pleurisy - this inflammatory changes in the pleura - the thin bilayer of the membrane that surrounds the lungs and lines the inside of the chest cavity, with the deposition of her fibrin particles (fibrinous, dry pleurisy) or the development of pleural effusion (serous, seroplastichemorrhagic or purulent pleurisy).
The space between the layers of the pleura (pleural cavity) usually filled with liquid lubricant, which guarantees a uniform expansion and contraction of the lungs during breathing.When pleurisy of the pleura becomes inflamed and thickens, leading to the fact that the two layers of membrane begin to rub together, causing pain.Pleurisy can develop in people of any age.Most cases occur due to infections and corresponding treatment takes place in a few days or weeks.However, some cases are caused by more serious diseases, such as lupus or pulmonary embolism.
Pleurisy may be a manifestation of a variety of disorders, which are diagnosed on the basis of characteristic features.However, quite of
dry pleurisy detected occasionally after a cold, chest trauma, as well as pulmonary infarction, lung abscess, uremia, systemic lupus erythematosus, systemic sclerosis, etc.
If the inflammation is strong, fluid can accumulate in the pleural cavity..;This disease is called pleural effusion.Excess liquid often provides lubricant that reduces pain, but it can also compress and disposed below the light breathing difficulties.Although pleural effusions often associated with pleurisy, it can occur in the absence of pleurisy (particularly heart failure).Because pleurisy and pleural effusion is not a disease but a manifestation of the underlying disease, it is the result of treatment depends on the degree of its severity.
disease occurs with general malaise, pain in the chest, with increasing temperature.The pain associated with pleurisy, aggravated by breathing, coughing, have a limited location.The most characteristic symptom - pleural friction noise of varying intensity.To distinguish from noise friction pleura crepitations recommend listening with a deep breath, and pressure-sensitive stethoscope, with pleural friction increases.In the blood, there is a small leukocytosis, increased ESR.The disease is favorable, resulting in recovery in 1-2 weeks, sometimes after it left pleural adhesions.
Treatment for anti-inflammatory drugs (aspirin, Analgin, indomethacin, etc.).Locally applied mustard.With a sharp pain prescribe codeine, Promedolum.If there is no apparent cause of illness and suspected tuberculosis conduct specific anti-tuberculosis treatment (ftivazid, PAS, streptomycin).How are folk remedies in this illness, see here.
pleural effusion more often serous or serous-fibrinous, usually it is a toxic-allergic reaction in tuberculosis, although the primary focus is usually not detected and only occasionally found later.Actually tuberculous pleural rare.Sometimes exudative pleurisy develops as a result of the tumor, which can also take place discreetly.Often seroplastic pleurisy develops in lobar pneumonia, pulmonary infarction, systemic lupus erythematosus, rheumatoid arthritis and others.
symptoms.The disease begins with the appearance of pain in his side, general malaise, loss of appetite, sometimes with a fever.With the advent of effusion pain disappears, and with it increase of increased shortness of breath, which is associated with compression of the lung and mediastinal shift.
When research is lagging behind the affected side while breathing.Percussion has dullness, and the upper limit of its descends posterior to the shoulder line down the spine.In the stupidity of breath is not carried out, voice trembling weakened or absent.The diagnosis to be confirmed by X-ray study, as well as pleural puncture (to clarify the nature of the effusion).When a puncture fluid obtained lemon-yellow color in the presence of fibrin clot detected therein.In pleural fluids determine the protein content and assayed precipitate.When pleurisy protein concentration exceeds 3%, as determined at the precipitate leukocytes, mainly lymphocytes.At the lower protein content should be thinking about transudate that develops in patients with a high water retention as a result of heart failure and kidney disease.
Hemorrhagic pleurisy characterized by the appearance of a large number of red blood cells in the effusion, pleural fluid that gives a reddish hue.It occurs in malignant tumors of the lungs, chest trauma, pulmonary infarction, and in patients with hemorrhagic diathesis.The clinical picture of hemorrhagic pleurisy symptoms generally corresponds seroplastic pleurisy.
purulent pleurisy (empyema) often associated with pneumonia, lung abscess, pyosepticemia rarely tuberculosis.The disease is characterized by severe, accompanied by persistent high fever, high temperature swing during the day, chills, sweats.Usually there is shortness of breath, blood leukocytosis, increased erythrocyte sedimentation rate.When protracted course of purulent exudate limited moored, there are changes in the fingers as drumsticks, may develop amyloidosis.
treatment.In exudative pleurisy in any case required hospitalization, temporary compliance with bed rest, nutritious food, rich in proteins and vitamins.Apply anti-inflammatory drugs (acetylsalicylic acid to 3 g / day), when seroplastic pleurisy in more severe cases, appoint prednizo-lon up to 20-30 mg / day.Since a common cause of pleurisy is tuberculosis, prednisone treatment for diseases of unknown etiology combine with TB means: streptomycin, ftivazi-house.With a significant effusion shows pleural puncture with removal of the liquid and the introduction into the pleural cavity of 200 mg of hydrocortisone.At a certain etiology of the disease in need of treatment of the underlying disease.Treatment of pleural empyema is possible only surgically.
tuberculous pleurisy contact may occur (with lung lesions or lymph nodes), lymphogenous or hematogenous route.The inflammatory process in the pleura may develop on the background of the body's hypersensitivity in patients with primary, infiltrative or disseminated tuberculosis.
pleurisy is often the first manifestation of tuberculosis, when the body has no other sites of disease.It can be dry or exudative.
When developing acute pleurisy in the foreground is usually the pain.On examination, determined the lag affected side of the chest when breathing.Palpation revealed tenderness and muscle tension.Percussion sound of the inflamed pleura shortened breath weakened.In dry pleurisy pleural friction auscultated.With a large number of fluid percussion determined characteristic superior oblique border blunting, intercostal spaces are smoothed or vybuhayut.Breath of effusion can not be heard.Are growing shortness of breath, symptoms of intoxication, the body temperature can be high or low grade.Patients prefer to position on the affected side.There have been rapid pulse, muffled heart sounds, cardiac shock offset to the opposite side of the exudate.
radiologically with fibrinous pleurisy different localization revealed a diffuse reduction in the transparency of the relevant departments, with exudative - intensive shadow with an oblique upper boundary.When interlobar pleurisy side view reveals characteristic lenticular shade along the pleural slots.An important diagnostic feature is the nature of fluid obtained by puncture of the pleural cavity.For tuberculous pleurisy characterized serous exudate relative density to 1022 and a protein content of from 3 to 6%.The cellular structure is dominated by lymphocytes.sowing method, less can be detected by flotation BC.
course and outcome of pleurisy depends on the nature of primary tuberculosis.Easier flow perifocal "reactive" pleurisy, not accompanied by the development of specific inflammation of the pleura.When disseminated TB may recur, exudate may be hemorrhagic, the long-term absorbable.
A break in the pleural cavity of caseous masses from the melt chamber or cavity may develop severe complications in the form of a purulent pleurisy - empyema, and spontaneous pneumothorax.Purulent pleurisy often begin acutely proceed with chills, pain, shortness of breath, body temperature can be hectic, pronounced symptoms of intoxication.Purulent tubercular pleurisy can occur at normal temperature.
Treatment of tuberculous pleurisy carried out according to generally accepted principles.For large effusions make therapeutic puncture removing exudate and introduction into the pleural cavity tuberculostatic funds.In severe hypersensitivity need hormone therapy, high doses of ascorbic acid.
antibacterial therapy is a combination of several drugs for a long time, depending on the basic process.In newly diagnosed, treatment is initiated with the appointment of three drugs I series.After the elimination of acute events need physiotherapy and therapeutic exercise, contributing to better resorption of pleural adhesions and healing with minimal residual changes.
treatment of purulent pleurisy carried out systematic aspiration of pus.In cases where pus thick, pleural cavity was washed with isotonic saline and injected intrapleurally tuberculostatic drugs.Total therapy should include specific and broad spectrum of anti-inflammatory drugs, as in cases of visceral pleura breakthrough occurs mixed infection.Sustained recovery is possible only with the obliteration of the pleural cavity.With the ineffectiveness of conservative therapy surgical treatment - pleurectomy, and in severe pulmonary process and the formation of pulmonary-pleural fistula - plevropulmonektomiya.