Dry pleurisy

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Dry pleurisy: symptoms and treatment

Dry pleurisy is common among pulmonary diseases. During this disease, the serous membrane of the lungs becomes inflamed, and fibrinous plaque appears on the surface of the pleura.

Table of contents:

To understand the essence of the disease, you need to know that the serous membrane is the outer covering of the lung and is a visceral pleural layer. The same membrane covers the inner space of the chest walls, where the lungs are. This covering is called the parietal pleural layer.

Between the lungs and the walls a space is formed in the form of a closed gap, called the pleural cavity. Inside the cavity there is a liquid of several milliliters to ensure the sliding movements of the lungs during breathing. When plaque forms on the pleura as a result of the disease, normal gliding is disrupted and breathing becomes difficult.

Causes of development of dry pleurisy

Rarely, dry pleurisy manifests itself as an independent disease. This pathology is directly related to infectious diseases of the respiratory organs. As a result, the pleura becomes infected, posing a danger to the health and life of the patient. Therapists, pulmonologists, radiologists and microbiologists are involved in the diagnosis and treatment of pleurisy. Thoracic surgeons are often involved in treatment. When prescribing therapeutic measures, the type of microorganism, the effect of antimicrobial drugs on it, the patient’s health condition and the stage of the disease are taken into account.

Dry pleurisy can be caused by non-infectious factors:

  • Chronic alcoholism affects internal organs. The liver suffers, and the body’s protective potential decreases. Such people are more likely to get infections. Inappropriate behavior leads to chest injuries and hypothermia, which increases the risk of illness.
  • Diabetes mellitus also negatively affects systems and organs. The immune system becomes weak, and excess glucose in the blood allows bacteria and microorganisms to actively develop.
  • Chronic pulmonary diseases contribute to damage to the pleura. First of all, these are asthma, bronchitis, COPD, emphysema and a number of other pathologies. More often than not, they are the prerequisites for pleurisy. These diseases are accompanied by sluggish infectious and inflammatory processes that gradually progress and cover new areas of the lungs and tissues.

There are known cases of pneumonia, during which pleural effusion is not associated with direct infection of the pleura. The cause is a developing reactive inflammatory process that has an irritating effect on the pleural layers.

Etiology and pathogenesis

The etiology of the disease is related to the reasons for its occurrence. Therefore, all types of pleurisy are conditionally divided into two groups. In the first case, infectious factors affecting the pleura with the help of bacteria and other harmful microorganisms are of decisive importance. These include pathogens that cause acute pneumonia and acute suppuration of the lungs. These diseases are often complicated by infection of the pleura. Pleurisy often occurs under the influence of tuberculosis microbacteria.

In addition to tuberculosis, sometimes pleurisy has a fungal etiology when fungi are affected. In other cases, pleural lesions are not associated with infection and are aseptic in nature. Pathogenic microorganisms do not directly participate in inflammatory processes. The nature of aseptic pleurisy is varied. Inflammation can occur due to injury or during surgery. During acute pancreatitis, invasive pancreatic enzymes penetrate into the pleural cavity. Often the cause of the disease is primary or secondary malignant tumors spreading throughout the pleura.

The pathogenesis of dry pleurisy has the following scheme. The penetration of viruses, bacteria and tuberculosis microbacteria into the pleural cavity occurs from inflamed lungs, organs and tissues located in close proximity. In addition, the infection penetrates through the blood and lymphatic vessels. Allergic pleurisy develops as a result of sensitization of the pleura by allergens and toxins coming from foci of inflammation.

During inflammation, blood and lymph flow in the pleura stops. Because of this, fibrinous fibers accumulate on the surface, preventing the removal of exudate from the vessels. The parietal pleura gradually absorbs exudate containing fibrin. A large amount of fibrin contributes to the formation of thick films in the pleural cavity. They form connective tissues with different consistencies. These formations make it difficult for the lungs to move when breathing. Sometimes dry pleurisy turns into an exudative form.

Symptoms of dry pleurisy

The development of dry pleurisy occurs together with pneumonia, tuberculosis and other serious respiratory diseases. The onset of the disease is characterized by acute manifestations in the form of tingling and pain in the side. Localization of unpleasant sensations is observed in the axillary region. During inhalation, the pain intensifies. Gradually they are felt when coughing, sneezing and when touching the affected area. Sometimes the pain is felt in the abdomen or shoulder. At the same time, attacks of painful dry cough occur, causing discomfort.

In the initial stage, there is an increase in body temperature, which gradually increases to 39 degrees as the disease progresses. The patient's heart rate increases and profuse sweating occurs. In the initial stage of the disease, it is difficult to determine the presence of dry pleurisy. Subsequently, symptoms manifest themselves in the form of limited mobility, intermittent and shallow breathing. The skin in inflamed areas becomes sensitive. When listening, friction of the pleural layers can be heard.

Timely treatment of dry pleurisy is important. In this case, the prognosis of the disease is favorable; recovery requires 1 - 2 weeks. If the recommendations of the attending physician are not followed, the treatment period increases with the risk of complications.

Treatment of dry pleurisy

Therapeutic measures are primarily aimed at eliminating diseases that provoke dry pleurisy. If typhoid fever, tuberculosis, measles and other infectious diseases are detected, special treatment is prescribed. Direct treatment of pathology includes thermal procedures in the chest area. The patient's condition is alleviated with the help of a pressure bandage, camphor or semi-alcohol compresses, iodine mesh and mustard plasters. To prevent the formation of adhesions that make breathing difficult, special breathing exercises are prescribed.

Pain is relieved with painkillers. To suppress cough, Sinecode, Libexin, Codelac and other antitussives are prescribed. During treatment, it is recommended to adhere to semi-bed rest or bed rest.

Diagnosis and prevention of pleurisy

To collect anamnesis, the attending physician first performs a detailed interview with the patient. The patient's place of work and place of residence is specified in order to exclude cases in these places. Dietary habits, potential contacts with sick people, previous infections and other complaints about malaise and abnormal functions of individual organs are clarified.

After the interview, a direct examination of the patient is carried out using auscultation, palpation and percussion. With dry pleurisy, asymmetrical deviations of the chest during breathing are visually observed. In addition, listening clearly shows the noise produced by the friction of the pleural lobes with each other.

Before definitively diagnosing dry pleurisy, additional laboratory and instrumental studies are performed. For this purpose, general blood and urine tests are carried out, as well as Mantoux tests for tuberculosis and a blood test for the Wasserman reaction. This determines the cause of pleurisy and complements the results of instrumental studies. The final and accurate diagnosis is established using non-invasive methods, including x-rays, ultrasound, electrocardiogram and pulmonary function tests.

The use of invasive methods involves diagnosis using pleural puncture and thoracoscopy. In the first case, the chest is pierced along with the pleura. This procedure is complex, requiring serious preparation, sterile conditions and compliance with certain rules. The puncture is taken between the seventh and eighth ribs. The liquid is slowly withdrawn with a syringe and transferred to a sterile container for further research.

During thoracoscopy, a special telescope is inserted between the fourth and fifth ribs to examine the inside of the chest cavity, the condition of the pleura and lung. At the same time, biological material is selected from all areas with suspected pathology.

Prevention of pleurisy consists of timely prevention and treatment of diseases complicated by inflammation of the pleura. Annual fluorography is required, and at the first symptoms, immediate contact with your doctor.

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Dry pleurisy: symptoms and treatment

Dry pleurisy - main symptoms:

  • Weakness
  • Chills
  • Chest pain
  • Pain when swallowing
  • Shallow breathing
  • Pain when inhaling or exhaling
  • Pain when coughing
  • Increased sweating at night
  • Restricted chest mobility

Dry pleurisy is a pathology characterized by the presence of an inflammatory process in the serous membrane of the lung. As a result, fibrinous edema forms on the surface of the pleural layers. Various other lung diseases can provoke this process, so most often dry pleurisy is a complication. It manifests itself as a rise in temperature and difficulty breathing. Only complex therapy will help eliminate all the symptoms of the disease.

What contributes to the development of the disease?

As noted above, dry pleurisy is a consequence of a certain disease of the lungs or other organs that are located near the pleural cavity.

Diseases of an infectious nature can be classified according to the type of pathogen, and non-infectious diseases - according to the nature of the disease of which they are signs.

The reasons that contribute to the formation of dry pleurisy are the following inflammatory diseases of the lungs of an infectious nature:

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

The last stage of insufficient kidney function is uremia. It is also characterized by inflammation of the lining of the lung. The occurrence of uremic dry pleurisy is facilitated by irritation of the pleural layers, which occurs due to nitrogenous waste. They are secreted through the serous membranes when the kidneys are not functioning properly.

How does the disease manifest itself?

Symptoms of pleurisy can be supplemented by manifestations of the underlying lung disease. They may also be the only signs of illness. As a rule, the patient’s condition is satisfactory, so the symptoms of the disease do not significantly affect the body. Temperature indicators are different, since everything depends on the activity of the main inflammatory process in the lung tissues. When the pleural layers become inflamed, symptoms such as:

  • chills;
  • increased sweating at night;
  • severe weakness;
  • painful sensations.

The patient feels pain behind the sternum while breathing. He has a sharp character. Pain intensifies when coughing, inhaling or changing body position. Breathing is characterized by rapidity. In some cases, to alleviate the condition, the patient takes a lying position on the affected side. This is how he manages to reduce pain, since the respiratory movements of the chest are limited.

Incomplete chest mobility

Similar symptoms occur when breathing. If there is no massive inflammation of the lung tissue, then the percussion sound over the damaged area does not change. Decreased breathing is observed if the patient has taken a comfortable position. There is noise above the inflammatory focus, which occurs due to friction of the pleura. Its timbre is similar to the sound of frosty snow.

Manifestations of diaphragmatic dry pleurisy

The presented pathology develops against the background of fibrinous inflammation of the pleura lining the diaphragm. It is impossible to listen to the friction noise of the affected pleura. The pain syndrome can affect the neck and abdomen. Symptoms of diaphragmatic pleurisy are characterized by abdominal tension. It stimulates acute disease of the abdominal organs. The result of this process is painful hiccups and pain when swallowing.

Patients complain of symptoms such as chest breathing and increased pain in the lower part of the sternum during deep inspiration. If you press on the area between the legs of the sternocleidomastoid muscle, painful sensations occur.

Diagnostic tests

It is impossible to determine dry pleurisy using formal diagnostics. Here it is necessary to find out the root cause of the pathology. Therefore, the patient must visit other specialists.

Auscultatory symptoms of the present disease can be recognized by weakened breathing on the damaged side and pleural friction noise. During palpation, it is possible to detect hardness and soreness of the muscles.

According to the results of fluoroscopy, there is a limitation in the excursion of the diaphragm on the damaged side. To exclude the presence of exudate, an ultrasound of the pleural cavity will be required.

An ECG will help to distinguish dry pleurisy from diseases such as intercostal neuralgia, angina pectoris, and myocardial infarction.

Therapeutic measures

Treatment of the presented pathology should take an integrated approach and actively influence the underlying disease. The patient is required to remain in bed. Treatment is carried out with anti-inflammatory medications and antibiotics. Antitussive medications are taken when there is a dry cough, which increases pain in the chest.

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

Treatment, including the administration of painkillers intramuscularly, will help reduce severe pain. Traditional treatment is also actively used:

  • compresses with a warming effect;
  • installation of medical cups;
  • applying an iodine mesh to the skin of the damaged area.

If there is no focus of the inflammatory process in the lung tissue, then treatment can be carried out at home. Symptomatic treatment involves using the method of immobilization of the affected half of the chest. For these purposes, use tight bandaging. Patients should drink more fluids, eat well, replenishing their body with vitamins and complete proteins. If the patient’s recovery is evident, then treatment can be supplemented with physiotherapy and therapeutic breathing exercises.

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

Preventive actions

If the pathology is treated on time, the prognosis is generally positive. But here it is worth considering the course of the underlying disease. To protect yourself from inflammation of the pleura, it is necessary to promptly treat diseases that are complicated by pleurisy.

If there was an early diagnosis of pneumonia and lung abscess, then the patient is obliged to promptly seek help from a specialist as soon as he has the first manifestations. In no case should you refuse to take an x-ray, since thanks to such diagnostics it is possible to detect inflammatory diseases and cure them in time. To exclude tuberculosis, annual fluorography will be required.

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

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

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

A disease characterized by acute, chronic and recurrent inflammation of the pleura is called tuberculous pleurisy. This disease has the peculiarity of manifesting itself through infection of the body with tuberculosis viruses. Pleurisy often occurs if a person has a tendency to pulmonary tuberculosis.

ARI (acute respiratory disease) is a group of illnesses of viral or bacterial origin, the characteristic feature of which is damage to the upper respiratory tract, symptoms of general intoxication of the body. Respiratory infections affect people of all ages, from young children to the elderly. This group of diseases manifests itself seasonally - more often pathologies occur when the seasons change (in the autumn-winter period). It is important to take timely measures to prevent acute respiratory infections so as not to become infected in the midst of an epidemic.

Histoplasmosis is a disease that develops due to the penetration of a specific fungal infection into the human body. With this pathological process, internal organs are affected. The pathology is dangerous, as it can develop in people of different age categories. Also in the medical literature you can find such names of the disease as Ohio Valley disease, Darling disease, reticuloendotheliosis.

Subcutaneous emphysema is a pathological process that causes air to accumulate in the subcutaneous tissue of the chest wall and then spread throughout the body. Such an air cushion compresses large vessels and arteries, as a result of which various organs are injured and cardiovascular failure develops. It should be noted that such a pathological process is not an independent disease - it is a consequence of damage to the trachea, bronchi, esophagus or lung.

Infectious mononucleosis is an acute infectious disease that is characterized primarily by damage to the lymphatic and reticuloendothelial systems. Infectious mononucleosis, the symptoms of which manifest themselves in the form of fever, polyadenitis and tonsillitis, in addition occurs with an enlargement of the spleen and liver, as well as leukocytosis with a predominance of basophilic mononuclear cells.

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

Symptoms and treatment of human diseases

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Source: http://simptomer.ru/bolezni/organy-dykhaniya/634-sukhoy-plevrit-simptomy

Dry pleurisy: symptoms, treatment, prevention

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

Causes and mechanisms of development

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

Secondary pleurisy develops:

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

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

Pleurisy is divided into 2 large groups:

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

The most common causes of aseptic pleurisy:

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

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

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

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

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

Most often, infectious pleurisy is caused by:

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

The infection can penetrate the pleural cavity in several ways:

  • hematogenous - with blood flow;
  • lymphogenous - with lymph flow;
  • contact - directly from organs affected by infection (including from the hilar lymph nodes - this most often occurs with tuberculosis);
  • direct - during medical procedures (operations, thoracoscopy, pleural puncture, if the rules of septic and antiseptic were violated) and in case of traumatic wounds.
Often, in order for infectious pleurisy to occur, infection on the pleural layers alone is not enough - specific sensitization (hypersensitivity) of the tissue is required. Its role is confirmed by the fact that in some patients infectious pleurisy was not observed even with massive invasion of the infectious agent (for example, with chest wounds with extensive contamination of the pleural layers), while in others it occurred when an insignificant amount of microorganisms entered the pleura. In this case, a separate form of this disease is distinguished - infectious-allergic pleurisy .

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

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

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

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

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

Symptoms of pleurisy

The most typical symptoms of pleurisy are:

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

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

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

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

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

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

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

Depending on how severe the symptoms are, pleurisy is:

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

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

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

Diagnosis of dry pleurisy

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

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

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

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

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

With pleurisy, such effects are not observed.

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

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

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

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

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

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

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

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

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

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

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

Treatment of dry pleurisy

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

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

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

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

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

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

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

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

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

Prevention

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

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

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

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

These measures are carried out after acute manifestations have subsided.

Prognosis for pleurisy

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

Kovtonyuk Oksana Vladimirovna, medical observer, surgeon, consultant doctor

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Dry pleurisy is a form of pleurisy - inflammation in the lining of the lungs - the pleura. It is characterized by the deposition of fibrin substance over the area of ​​the pleural layers, therefore this form of the disease is synonymously called fibrinous pleurisy.

The application of fibrin on the surface of the pleural layers invariably leads to the separation of their movement relative to each other and causes severe pain in the patient, as well as other signs of inflammation of the pleural layers.

This type of pleurisy usually accompanies infectious diseases: it most often occurs with lobar pneumonia. Quite often precedes exudative pleurisy. The course of the underlying disease, if it leads to pleurisy, is complicated. Treatment should be selected according to the underlying disease.

Why the disease may occur

Most often, the causes of dry pleurisy come down to one of the following:

  1. Pneumonia.
  2. Tuberculosis of the lungs.
  3. Viral infection - enteroviruses of group B Coxsackievirus are most often associated with the dry form of the disease.
  4. Purulent processes affecting the tissue of the lungs or the spaces and organs located near the lungs.

In this case, pathogenic microorganisms are transferred to the pleura through the lymphatic system, that is, by the lymphogenous route, or through the bloodstream, that is, by the hematogenous route. And if the root cause is pneumonia, then there is also contact spread through inflammation of the lung tissue, spreading to the pleura itself.

How to recognize the disease

Diagnosis of dry pleurisy is based, as a rule, on a characteristic clinical picture: pain and other signs identified by the doctor when questioning and examining the patient, as well as on the results of laboratory and instrumental studies.

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

The reasons for them are that many nerve endings responsible for the pain system are scattered in the pleural layers, the fibrinous irritation of which causes these symptoms. The patient strives to fix his body in a position in which the movement of the lung on the affected side and pain, respectively, are reduced.

Usually, for this, the patient lies on the sore side and moves little, limiting his movements.

Depending on the location of the affected pleural area, pain can radiate to various areas of the chest and abdominal walls.

The main symptom, thanks to which the diagnosis of dry pleurisy disproves other, somewhat similar diseases, already in the first stages, is the constant, clear connection of pain in the chest with the patient’s act of breathing: pain sensations suddenly arise or significantly intensify at the height of a deep breath. When the inflammatory process becomes less pronounced, the pain also decreases.

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

However, the latter is usually not too pronounced: no more than 37.5-38 degrees.

When examining a patient, you can often find the following manifestations that accompany dry pleurisy:

  1. Sternberg's symptom - pain if palpation is performed, that is, feeling,

Pectoralis major muscle

the pectoralis major muscle in front, as well as the trapezius muscle in the back.

  • Positive symptoms in the pain points of Mussi, which are located between the legs of the sternocleidomastoid muscle. This symptom accompanies not only dry pleurisy, so you need to take it critically.
  • The affected half of the chest usually lags behind the healthy half in movement during breathing.
  • Listening to the lungs over the affected area may reveal signs of weakened breathing and pleural friction noise, which is somewhat reminiscent of the creaking of snow underfoot in frosty weather, and the latter can be heard both on inhalation and exhalation.

    • (NB) The rougher the pleural friction noise, the more advanced the stage of the disease in the patient at the time of the diagnostic search.

    Laboratory diagnostics, which confirm dry pleurisy, include the following methods:

    1. A clinical blood test, which usually reveals nonspecific signs characteristic of an infectious process, which is the cause of dry pleurisy. The number of white blood cells – leukocytes – increases. This symptom is called leukocytosis. The erythrocyte sedimentation rate increases. Symptoms of anemia, a decrease in the number of red blood cells, may develop. These symptoms manifest themselves in weakness, lethargy in the patient and pallor of his skin.
    2. Blood chemistry. Changes in it are also non-specific, but still important. The patient develops dissociation of protein components of the blood - dysproteinemia, which is expressed in an increase in the amount of α-globulins with a simultaneous decrease in the amount of albumin. In addition, the blood levels of inflammatory proteins, such as C-reactive protein, haptoglobin or seromucoid, increase.

    Instrumental diagnostics, with the help of which dry pleurisy is confirmed, includes radiography of the chest organs in frontal and lateral projections.

    The main symptom of dry pleurisy is a decrease in the transparency of the lung tissue above the diaphragm. There will also be high standing and limited mobility of the latter.

    Therapeutic measures

    Treatment of fibrinous pleurisy should begin with identifying the underlying disease, which is complicated by inflammation of the lung lining itself. Treatment should be prescribed first for this disease, and then it is advisable to begin treating dry pleurisy itself. Moreover, the reasons for this approach are dictated by common sense: if you exclude the main link of the painful combination, the treatment of the complication, in this case dry pleurisy, will be easier.

    Since inflammation of the pleural layers usually complicates the infectious process, its treatment usually begins with antibacterial drugs. Such treatment should be prescribed taking into account the microorganism that causes the underlying disease and its sensitivity to drugs. If, as often happens now, the exciting link is an association of microorganisms, you need to try to cover the sensitivity spectrum of all participants in the association with the least amount of antibacterial drugs.

    The most common and effective treatment is the following drugs:

    1. Clindamycin + III generation cephalosporins, for example, cefotaxime.
    2. Amoxicillin + clavulanic acid.
    3. Imipenem.

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

    Anti-inflammatory treatment will also be effective, of course, in combination with the above-mentioned drugs.

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

    Source: http://jmedic.ru/o-plevrite/suhoj-plevrit.html

    Dry pleurisy

    Dry pleurisy is a reactive inflammation of the parietal and visceral pleura with fibrin deposition on its surface. Symptoms of dry pleurisy are characterized by pain in the chest, aggravated by breathing, dry cough, low-grade fever, and malaise. Diagnostic criteria for dry pleurisy are clinical and auscultatory data (pleural friction noise), radiological signs, and ultrasound data of the pleural cavity. The main treatment of dry pleurisy is aimed at eliminating the primary pathology (tuberculosis, acute pneumonia, etc.); symptomatic therapy includes the use of analgesic, anti-inflammatory, and antitussive drugs.

    Dry pleurisy

    The general term “pleuritis” in pulmonology refers to a group of inflammatory lesions of the pleura of various origins, occurring with or without the formation of pathological effusion. Pleurisy can be independent (primary) in nature, but more often develops secondary, against the background of acute or chronic processes in the lungs. Taking into account the presence or absence of effusion and its nature, dry (fibrinous) pleurisy and exudative (serous, serous-fibrinous, hemorrhagic, purulent) pleurisy are distinguished. Pleurisy can have a bacterial (nonspecific and specific), viral, tumor, or traumatic etiology.

    Causes and mechanism of development of dry pleurisy

    Dry pleurisy has no independent meaning. Most cases of fibrinous pleurisy are etiologically associated with pulmonary tuberculosis or tuberculosis of the intrathoracic lymph nodes. Dry pleurisy of tuberculous etiology occurs when the lesions are located subpleurally, break through into the pleural cavity with contamination of the latter, or as a result of hematogenous introduction of pathogens. The causes of the development of dry pleurisy are also often nonspecific lung lesions: pneumonia, bronchiectasis, pulmonary infarction, lung abscess, lung cancer.

    Among extrapulmonary processes, dry pleurisy can be complicated by diseases of the digestive system (cholecystitis, pancreatitis, subphrenic abscess), collagenosis (SLE, rheumatism, systemic vasculitis), infections (brucellosis, typhoid and typhus, whooping cough, measles, influenza). In some cases, dry pleurisy is accompanied by eating disorders (cachexia, scurvy), uremia.

    The pathogenetic basis of dry pleurisy is the inflammatory reaction of the parietal and visceral pleura, which occurs with hyperemia, edema, and thickening of the pleural layers. The amount of exudate is so insignificant that it is reabsorbed by the pleura with sedimentation of fibrin threads on the surface of the pleura in the form of pleural overlays, making it difficult for the sheets to slide. In the future, this can lead to the formation of massive moorings and limitation of lung mobility.

    In most cases, dry pleurisy turns into exudative, but it can resolve without the formation of pleural effusion.

    Symptoms of dry pleurisy

    If the costal pleura is involved, dry pleurisy begins with severe pain in the half of the chest corresponding to the lesion. The pain intensifies at the height of inspiration, when coughing or straining, forcing the patient to lie on the affected side and thereby limit the mobility of the chest. As the activity of the inflammatory process subsides and the pleural layers are covered with fibrinous deposits, the sensitivity of the nerve endings of the pleura decreases, which is accompanied by a decrease in the pain response.

    In case of inflammation of the diaphragmatic pleura, pain is localized in the abdominal cavity, simulating the clinical picture of acute cholecystitis, pancreatitis or appendicitis. With dry apical pleurisy, pain is determined in the projection of the trapezius muscle; when the pericardium is involved in inflammation, pleuropericarditis develops.

    With fibrinous pleurisy, a dry cough is noted, general symptoms of inflammation are malaise, loss of appetite, night sweats. Body temperature is usually subfebrile, but can be normal or reach febrile values ​​(°C). Fever is accompanied by chills and tachycardia.

    The duration of the clinical course of dry pleurisy is 1–3 weeks. Its outcome can be complete recovery, transition to an exudative form, or a chronic course. In the latter case, dry pleurisy lasts for months with periodic exacerbations.

    Diagnosis of dry pleurisy

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

    Auscultatory signs of dry pleurisy are weakening of breathing on the affected side, listening to a localized or extensive pleural friction noise. Pleural friction noise occurs when the rough pleural layers come into contact with each other; can be subtle, gentle or rough, sharply expressed. Palpation reveals muscle rigidity and soreness.

    Fluoroscopy and radiography of the lungs show limited excursion of the diaphragm on the affected side, obliteration of the sinuses, high standing of the diaphragm, changes in its contour (irregularities, flattening, bulging). To exclude the presence of exudate, an ultrasound of the pleural cavity is performed.

    Treatment of dry pleurisy

    Since dry pleurisy in most cases is a secondary process, the main treatment should be aimed at eliminating the primary disease. In case of fibrinous pleurisy of tuberculous etiology, specific anti-tuberculosis therapy with streptomycin, tubazide, rifampicin, etc. is indicated. In the presence of nonspecific inflammation of pulmonary and extrapulmonary localization, antibacterial and anti-inflammatory therapy is carried out.

    In order to relieve pain in the acute period of dry pleurisy, it is recommended to adhere to bed rest, apply a tight pressure bandage to the chest, apply warm compresses, mustard plasters, and cupping. To relieve cough, antitussives (codeine, ethylmorphine, etc.) are prescribed. To prevent massive adhesions in the pleural cavity, breathing exercises are performed. For recurrent dry pleurisy, pleurectomy with lung decortication can be performed.

    Forecast and prevention of dry pleurisy

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

    Prevention of fibrinous pleurisy consists of treating pulmonary and extrapulmonary inflammatory processes, preventing hypothermia and colds, and adequate nutrition.

    Dry pleurisy - treatment in Moscow

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    Source: http://www.krasotaimedicina.ru/diseases/zabolevanija_pulmonology/dry-pleurisy