Pleurisy - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | Respiratory Diseases

pleurisy - inflammatory disease of the pleura, which is characterized by the deposition of fibrin on the surface (fibrinous or dry pleurisy), or accumulation of fluid in the pleural cavity (pleural effusion).

Normally the pleura is a thin transparent shell.The outer leaf of the pleura covers the inner surface of the chest (the parietal pleura), and the inner - the lungs, mediastinum and diaphragm organs (visceral pleura).Between the sheets of pleura normally contains a small amount of liquid.

Causes of pleurisy

Depending on the cause of pleurisy all divided into two groups: infectious and non-infectious.Infectious pleurisy associated with the life of disease-causing organisms.Activators of infectious pleurisy may be:

• bacteria (Streptococcus pneumoniae, Streptococcus, Staphylococcus aureus, Haemophilus influenzae, and others).
• Mycobacterium tuberculosis.
• protozoa such as amoeba.
• fungi.
• parasites such as Echinococcus.

Typically, such pleurisy arise against pneumonia, active pulmonary tube

rculosis, at least with lung abscess or subphrenic space.

Noncommunicable pleurisy occur for the following diseases:

• malignant tumors.This can be a primary tumor of the pleura, and metastases at other organ tumors.
• systemic diseases, such as systemic lupus erythematosus, rheumatoid arthritis, and other systemic vasculitis.
• chest trauma and surgery.
• pulmonary infarction after pulmonary embolism.
• myocardial infarction (myocardial Dressler's syndrome).
• enzymatic effusion in acute pancreatitis when pancreatic enzymes are dissolved pleura and the pleural cavity.
• end-stage chronic renal failure (uremic pleurisy).

For the occurrence of infectious pleurisy must be penetration of microorganisms into the pleural cavity.This may occur by contact of the centers of infection of the lung tissue, lymphogenous way to shock lymph, hematogenous - while circulating in the blood of the pathogen.In more rare cases, direct penetration of the pathogen from the environment in wounds of the chest, as well as during operation.Penetrated bacteria cause inflammation of the pleura with propotevanie fluid (exudate) into the pleural cavity.If pleural vessels are functioning normally, then the liquid is sucked back.In the pleural sheets deposited fibrin (a protein found in large numbers in the effusion), formed by dry pleurisy.At high intensity of the vessels of the pleura can not cope with large amounts of exudate, it accumulates in a closed cavity.In this case diagnosed pleural effusion.

Schematic representation of right-exudative pleurisy.

When malignancy tumor toxic products damage the pleura, which leads to the formation of exudates and significantly hampers its reabsorption.When systemic diseases, as well as vasculitis, pleurisy caused by the defeat of the small vessels of the pleura.Traumatic pleurisy occur as a reaction to pleural hemorrhage.Pleurisy in chronic renal failure is associated with the effect of uremic toxins.Enzymatic pleurisy is associated with irritation of the pleura enzymes from the damaged pancreas.Myocardial noninfectious lung inflammation by contact switches to the pleura.A myocardial infarction leading role in the occurrence of pleurisy plays impaired immunity.

Symptoms of pleurisy

In most cases, dry pleurisy develops acutely.Patients usually clearly indicate the time of occurrence of the disease.Characteristic complaints of chest pain, fever, general weakness expressed.

Chest pain associated with stimulation of nerve endings pleural fibrin.The pain is usually unilateral on the affected side, quite intense, with a tendency to strengthen with a deep breath, coughing, sneezing.Body temperature rises to 38 ° C, seldom higher.With the gradual onset of the disease at first, body temperature may be normal.It is also concerned about the general weakness, sweating, headache, irregular pain in muscles and joints.

When symptoms of pleural effusion due to accumulation of fluid in the pleural cavity.Complaints vary depending on the embodiment of onset.If pleural effusion occurred after fibrinous, then it is possible to trace a clear chronology of the events.At the beginning of an intense worries sided chest pain patient's disease that increases with deep inspiration.Then, when the exudate formed, the pain disappears, and in its place comes a feeling of heaviness, pressure in the chest, shortness of breath.It may also mark a dry cough, fever, general weakness.If there is primary pleural effusion, then the pain is not typical.At the same time, patients complain of general weakness, sweating, fever, headache.A few days later there is shortness of breath, feeling of heaviness in the chest, with little physical effort, and with a large number of exudate - alone.At the same time non-specific symptoms of intoxication are amplified.

When the above-mentioned complaints is an urgent need to address to the therapist .With the progressive deterioration (increase in body temperature, difficulty breathing appearance, increased dyspnea) hospitalization in a hospital.

diagnosis of pleurisy

external examination which makes the doctor, it is very important for the diagnosis of pleurisy and determination of his character.Auscultation (listening to the lungs in different phases of respiration stethoscope) can be detected pleural friction that is specific to the fibrinous pleurisy, with pleural effusion percussion (tapping a specific area to detect the characteristic sound phenomena) marked dullness of effusion area.Thus, it is possible to determine the spread of exudate in the pleural cavity.

in general and biochemical blood tests are marked non-specific inflammatory changes: ESR acceleration, increased white blood cell count;appearance or increasing the concentration of CRP-inflammatory proteins and other seromucoid.

Instrumental methods play a significant role in the diagnosis of pleurisy, as they allow to see the lesion and to determine the nature of the inflammatory process.When X-ray light in the case of fibrinous pleurisy is possible to determine the high standing of the dome of the diaphragm on the affected side, limiting the mobility of lung edges in breathing, as well as seal pleura.

Radiography of the lungs in fibrinous pleurisy.The arrow shows pleural thickening.

When pleural effusion is characterized by a pre-loaded, a slight decrease in size on the affected side, which can be seen below the layer of liquid homogeneous or inclusions.

Radiography of the lungs in exudative pleurisy.The arrow shows the fluid layer.

US pleural cavities with fibrinous pleurisy reveals fibrin deposition on sheets pleural thickening with them, and when escudativnom layer of liquid below the lung.Character effusion, and often, and the cause of pleurisy is determined by analyzing exudate, pleural resulting puncture.

Treatment of pleurisy Treatment of pleurisy

should be comprehensive, individual and directed at the underlying cause of the disease.When pleurisy caused by infections, shows the use of antibacterial broad-spectrum drugs in the first few days.Then, after determining the pathogen, specific therapy is recommended.It is also used anti-inflammatory drugs (voltaren, indomethacin) and desensitizing therapy.

Noncommunicable pleurisy , tend to be a complication of another disease.Therefore, in addition to non-specific treatment is necessary to complete the treatment of the underlying disease.

Surgical evacuation of fluid in the following cases:

• a large volume of fluid (usually reaching the edges II);
• if exudate compression of surrounding organs;
• to prevent the development of empyema (pus formation in the pleural cavity) of the pleura.

currently recommended one-stage removal of no more than 1.5 liters of fluid.With the development of empyema after the evacuation of pus in the pleural cavity is injected with an antibiotic solution.

Pleural puncture is performed, usually in a hospital.This manipulation is performed in the position of a patient sitting in a chair with a support forward into his arms.Typically, a puncture is carried out in the eighth intercostal space on the back surface of the thorax.Produce anesthesia puncture site of the alleged solution of novocaine.Long thick needle punctures the tissue layers surgeon and enters the pleural cavity.As the needle begins to drain exudates.After removal of the desired amount of liquid the surgeon removes the needle to the puncture sterile dressing is applied.After the puncture, the patient for several hours under the supervision of experts from the danger of the pressure drop, or the development of complications associated with the technique of puncture (hemothorax, pneumothorax).The next day, we recommend a control chest X-ray.Thereafter, in good health the patient can be sent home.Pleural puncture is not a difficult medical procedures.Preoperative preparation and subsequent rehabilitation is usually not required.

For fibrinous pleurisy characterized by favorable course.Usually after 1-3 weeks of treatment, the disease ends in recovery.The exception is in tuberculosis pleurisy, which is characterized by a long period of sluggish flow.

During exudative pleurisy distinguished several stages: the first stage is an intensive formation of exudate and reveals all the above clinical picture.This step depending on the cause of the inflammation and concomitant condition of the patient takes place 2-3 weeks.Then comes the stage of stabilization, when exudate is no longer produced, but the reabsorption of its minimum.At the end of the disease are removed from the pleural cavity ekscudata natural or artificial means.After removing exudate often between pleural sheets are formed connective tissue bands - spikes.If adhesions is expressed, it can lead to disruption of the mobility of the lungs during breathing, the development of stagnation, during which the risk of re-infection increases.In general, in most cases, patients with exudative pleurisy after treatment complete recovery occurs.

Complications

pleurisy pleurisy Complications include: the formation of pleural adhesions, pleural empyema, circulatory disorders due to compression of vessels large number of exudate.Against the background of inflammation, especially in the current long-term or recurrent pleurisy, there is thickening of the pleura, the fusion between them, as well as the formation of adhesions.These processes pleural cavity is deformed, resulting in impaired lung respiratory mobility.In addition, due to pleural adhesions of the pericardium with heart leaf possibly offset.In marked adhesive process at high risk for respiratory and heart failure.In this case, surgical pleural sheets separation, removal of adhesions.Empyema occurs when exudate festering.

empyema

forecast always serious in the development of pleural empyema in elderly and debilitated patients mortality is up to 50%.Suspected abscess exudate can be in the following cases:
• while maintaining a high body temperature or the return of fever on the background of antibiotic therapy.
• if new or worsening chest pain, shortness of breath.
• while maintaining a high level of white blood cells in the background of antibiotic therapy, as well as the accession of anemia.

For diagnosis of pleural empyema is necessary to perform pleural puncture.In the presence of punctate pus, a large number of white blood cells and bacteria, diagnosis of empyema is not in doubt.Surgical treatment, is the evacuation of pus, washing the pleural cavity with antiseptic solutions, and a massive antibiotic therapy.

Another dangerous complication of exudative pleurisy is a compression and mixing of the blood vessels in the accumulation of a large volume of liquid.When a loss of blood flow to the heart, death occurs.In order to save the patient's life in an emergency procedure removes fluid from the pleural cavity.

therapists Sirotkin EV