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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.

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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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Pleurisy: symptoms and treatment

Pleurisy - main symptoms:

  • Headache
  • Weakness
  • Fever
  • Dyspnea
  • Chest pain
  • Cough
  • Swelling of the face
  • Fluid in the lungs
  • Muscle pain
  • Fever
  • Rapid breathing
  • Heaviness in the side
  • Feeling of heaviness in the chest area
  • Wheezing in the chest
  • Enlarged veins in the neck
  • Shallow breathing
  • Inability to breathe deeply
  • Bluishness of facial skin
  • Aches in the joints
  • Bulge on the sore side of the chest
  • Cutting in the side

Pleurisy is a general name for diseases in which inflammation of the serous membrane around the lungs - the pleura - occurs. The disease usually develops against the background of pre-existing diseases and may be accompanied by the formation of effusion on the surface of the membrane (exudative pleurisy) or fibrin (dry pleurisy). This problem is considered one of the most common pulmonary pathologies (300–320 cases per 100 thousand population), and the prognosis for treatment depends entirely on the severity of the primary disease and the stage of inflammation.

Description of the disease

What is pleura? This is a two-layer serous membrane around the lungs, consisting of two so-called layers - the internal visceral and external parietal. The visceral pleura directly covers the lung, its vessels, nerves and bronchi and separates the organs from each other. The parietal membrane covers the inner walls of the chest cavity and is responsible for ensuring that no friction occurs between the layers of the lung when breathing.

In a healthy state, between the two pleural layers there is a small space filled with serous fluid - no more than 25 ml. The fluid appears as a result of filtration of blood plasma through vessels in the upper pulmonary part. Under the influence of any infections, serious illnesses or injuries, it rapidly accumulates in the pleural cavity, and as a result, pulmonary pleurisy develops.

If the vessels are functioning normally, excess fluid is absorbed back, and fibrin protein settles on the pleura. In this case, they talk about dry or fibrinous pleurisy. If the vessels do not cope with their function, effusion (blood, lymph, pus) forms in the cavity - the so-called effusion, or exudative pleurisy. Often in a person, dry pleurisy subsequently turns into effusion.

Secondary pleurisy is diagnosed in 5–10% of patients in therapeutic departments. It is believed that both men and women are equally susceptible to this pathology, but statistics more often indicate damage to the pleura in adults and elderly men.

Causes

Pleurisy very rarely occurs as an independent disease; it is usually recorded against the background of other pathologies of an infectious and non-infectious nature. In accordance with this, all types of the disease (both fibrinous pleurisy and effusion) are divided into 2 large groups based on the reasons for their appearance.

Infectious causes

Infectious lesions of the pleura most often cause inflammation and the formation of purulent exudate between the pleural layers. The pathogen enters in several ways: as a result of direct contact with the source of infection (usually in the lung), through lymph or blood, and also due to direct contact with the environment (trauma, penetrating wounds, unsuccessful operations).

The causes of infectious diseases of the pleura are:

  • Tuberculosis bacillus (tuberculous pleurisy is diagnosed in 20% of patients);
  • Bacteria (staphylococci, pneumococci, etc.);
  • Protozoa and parasites (amoebas, echinococci);
  • Fungal infections (candidiasis, blastomycosis);
  • Syphilis, brucellosis, typhus, etc.;
  • Infections after trauma and penetrating wounds.

Non-infectious causes

Non-infectious pleurisy can occur due to systemic diseases, chronic pathologies, tumors, etc. The most popular causes of such ailments are:

  • Malignant formations in the pleura or metastases from other organs;
  • Connective tissue pathologies (rheumatoid arthritis, systemic lupus erythematosus, vasculitis, etc.);
  • Myocardial infarction and pulmonary embolism (pulmonary infarction);
  • Chronic renal failure;
  • Other diseases (pancreatitis, leukemia, hemorrhagic diathesis, etc.).

When a tumor forms, the pleura is damaged and the formation of effusion increases. As a result, effusion pleurisy begins to develop.

After a pulmonary embolism, inflammation spreads to the pleural membrane; with myocardial infarction, the disease develops against a background of weakened immunity. In systemic pathologies (vasculitis, lupus), pleurisy develops due to vascular damage; renal failure causes exposure of the serous membrane to uremic toxins.

Varieties

Modern medicine knows of pleurisy of various types and forms, and there are several classifications of this pathology. But in Russian practice, the classification scheme of Professor N.V. Putov is traditionally used. In accordance with it, the following types of pleural pathologies are distinguished.

  • Infectious (staphylococcal, tuberculous pleurisy, etc.);
  • Non-infectious (indicating the disease that became the cause);
  • Unclear etiology (idiopathic).

According to the presence of effusion and its nature:

  • Exudative pleurisy (with serous exudate, serous-fibrinous, cholesterol, putrefactive, etc., as well as purulent pleurisy);
  • Dry pleurisy (including adhesive pleurisy, in which adhesions are fixed between the pleural layers).

According to the course of inflammation:

According to the location of the effusion (degree of pleural damage):

  • Diffuse (total inflammation);
  • Enclosed pleurisy, or delimited (diaphragmatic, parietal, interlobar, etc.).

The types of disease are also distinguished according to the scale of distribution: unilateral (left- and right-sided) or bilateral inflammation of the pleural membrane.

Symptoms

Traditionally, inflammation of the serous membrane in adults and children begins with the development of fibrinous pleurisy.

Typically, this form of the disease lasts 7–20 days, and then, if recovery does not occur, it develops into effusion or chronic. Advanced forms of pleural inflammation can also cause dangerous consequences - a sharp decrease in immunity, pleural adhesions, empyema (large accumulation of pus), kidney damage and even death. One of the most dangerous forms, which most often provokes complications, is encysted effusion pleurisy, a transitional stage between acute and chronic inflammation.

Symptoms of dry (fibrinous) inflammation

With dry pleurisy, the disease begins acutely and suddenly. The first symptoms of pleurisy are:

  • Sharp pain in the chest (on the side where inflammation develops);
  • When coughing, sneezing and bending the body, pain increases;
  • When you inhale forcefully, a dry cough may begin;
  • The temperature with fibrinous pleurisy is normal, if it increases, it is not higher than 38–38.5ºС;
  • Weakness, malaise, and headaches appear.
  • The patient suffers from aching joints and intermittent muscle pain.

One of the main diagnostic symptoms of fibrinous pleurisy is auscultatory (noise) signs. When listening, the noise of friction of the pleural layers against each other (due to fibrinous deposits) or wheezing is noticeable.

Dry pleurisy of different types has its own specific manifestations. Most often, the parietal form of inflammation is diagnosed; the main symptoms are chest pain, which always worsens when coughing and sneezing.

With diaphragmatic inflammation, pain can radiate to the shoulder, the anterior part of the peritoneum; there is discomfort when swallowing and hiccups. Apical dry pleurisy can be recognized by pain in the shoulders and shoulder blades, as well as in the arm, along the nerve endings. Dry pleurisy in this form usually develops with tuberculosis and can subsequently develop into encysted pleurisy.

Symptoms of effusion (exudative) inflammation

In contrast to the dry form of the disease, the symptoms of effusion inflammation of the pleura are almost the same for different types and locations of effusion fluid. Typically, exudative pleurisy begins with the fibrinous stage, but soon pain and discomfort in the chest are smoothed out due to the fact that the visceral and parietal layers are separated by fluid and no longer touch.

Sometimes this form of the disease develops without the traditional dry stage. In such a situation, the patient does not feel any discomfort in the chest for several days, and only then do characteristic signs appear: fever, weakness, heaviness in the chest, shortness of breath, etc.

The main external manifestations of exudative pleurisy are:

  • Fever (temperature reaches 39–40ºС);
  • Shortness of breath, frequent and shallow breathing;
  • The face and neck swell, turn blue, and the veins in the neck swell;
  • The chest at the site of the lesion increases, the intercostal spaces may bulge or become smooth;
  • The lower fold of skin on the sore side of the chest swells noticeably;
  • Patients lie on their healthy side, avoiding unnecessary movements;
  • In some cases - hemoptysis.

Symptoms of purulent inflammation

Purulent pleurisy is quite rare, but is one of the most severe forms of this disease, which entails serious consequences. Half of all complications of such inflammation end in death. This disease is especially dangerous for young children in the first year of life and elderly patients. The purulent variety usually develops against the background of pneumonia or lung abscess.

The symptoms of this pathology vary depending on age: in young patients the disease can be disguised as umbilical sepsis, staphylococcal pneumonia, etc. In older children, the signs of purulent inflammation of the pleura are the same as in adults.

Purulent pleurisy can be recognized by the following signs:

  • Stitching pain in the chest, which subsides as the pleural cavity fills with pus;
  • Heaviness and pain in the side;
  • Shortness of breath and inability to breathe deeply;
  • The cough is dry and infrequent at first, then intensifies, purulent sputum appears;
  • The temperature jumps to 39–40ºС, pulse – 120–130 beats per minute.

If the disease develops due to a pulmonary abscess, then the breakthrough of the abscess begins with a protracted, painful cough, which ends with a sharp and severe pain attack in the side. Due to intoxication, the skin turns pale, becomes covered in cold sweat, blood pressure drops, and the patient cannot breathe fully. Shortness of breath increases.

Symptoms of tuberculosis inflammation

Tuberculous pleurisy is the most common pathology among all exudative forms. With respiratory tuberculosis, pleural inflammation is more often diagnosed in children and young people.

In clinical practice, there are three main forms of tuberculous pleurisy:

  • Allergic tuberculous pleurisy;
  • Perifocal inflammation of the pleura;
  • Pleural tuberculosis.

The allergic stage begins with a sharp increase in temperature to 38ºC and above, tachycardia, shortness of breath, and pain in the side are observed. As soon as the pleural cavity fills with effusion, these symptoms disappear.

Perifocal tuberculous pleurisy usually occurs against the background of pre-existing pulmonary tuberculosis and lasts a long time, with periods of remission and exacerbation. Symptoms of the dry form of tuberculous pleurisy are smoothed out: chest pain, noise from pleural friction. With the effusion form, more distinct signs appear - fever, sweating, tachycardia.

With pulmonary tuberculosis, the classic clinical picture of effusion of the pleura develops: shortness of breath, pressing pain in the chest and side, wheezing, fever, bulge on the affected side of the chest, etc.

Diagnostics

In order to make the correct diagnosis and select the appropriate treatment for pleurisy, it is important to determine the cause of inflammation and the formation of exudate (in effusion forms).

Diagnosis of this pathology includes the following methods:

  • Conversation with the patient and external examination;
  • Clinical examination (listening for chest sounds, palpation and percussion - tapping the area of ​​pleural effusion);
  • X-rays of light;
  • Analysis of blood and pleural exudate (puncture);
  • Microbiological examination of pleural effusion.

The most effective method for diagnosing pleural pathology today is x-ray. An x-ray allows you to identify signs of inflammation, the volume and location of exudate, as well as some causes of the disease - tuberculosis, pneumonia, tumors, etc.

Treatment

When diagnosing pleurisy, treatment pursues two important goals - to eliminate the symptoms and eliminate the cause of the inflammation. How to treat pleurisy, in a hospital or at home? Dry forms of the disease in adults can be treated on an outpatient basis, while exudative forms require mandatory hospitalization. Tuberculous pleurisy is treated in tuberculosis dispensaries, purulent - in surgical departments.

Pleurisy is treated with medications depending on the type:

  • Antibiotics (for infectious forms);
  • Non-steroidal anti-inflammatory drugs and painkillers;
  • Glucocorticosteroids and immunostimulants;
  • Diuretics and antitussives;
  • Cardiovascular drugs.

Complex treatment of pleurisy also includes physiotherapeutic procedures, taking multivitamins, and a gentle diet. Surgical removal of exudate from the pleural cavity is indicated in the following cases: when there is too much fluid and the effusion reaches the second rib or the fluid begins to compress neighboring organs, and also when there is a threat of developing purulent empyema.

After successful recovery, patients who have suffered pleurisy are monitored at the dispensary for another 2–3 years.

Prevention

Prevention of pleurisy is the prevention and timely diagnosis of diseases that can provoke the development of inflammation of the pleural layers.

To do this, you need to follow simple recommendations:

  • Strengthen the immune system: exercise regularly, take multivitamins, eat right;
  • Train the respiratory system: simple breathing exercises along with morning exercises will help avoid inflammation of the respiratory system;
  • Avoid complications of seasonal ARVI;
  • At the slightest suspicion of pneumonia, you need to take an x-ray and begin full-fledged complex therapy;
  • Stop smoking: nicotine often causes tuberculosis and tuberculous lesions of the pleura.

Strengthening the immune system, paying attention to your health and timely consultation with a doctor will help not only protect yourself from inflammation of the pleura, but also prevent such dangerous consequences as pleural adhesions, empyema, pleurosclerosis and overgrowth of the pleural cavity.

If you think that you have pleurisy and the symptoms characteristic of this disease, then doctors can help you: a pulmonologist, a therapist.

We also suggest using our online disease diagnostic service, which selects probable diseases based on the entered symptoms.

Pneumonia is an infectious inflammation of the lungs that affects the alveoli or other lung tissue. Pneumonia can occur from various pathogens - bacteria, viruses, fungi. Therefore, there are a large number of types of pneumonia, each of which has its own symptoms and characteristics. A certain amount of certain bacteria is always present in the lungs of a healthy person. And in most cases, the immune system fights them well. But when the body is weakened and cannot cope with them, pneumonia actively develops.

A disease that is characterized by the formation of pulmonary insufficiency, presented in the form of a massive release of transudate from the capillaries into the pulmonary cavity and ultimately promoting infiltration of the alveoli, is called pulmonary edema. In simple terms, pulmonary edema is a condition where fluid stagnates in the lungs and has leaked through the blood vessels. The disease is characterized as an independent symptom and can develop on the basis of other serious ailments of the body.

Left-sided pneumonia is the rarest form of development of an infectious process in the lungs of the two existing varieties. Despite this, the disease poses a great threat to the patient's life. The main cause of the development of the disease is the pathological influence of pathogenic microorganisms, which penetrate into the left lung extremely rarely and often with a severe weakening of the immune system. In addition, doctors identify a large number of predisposing factors.

Lymphadenopathy is a condition in which the lymph nodes become enlarged. Such pathological changes indicate a serious disease that is progressing in the body (often of an oncological nature). To make an accurate diagnosis, several laboratory and instrumental tests are required. Lymphadenopathy can form in any part of the body and even affects internal organs.

Tracheitis and bronchitis are often interrelated, combining into one pathological condition - tracheobronchitis. This is a disease, as a result of which the inflammatory process covers the trachea and bronchi. According to ICD-10, the disease is coded J06-J21. It can only be fully cured in a hospital setting. Self-medication using folk remedies (without a doctor’s prescription) is unacceptable.

With the help of exercise and abstinence, most people can do without medicine.

Symptoms and treatment of human diseases

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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

To prevent this serious and dangerous disease, you should strengthen the body's defenses, lead a healthy lifestyle, eat right, and also take vitamins that help maintain health.

So, the following decoction helps well with pleurisy. To prepare it, take one tablespoon each of licorice root, knotweed herb and marsh grass, three-leaf and coltsfoot leaves, two tablespoons each of elecampane root and St. John's wort herb. Grind this herbal mixture and take 2 tablespoons of it. Fill them with half a liter of hot boiled water and pour this mixture into a thermos, where the broth will infuse all night. You need to take this decoction 3-4 times a day.

Another effective recipe for treating pleurisy will require equal parts of geranium herb, juniper (pine needles or berries), adonis herb, oregano, and corn silk. Grind this mixture in a meat grinder and take two tablespoons of it. The principle of preparation and method of administration are as in the previous recipe.

In addition to herbs, breathing exercises, foods rich in proteins and fats, as well as vitamins also help with pleurisy.

The patient breathes heavily, body temperature is always elevated. But it can be either medium-high or very high. In this case, it is easier for the patient to lie on the side that is susceptible to the disease.

— Antibacterial treatment for diseases of an infectious and allergic nature, and targeted chemotherapy for pleurisy of other origins, antibiotic and chemotherapeutic agents are administered intramuscularly or intravenously, if necessary, inside the lung.

— Cleansing of the pleural cavity is carried out by removing the effusion, and, if necessary, by rinsing with antimicrobial drugs. Indications for the need for immediate evacuation are displacement of the heart and important vessels to the healthy side with cardiac dysfunction, acute vascular insufficiency of the lung (severe shortness of breath, bluish skin color, fast weak pulse, low blood pressure).

- The use of allergic agents and anti-inflammatory drugs (salicylic acid derivatives, amidopyrine, etc.). For tuberculous and rheumatic lesions of the pleura, the use of prednisolone in a daily dosage of mg is effective.

- The use of therapeutic methods that are aimed at strengthening the protective and immunobiological functions of the body: bed rest in the acute phase, a special diet, food rich in vitamins, with the required amount of proteins (1.5-2 g per kilogram of weight), limiting fluid and salt , intravenous injections with ascorbic acid, B vitamins, plasma droppers, oxygen therapy, and when the disease subsides, physical methods of therapy are used.

— Treatment aimed at eliminating the symptoms of the disease (compresses, mustard plasters, antitussives, etc.).

This form of pleurisy threatens the patient with the development of such serious diseases as empyema, bronchial fistula .

Symptoms of dry disease include chest pain that gets worse when you inhale. If the body is tilted back, that is, in the opposite direction, the pain becomes even stronger and subsides if the patient lies on his side. The pain may radiate to the neck and muscles of the upper body. With this type of disease, frequent breathing is observed.

With metapneumatic purulent pleurisy, the patient also experiences pain in the chest area and shortness of breath. To make an accurate diagnosis and clarify the type of disease, it is necessary to do an X-ray examination of the lungs.

Antibiotic-resistant staphylococcus is of great importance. Recently, the importance of gram-negative bacteria, pneumococcus, and bacterial associations has increased.

Development of the disease. The cause of the development of the disease is the entry into the pleural cavity of pus from large or small lung abscesses located under the pleura.

There are several types of pyopneumothorax:

- delimited form (can be single-chamber or multi-chamber).

In the case of a severe form of the disease, the perforation hole increases with inhalation and decreases with exhalation. The function of the valve is performed by a protein formed during blood clotting, or by the edematous mucous membrane of the bronchus.

The main symptoms of pyopneumothorax are the syndrome of poisoning of the body with toxins, manifestations of acute respiratory injury and cardiovascular failure, which occurs due to compression of the mediastinum. Overheating develops, the person loses consciousness, convulsions occur, there is a paroxysmal cough, pale or bluish color of the skin, faster breathing than before, and an attack of suffocation is possible. Abdominal syndrome occurs - the abdomen swells sharply, vomiting, constipation or diarrhea appear, signs of paretic intestinal obstruction.

The causative agent of the disease enters the body by contact from subpleurally localized pneumonic foci of the lungs, purulent inflammation. When the pathogen enters hematogenously from different foci of infection (with osteomyelitis, inflammation of the middle ear, umbilical phlegmon, purulent appendicitis, inflammation of the abdominal cavity), a rarely observed primary purulent pleurisy is caused.

This disease is characterized by the formation of large fibrinous deposits on the pleura, covered with pus, reaching a fairly significant thickness. On the surface of the pleura, areas of small hemorrhages, sharp overflow of blood vessels, desquamation of cells from the surface of the endothelium, and abundant penetration of poly- and mononuclear cells into the tissue are noted.

The course of the disease depends on age. In infants during the first three months of life, the disease develops gradually and is hidden by general symptoms characteristic of umbilical sepsis, pneumonia caused by staphylococci. The chest on the affected side becomes convex. There is drooping of the shoulder and poor mobility of the arm.

Typical symptoms of total purulent pleurisy are observed in older children. There is a dry cough with sputum, in some cases with pus - when the pleural abscess breaks into the bronchi.

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