and joint damage. Metastatic pleurisy is characterized by a slow accumulation of exudate and is asymptomatic.

A large amount of exudate leads to a displacement of the mediastinum in the opposite direction, disturbances in the external respiration and cardiovascular system (a significant decrease in the depth of breathing, its increase in frequency, the development of compensatory tachycardia, a decrease in blood pressure).

Complications of pleurisy

The outcome of pleurisy largely depends on its etiology. In cases of persistent pleurisy, the development of adhesions in the pleural cavity, fusion of interlobar fissures and pleural cavities, the formation of massive moorings, thickening of the pleural layers, the development of pleurosclerosis and respiratory failure, and limited mobility of the dome of the diaphragm cannot be ruled out in the future.

Diagnosis of pleurisy

Along with the clinical manifestations of exudative pleurisy, when examining the patient, asymmetry of the chest, bulging of the intercostal spaces on the corresponding half of the chest, and lag of the affected side when breathing are revealed. The percussion sound over the exudate is dull, bronchophony and vocal tremor are weakened, breathing is weak or cannot be heard. The upper limit of the effusion is determined by percussion, chest x-ray or ultrasound of the pleural cavity.

When performing a pleural puncture, a fluid is obtained, the nature and volume of which depends on the cause of pleurisy. Cytological and bacteriological examination of pleural exudate makes it possible to clarify the etiology of pleurisy. Pleural effusion is characterized by a higher relative density, a variety of cellular elements, and a positive Rivolt reaction.

In the blood, an increase in ESR, neutrophilic leukocytosis, an increase in the values ​​of seromucoids, sialic acids, and fibrin are detected. To clarify the cause of pleurisy, thoracoscopy with pleural biopsy is performed.

Treatment of pleurisy

Therapeutic measures for pleurisy are aimed at eliminating the etiological factor and alleviating symptoms. For pleurisy caused by pneumonia, antibiotic therapy is prescribed. Rheumatic pleurisy is treated with nonsteroidal anti-inflammatory drugs and glucocorticosteroids. For tuberculous pleurisy, treatment is carried out by a phthisiatrician and consists of specific therapy with rifampicin, isoniazid and streptomycin for several months.

For symptomatic purposes, the prescription of analgesics, diuretics, and cardiovascular drugs is indicated; after resorption of the effusion, physiotherapy and physical therapy are indicated.

In case of exudative pleurisy with a large amount of effusion, they resort to its evacuation by performing pleural puncture (thoracentesis) or drainage. It is recommended to evacuate no more than 1-1.5 liters of exudate at a time in order to avoid cardiovascular complications (due to a sharp straightening of the lung and reverse displacement of the mediastinum). For purulent pleurisy, the pleural cavity is washed with antiseptic solutions. According to indications, antibiotics, enzymes, hydrocortisone, etc. are administered intrapleurally.

In the treatment of dry pleurisy, in addition to etiological treatment, patients are advised to rest. To relieve pain, mustard plasters, cupping, warm compresses and tight bandaging of the chest are prescribed. To suppress cough, codeine and ethylmorphine hydrochloride are prescribed. Anti-inflammatory drugs are effective in the treatment of dry pleurisy: acetylsalicylic acid, ibuprofen, etc. After normalization of health and blood counts, a patient with dry pleurisy is prescribed breathing exercises to prevent adhesions in the pleural cavity.

In order to treat recurrent exudative pleurisy, pleurodesis is performed (injection of talc or chemotherapy into the pleural cavity to glue the layers of the pleura). To treat chronic purulent pleurisy, they resort to surgical intervention - pleurectomy with decortication of the lung. If pleurisy develops as a result of inoperable damage to the pleura or lung by a malignant tumor, palliative pleurectomy is performed according to indications.

Forecast and prevention of pleurisy

A small amount of exudate can resolve on its own. The cessation of exudation after elimination of the underlying disease occurs within 2-4 weeks. After evacuation of the fluid (in the case of infectious pleurisy, including tuberculous etiology), a persistent course with repeated accumulation of effusion in the pleural cavity is possible. Pleurisy caused by oncological causes has a progressive course and an unfavorable outcome. Purulent pleurisy has an unfavorable course.

Patients who have suffered pleurisy are under clinical observation for 2-3 years. It is recommended to exclude occupational hazards, fortify and high-calorie nutrition, and exclude colds and hypothermia.

In the prevention of pleurisy, the leading role belongs to the prevention and treatment of the main diseases leading to their development: acute pneumonia, tuberculosis, rheumatism, as well as increasing the body's resistance to various infections.

Pleurisy - treatment in Moscow

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