Wet pleurisy. Pleurisy of the lungs - symptoms and treatment, types, causes, consequences and prevention. Additional symptoms of pleurisy

Most people, experiencing periodic tingling chest pains, do not go to the doctor, believing that such symptoms can be caused by the usual uncomfortable position. And even a cough that has appeared does not cause concern - everything is written off as a cold. But the symptoms presented may indicate the onset of a serious illness - pleurisy of the lungs. It is he who can lead to serious consequences, some of which can only be treated with surgery.

In order to prevent such a variant of events, it is necessary to be fully informed about the dangers and other features of the presented ailment. You should know all the symptoms in order to consult a doctor in time. And do not be afraid if purulent pleurisy is diagnosed - with timely medical treatment, such forms of the disease will not occur, and the range of actions will be limited to taking antibiotics.

The concept and features of pleurisy of the lungs

The pleura is a protective shell of the lung, which helps the respiratory organs to fully open during inhalation and “eliminates” the pain syndrome when it comes into contact with the diaphragm. Its inflammation leads to the disease pleurisy, which causes pain and other unpleasant symptoms.

The protective sheath consists of numerous blood and lymphatic vessels. With inflammation, the pleural cavity is filled with fluid or pus, which leads to an increase in the lung, and, consequently, difficulty breathing and pain when inhaling.

It should also be noted that inflammation can be carried out without accumulation of fluid. This is called the dry form of pleurisy. It is quite common and can "hide" for a long time from a sick person. Therefore, it is not enough to know what pleurisy of the lungs is. One must be aware of all the incidents and features that are rare, but have rather severe forms of manifestation.

Reasons for the development of the disease

Experts say that pleurisy cannot come on suddenly without any prerequisites. This disease can be attributed to the "afterword" of dangerous ailments, which, in turn, are divided into infectious and non-infectious.

Infectious causes of pleurisy:

• the presence of a bacterial infection that has not been detected for a long time, for example, staphylococcus aureus or pneumococcus;
• fungal infections of the respiratory system;
• typhoid fever;
• tuberculosis, which did not give itself out as standard symptoms;
• syphilis and other sexually transmitted diseases;
• bruises or fractures of the chest;
• transferred surgical operations with introduced infection.

Non-infectious causes include:

• cancer of the mammary glands and other organs that caused the occurrence of metastases in the pleura of the lungs;
• various malignant tumors developed in the pleural sheets themselves;
• damage to connective tissues that has occurred;
• lung infarction;
• blockage of the pulmonary artery - PE.

But, despite the presented feature of the causes of pleurisy, this disease can also occur due to hypothermia of the lungs, and a person may not notice this - a draft in the summer can provoke the development of inflammation of the pleura.

Symptoms of the presented disease

The danger of pleurisy lies in its long development. So, for example, inflammation can be a rather long process, and the symptoms will be expressed in a slight pain syndrome when inhaling. Such signs of pleurisy will increase over time, fever and coughing attacks are not excluded, but this can begin only after a month, and this already indicates the neglect of the disease.

Symptoms of pleurisy, depending on its form, can vary significantly. With a dry form, a person begins to be disturbed by a general malaise, he is shivering and possibly a slight increase in temperature. Already behind these listed symptoms, one can notice rapid breathing due to the inability to make a full breath easy, since actions lead to pain. After some time, the patient is worried about a small cough, which then becomes permanent and flows into the corresponding attacks.

During inflammation of the lining of the lungs, the patient tries to take a comfortable position, because it is inconvenient for him to lie on his side from the side of the affected lung. He has a bluish complexion and swollen veins in his neck.

Symptoms of pleurisy of the lungs in adults are no different from small representatives of humanity. Children also often suffer from inflammation of the pleura, which occurs due to reduced immunity or hypothermia. If your baby complains of pain in his chest or side, take a closer look at him at rest or in a dream. During rest, the baby does not control his breathing and opening his lungs, so you will notice rapid breaths, and in the presence of accumulated fluid, characteristic wheezing. You can also independently determine the affected lung - the baby will lie on the side of a healthy respiratory organ. If both lungs are affected, he will sleep restlessly and constantly change position.

With exudative pleurisy - when fluid or pus accumulates - the patient may feel some relief. He will stop hurting in his side, but the cough will not decrease. As the amount of foreign content in the lungs increases, a person develops shortness of breath, and the heart and other internal organs are displaced. Therefore, in addition to pain in the side, palpitations and abdominal pain may appear, which indicates the impact of the respiratory organ on the stomach and other components of the gastrointestinal tract.

Varieties of pleurisy and their features

As already mentioned above, pleurisy has several forms of manifestation. They are characterized by features of inflammation of the pleura and the course of the disease. There are also characteristic differences in the treatment of a certain form. When diagnosing pleurisy, the doctor always indicates the form of inflammation. There are three main forms: exudative, dry and purulent pleurisy. All forms can lead to a different variety, with different symptoms and treatments.

Dry (fibrinous) pleurisy

Dry pleurisy occurs more often than forms with accumulation of exudate - a liquid with a high concentration of fibrin. The presented form of pleurisy is always accompanied by severe pain when breathing and sneezing. Elevated body temperature often leads to fever.

The dry form of the presented disease is characterized by severe inflammation of the protective membrane, which is diagnosed by an auscultated pleural friction noise. Here, the specialist will note weakened breathing in the area of ​​fibrinous pleural overlays. That is why the presented form also has a second name - fibrinous.

Fibrinous pleurisy occurs much more often, but it also takes much less time to recover. With timely intervention, it is possible to come to a healthy state in 2-3 weeks. Also, the treatment of the disease can be significantly delayed if adhesions form on the pleural mucosa. Depending on the location of cysts and adhesions, fibrinous pleurisy is divided into varieties:

1. Diaphragmatic - the lower parts of the lungs are damaged, as a result of which the patient will be disturbed by pain in the abdominal cavity, painful swallowing and frequent hiccups.
2. Apical - the upper cavity of the lungs is damaged, and pain is felt in the shoulder or shoulder blade.
3. Paramediastinal - anterolateral areas are damaged, which is sometimes mistaken for heart disease.
4. Parietal - the most common form, the patient feels pain in the chest, which cause suffering when coughing or sneezing.

If you feel the symptoms presented, you should immediately consult a doctor. With untimely intervention, dry pleurisy turns into exudative.

Exudative pleurisy

Exudative pleurisy is most often the result of pneumonia, tuberculosis or rheumatism. It is characterized by the accumulation of exudate in the pleural cavity. Exudate is a liquid that, through large amounts, provokes additional pressure and thereby makes it difficult to breathe. Often there are cases of accumulation of exudate in the amount of several liters.

The main symptoms of the presented form of the disease are shortness of breath and general malaise, accompanied by headaches and fever. When fluid accumulations increase, the doctor notes a shortened percussion sound in the patient. The exudative form of pleurisy is easily diagnosed by X-ray examination.

Exudative pleurisy also has its own varieties, which are characterized by the structure of the accumulated exudate. Types of exudative pleurisy include:

1. Serous pleurisy - serous fluid accumulates.
2. Putrid - there is an unpleasant odor in the liquid, which often accumulates with gangrene of the lungs.
3. Chylous - there is an accumulation of lymph, which is caused by preliminary squeezing of the lymphatic flow by the tumor that has arisen.
4. Purulent - there is an accumulation of pus. Despite the subspecies of the exudative form, experts often attribute it to a separate type of pleurisy.

Exudative pleurisy can be cured by taking antibiotics, but only at the initial stage of the disease. In large quantities, the accumulated fluid is removed using a puncture.

Tuberculous pleurisy

Tuberculous pleurisy directly indicates the development of the tuberculous process, which is latent. For example, the presented form of the disease rarely occurs on its own. Here, the consequences of the development of tuberculosis of the lymph nodes or the lungs themselves are more often noted. In turn, this form is also divided into varieties:

1. Perifocal form - has a feature of development over the lesion, where inflammation sometimes covers the entire area of ​​the pleura. The accumulation of fluid is also noted here, but only with the exudative form. Treatment takes a considerable amount of time, since there is no sowing of pathogens in the effusion. Relapses are common during treatment.
2. An allergic form is a response to the multiplication of tuberculosis bacteria. There is a large amount of fluid in the exudative form. With timely intervention, the liquid has the properties of self-resorption within a month.
3. Tuberculosis of the pleura - the symptoms do not differ from the other varieties presented, and the form itself is characterized by the development of tuberculosis of the pleural cavity.

Tuberculous pleurisy is a rather dangerous disease, therefore, at the first symptoms, it must be diagnosed and effective treatment initiated.

Encapsulated pleurisy

Encapsulated pleurisy is an accumulation of fluid in one lung cavity. Often the patient feels pain in only one place and is unaware of the development of tuberculosis in him, which is accompanied by encysted pleurisy. Such ignorance and untimely diagnosis significantly increases the time of treatment, and its methods of elimination become more complicated.

Adhesive pleurisy

Adhesive pleurisy has a second name - chronic. This form of the disease occurs every time with untimely treatment of the acute form. It is also an accompaniment to diseases such as tuberculosis and hemothorax. It is characterized by thickening of the pleura, which provokes a violation of the ventilation function of the respiratory system.

With this form of pleurisy, the volume of the lungs is significantly reduced, as a result of which a significant oxygen starvation of the whole organism is formed, which is expressed by dizziness and nausea. It should also be noted that pain in adhesive pleurisy in the initial stages appears only at the time of coughing or sneezing. Such features can lead to a complicated form quickly enough, which will entail a long and complex treatment.

Purulent pleurisy

Purulent pleurisy develops as a consequence of a lung abscess caused by the occurrence of multiple or single abscesses. The presented infection subsequently passes through the lymphatic pathways to the pleura, or there is a direct hit of pus into the pleural cavity. This form can be formed as a result of untimely intervention in the treatment of tuberculous serous pleurisy, as well as a consequence of neglected pneumonia. It should also be noted that purulent pleurisy can develop by the formation of metastases at the time of the spread of peritonitis or purulent appendicitis.

Acute purulent pleurisy is characterized by the spread of the lesion throughout the pleural cavity, which greatly complicates the diagnosis of the disease. Here the patient has a high fever, which is accompanied by prolonged fever with sweating. It is difficult for a sick person to breathe, pallor of the skin is noted, indicating a general intoxication of the body.

Methods for diagnosing pleurisy

Diagnosis of pleurisy is a rather important aspect, since a timely diagnosis can directly affect the speedy recovery of the patient. The following diagnostic methods are used here:

1. External examination - the doctor listens to the lungs in various phases of breathing. With the presented examination, one can detect a characteristic pleural murmur and dullness of percussion sound over the effusion zone. These "finds" indicate the accumulation of exudate and its location.
2. A general blood test is carried out, where attention is paid to an increased number of leukocytes and an increased rate of ESR - signs of an inflammatory process in the body.
3. As instrumental methods, lung radiography is used. In the picture, you can clearly see the affected areas and accumulated fluid. Also, by means of an x-ray, the doctor diagnoses the compaction of the pleura.
4. An ultrasound of the pleural cavity is performed - the presence of deposited fibrin on the pleura sheets is noted.
5. Conducting a chemical analysis of sputum or exudate through a puncture allows you to identify the cause of the presented inflammation, on which further treatment depends.

As a rule, when conducting a diagnosis, doctors use all of the above methods to make an accurate diagnosis.

Pleurisy treatment methods

As already described above, the treatment of pleurisy depends on its form. But the initial actions to eliminate the disease are aimed at alleviating the symptoms and eliminating the factor that caused the presented disease.

Features of conservative treatment

The consequences caused by pneumonia are treated in the form of antibiotic therapy. Non-steroidal anti-inflammatory and glucocorticosteroid drugs are prescribed here. Dry pleurisy is always treated with antibiotics. The main role in the treatment is played by antihistamines and painkillers, which will quickly eliminate unpleasant symptoms in the form of pain. If severe coughing fits are observed, the doctor may prescribe antitussive drugs. Self-treatment of pleurisy with antibiotics is prohibited, since you can only aggravate the situation. Also, in the dry form of the disease, the use of expectorants is in no case allowed, since there is no sputum in this case, which means that coughing attacks will lead to increased pain.

Tuberculous pleurisy is subject to antibiotics such as rifampicin, isoniazid, streptomycin. Reception of the presented medications should be carried out only as directed by a doctor with a duration until complete recovery.

As for the treatment of the exudative form of pleurisy, everything is somewhat more complicated here. To begin with, the patient is registered in a hospital in the pulmonology department. The beginning of treatment consists in a puncture, since it is necessary to determine the cause of the disease based on the results of fluid analyzes. In case of detection of tuberculosis in a patient, he is transferred to the department for tuberculosis patients. If the cause is oncology, oncology is treated in the department for patients with oncological inflammations.

It should also be noted that the puncture is not only a method for identifying the cause, but also as an independent treatment. That is, a patient with exudative pleurisy will have to remove the fluid without fail, since in large quantities it can lead to the formation of adhesions. This procedure is performed under local anesthesia and more than once, because in some cases the formation of fluid can be diagnosed as early as 5 days after the first puncture. Antibiotic therapy is also carried out here, depending on the form and course of the disease.

Treatment of pleurisy of the lungs with alternative methods

Pleurisy of the lungs and treatment with folk methods is a rather dangerous occupation, as it can lead to severe complications. Such methods of treatment can be used as additional, but not basic. It is also recommended to consult with doctors when using a particular prescription you have chosen. Due to various forms and features, “mismatch” can be fraught with the occurrence of any complications.

Experts also argue that the treatment of alternative methods of pleurisy of the lungs can be carried out only if the disease is in a dry form. Exudative pleurisy is most often subject to puncture. Even experienced doctors do not risk using only antibiotic therapy as the main treatment.

The methods of folk treatment include:

1. Use for oral administration a mixture of honey and onion juice, mixed in a 1: 1 ratio. The composition should be taken twice a day before meals in an amount of not more than one tablespoon. You can also use black radish juice instead of onion juice. Instructions for use remain the same.
2. Use a tincture that includes alcohol and foot root. Here 4 tablespoons of the crushed component are mixed with half a liter of alcohol. The composition is sent in a dark vessel and in a warm place for infusion for 10 days. Then take three times a day for a teaspoon, after which the tincture is washed down with milk without fail.
3. As an external application, you can use olive oil. Rub the affected side of the lung and wrap yourself in a woolen blanket. Attention! This method is used only after consulting a doctor, because warming up with pleurisy can lead to an increase in fluid.

As folk remedies for the treatment of pleurisy, regularly massage with an experienced specialist. Don't forget to take regular walks. But the described methods cannot be used at the stage of exacerbation of the disease. This is fraught with additional hypothermia and, as a result, complications.

Treatment of pleurisy with gymnastics

How to treat pleurisy at home and not harm yourself? Of course, to carry out therapeutic exercises, which will significantly facilitate the patient's breathing and provoke the resorption of fluid from the pleural cavity. It should be noted that any classes are prohibited if there are symptoms in the form of pain during inhalation and exhalation.

As a treatment, some exercises are used that help prevent the formation of adhesions and other cysts on the pleura, which entails surgical intervention. Use the following simple sets of exercises:

1. Lie on the floor on your back and, as you exhale, bend one leg, bringing your knee to your chest. Do this for a few reps and switch legs.
2. In a standing position, pull your hands to your shoulders, and then, while inhaling, raise your arms up and stretch slightly. Return to the starting position and do a few repetitions.
3. In the starting position, standing and hands below, clasped in the lock. Raise your arms up while inhaling, turn your palms up and bend your back slightly back. As you exhale, come back.

• lying on the bed, put your hand on your stomach and take a full breath with your lungs;
• lying on your back, inhale and pull the leg to the chest from the side of the affected lung.

Combine breathing exercises with self-massage of the chest and intercostal spaces.

Risk of disease to others

Many are interested in a completely objective question: is pleurisy of the lungs contagious for others? Here, specialists are somewhat encouraging people who, for whatever reason, were forced to communicate with patients. The presented disease is dangerous only if the cause of pleurisy is in the form of a viral disease. In other cases, pleurisy of the lungs is not transmitted to interlocutors and just to people around.

Many studies have shown that even the presence of viral causes of pleurisy of the lungs, the likelihood of infection is very small. But the experts themselves warn people to be careful and try not to contact the sick. If such actions are unavoidable, follow the rules and precautions. Use a respiratory mask, and if you experience cough and chest pain when inhaling, contact your doctor immediately.

Complications of pleurisy of the lungs

Complications of pleurisy of the lungs, the consequences of which can only be eliminated by surgical intervention, are concluded in the formation of adhesions in the pleural cavity. Also, as complications, one can single out circulatory disorders due to squeezing of blood vessels through exposure to exudate.

More complicated processes include thickening of the pleura, which can lead to complete deformation of the pleural cavity and the respiratory organ as a whole. Such violations lead to a failure of the respiratory mobility of the lungs. As a result, the risk of respiratory and heart failure increases.

It is important to know what diseases can be complicated by exudative pleurisy. Due to compression of the abdominal cavity, there is a high probability of developing gastrointestinal diseases, complications of oncological and other inflammatory diseases. You can also note the occurrence of problems with the joints, which is detected due to impaired blood circulation, and, therefore, the enrichment of the joints and internal organs with useful microelements. A dangerous disease, like exudative pleurisy, can cause complications even with fractures, which is also provoked by poor provision due to disorders of the respiratory and cardiovascular systems.

More dangerous consequences caused by exudative pleurisy may be the fusion of the lungs with other internal organs. And if, when connecting the respiratory organ with the diaphragm and other internal organs, it is possible to perform a separation operation, then in the case of fusion with the heart, surgeons do not take responsibility. Such actions can occur only in case of serious problems that threaten the life of a sick person.

Medical science understands pleurisy an inflammatory process that affects the pleura and leads to the formation of accumulations of fluid (fibrin) on its surface.

The modern point of view is based on the notion that pleurisy is a syndrome, i.e. manifestation of any disease.

Disease classification

Pleurisy is divided into two main forms: dry, or fibrinous, and effusion, or exudative.

For dry pleurisy characterized by the presence of inflammation of the lung membrane, on the surface of which fibrinous plaque or fibrinous overlays form. In this group, the most common adhesive pleurisy, in which adhesions are formed between the pleura.

At effusion form disease, accumulation of inflammatory fluid in the pleural cavity is observed.

The classification of pleurisy is based on several features.

The nature of the flow:

serous pleurisy when serous exudate accumulates in the pleural cavity;
serous-fibrinous pleurisy, representing the next phase of serous pleurisy or a separate disease;
putrid pleurisy in which the inflamed fluid in the pleura has a specific odor. As a rule, this type of pleurisy occurs with gangrene of the lung;
purulent pleurisy, characterized by the accumulation of pus in the pleural cavity;
chylous pleurisy occurs due to rupture of the milk duct, which leads to the ingress of milky fluid into the pleural cavity;
pseudochylous pleurisy is formed on the basis of purulent, when fatty inclusions appear on the surface of the liquid. They are transformed purulent cells;
hemorrhagic pleurisy diagnosed when red blood cells (erythrocytes) enter the exudate;
mixed, including signs of several types of pleurisy at once, which are of a pulmonary nature.

Etiology:

infectious non-specific;
infectious specific pleurisy.

Localization of the inflammatory process:

apical (apical) pleurisy, develops exclusively in the part of the pleura located above the tops of the lungs;
pleurisy of the costal part (costal), limited by areas of the costal pleura;
diaphragmatic, localized in the diaphragmatic pleura;
costodiaphragmatic;
interlobar pleurisy located in the interlobar groove.

Distribution scale:

unilateral(in turn it is subdivided into left-sided and right-sided);
bilateral pleurisy.

Pathogenesis:

hematogenous when the pathogen of an infectious nature enters the pleura with blood flow;
lymphogenous in which the infectious agent enters the pleura through the lymphatic tract.

Symptoms and signs

The main symptom of fibrinous pleurisy is pain in the chest area, especially during inhalation. The pain is aggravated by coughing and is stabbing in nature.

The appearance of shortness of breath is associated with compression of the affected lung due to fluid accumulation. Clinic of the disease: the temperature rises, excruciating dry cough intensifies.

Other symptoms and signs develop relative to the underlying disease.

Complications

Inadequate and delayed treatment contributes to the formation of adhesions. Consequences can be associated with limited lung movement and respiratory failure.

In the case of infectious pleurisy, the risk of suppuration and the formation of pleural epiema increases, which is characterized by a purulent accumulation in the pleura, requiring local treatment with surgical methods.

Epiema of the pleura can cause fever and intoxication of the body. Its breakthrough leads to the appearance of a lumen in the bronchi and, as a result, an increase in cough with the production of large volumes of sputum.

Causes of the disease

The etiology of the disease is diverse, but comes down to several main factors:

The appearance of neoplasms damages the pleura and exudate is formed, and reabsorption becomes almost impossible.

Systemic diseases and vasculitis injure the vessels, and the pleura reacts with the appearance of an inflammatory focus in response to hemorrhage.

Chronic type of kidney failure leads to enzymatic pleurisy, when the body begins to produce toxins from the affected pancreas.

Non-infectious inflammation due to a lung infarction by the contact method also captures the pleura, and myocardial infarction disrupts immunity, thereby contributing to the development of pleurisy.

Diagnosis and treatment

Laboratory methods for diagnosing pleurisy include: a complete blood count, with pleurisy, the ESR index increases, neutrophilic leukocytosis appears with a shift of the leukocyte formula to the left; taking a pleural puncture and studying the pleural fluid, the amount of protein (Rivalt's test) and the cellular composition of tissues are measured; analysis for histology and bacteriological examination is carried out.

Laboratory studies allow you to establish the etiology of pleurisy. The diagnosis is made during a comprehensive examination.

Instrumental diagnostic methods include: - X-ray, radiograph, CT, CT with contrast, ultrasound, ECG, thoroscopy.

Treatment of pleurisy begins with the treatment of the disease that contributed to the occurrence of effusion. At the first consultation, the doctor must describe to the patient the seriousness of the disease and the need to comply with all the rules of treatment and recovery. At this stage, differential diagnosis is important.

Dry pleurisy and the accompanying dry cough are alleviated by bandaging the chest with an elastic bandage. To enhance the effect, a pillow locally bandaged on the affected side is used. The bandage is changed 1-2 times a day to prevent irritation of skin areas and hypostatic lungs.

With a strong cough, anti-tussive drugs are prescribed in parallel with bandaging.

At the next stage of treatment, manipulations are carried out to remove excess pleural fluid: an operation is performed to puncture the pleura and pump out the fluid.

Interesting Facts
- The incidence of pleural effusion in industrialized countries is 320 per 100,000 population per year. This is about 5-10% of inpatients.
- In rare cases, pleurisy affects the lungs of cats. Such a disease is registered in animals only in 4% of cases of the total number of pulmonary diseases.

The infectious nature of pleurisy requires that antibiotics be included in the treatment program. The basis for choosing one or another drug is the result of a bacteriological study.

Anti-inflammatory drugs stop the syndrome and facilitate the course of the disease.

Diuretics are used in the development of significant effusion. Diuretics are effective in pleurisy accompanied by cirrhosis of the liver, heart failure and nephrotic syndrome.

Physiotherapy techniques. Fibrous pleurisy at the initial stage of development is treated with alcohol compresses. Electrophoresis with a solution of calcium chloride, magnetic therapy are effective.

After completing the course of inpatient treatment, rehabilitation is necessary through sanatorium treatment, preferably with the Crimean climate.

The prognosis for pleurisy is quite favorable, but in general it depends on the underlying disease and the capabilities of the human body.

The most complex metastatic pleurisy is formed against the background of serious diseases: lung cancer or in the case of breast cancer, therefore, it requires constant monitoring after the main course of treatment.

Exudative pleurisy is relatively benign. As a result of treatment, the affected fluid tends to dissolve. In rare cases, areas with fused pleura may remain.

Working capacity after competent treatment is restored completely. However, those who have been ill with tuberculous exudative pleurisy should be under constant dispensary observation.

Prevention

Preventive measures to prevent the occurrence of pleurisy are mainly aimed at eliminating diseases that provoke its occurrence: pulmonary tuberculosis and other pulmonary diseases of a non-tuberculous nature, rheumatism.

Overwork should be avoided, the correct mode of "sleep-wakefulness" is necessary. It is imperative to get rid of bad habits, especially smoking and occupational hazards.

Folk methods of treatment

Treatment of pleurisy at home is possible only after consultation with your doctor.

In most cases, folk remedies for getting rid of pleurisy are based on the use of products such as honey and horseradish.

Composition No. 1. Ingredients: 100 g of honey (preferably May), 50 g of pork fat, aloe leaves (plant age of 5 years or more), 1 tbsp. l. cocoa, 1 tbsp. l. Sahara. Preparation: The leaves are peeled and crushed. All ingredients are mixed and heated in a water bath until the mass becomes homogeneous. Reception: 1 tbsp. l. 3 times a day before meals. Course - 2 months.

Composition No. 2. Ingredients: 1 tablespoon honey, 1 cup milk, 1 egg, 50 g internal pork fat. Preparation: Melt the honey. Boil milk and cool until warm. Separate the protein from the yolk. Mix all ingredients. Reception: the mixture is taken exclusively freshly prepared. The composition is used 2 times a day - in the morning and in the evening.

Composition No. 3. Ingredients: 1 cup of honey, 250 g of badger fat, 300 g of aloe leaves (plant age of 3 years or more). Preparation: aloe leaves are cleaned and crushed. Preparation: mix melted honey with badger fat and add a mixture of aloe leaves. Heat the resulting composition in the oven for 15 minutes. Reception: 3 times a day for 1 tbsp. l. before meals.

Composition No. 4. Ingredients: 150 g horseradish root, 3 medium or 2 large lemons. Preparation: Squeeze juice from lemons. Grind the rhizome of horseradish and mix with the resulting juice. Reception: ½ tsp. in the morning on an empty stomach or in the evening before going to bed.

The high efficiency of many collections based on medicinal plants has been proven. They have a positive effect in eliminating inflammatory processes in the lungs. But their use should take place in combination with drug treatment at the recovery stage.

Diseases of the upper respiratory tract require the use of expectorant and anti-inflammatory preparations, which are licorice rhizomes, fennel fruits, white willow bark, plantain, linden flowers, coltsfoot leaves.

These medicinal plants are used individually or mixed in proportions of 1:1. Dry herbs are poured with boiling water, insisted for 15-20 minutes and drunk like tea. Such fees strengthen the immune system, have a tonic and anti-inflammatory effect. You can use them all year round, alternating herbs every 1.5-2 months.

Diseases of the pleura are common in general practice and may reflect a wide range of underlying pathological conditions affecting the lungs, chest wall, and systemic diseases. The most common manifestation is a pleural effusion, and in the vast majority of these patients, radiological confirmation and further investigation are required. Recent advances in chest imaging, therapy, and surgery have improved the diagnosis and treatment of patients with pleural pathology.

The pleura gives the chest the ability to give the lungs the necessary shape and set them in motion with a minimum expenditure of energy. Why two pleural sheets (parietal and visceral) should slide one over the other - this process is facilitated by a small amount (0.3 ml / kg) of fluid.

The pleural fluid is filtered from the small vessels of the parietal pleura into the pleural cavity and reabsorbed by the lymphatic vessels of the same sheet. Experimental data show that the volume and composition of the pleural fluid is normally very stable, and effusion occurs only if the filtration rate exceeds the maximum lymph outflow or reabsorption is impaired.

Pleural effusion

Pleural effusions are traditionally classified into transudates (total protein< 30 г/л) и экссудаты (общий белок >30 g/l). In intermediate cases (namely, when the protein content is 25-35 g / l), the determination of the content of lactate dehydrogenase (LDH) in the pleural fluid and the albumin gradient between serum and pleural fluid helps to distinguish between exudate and transudate.

The most common causes and characteristic signs of pleural effusions are given in and. Their differentiation is important because "low-protein" effusions (transudates) do not require further diagnostic measures; only the treatment of the pathology that caused them is necessary, while if pleural exudate is detected, additional diagnostics are certainly needed.

Effusions can be unilateral or bilateral. The latter are often detected in heart failure, but can also occur in hypoproteinemic conditions and in collagenoses with vascular damage. A thorough history, including occupation, foreign travel and risk factors for thromboembolism, and a thorough physical examination are very important.

• clinical picture. The most common symptom of a pleural effusion is shortness of breath, the severity of which depends on the amount of effusion, the rate of fluid accumulation, and whether there is pre-existing lung disease. Pain caused by pleurisy may be an early sign and be due to inflammation or infiltration of the parietal pleura.

Physical examination reveals restriction of respiratory movements of the chest, "stone" dullness on percussion, muffled breathing on auscultation, and often a zone of bronchial breathing above the fluid level.

• Research methods. Diagnosis is confirmed by chest x-ray; but at least 300 ml of fluid must accumulate in the pleural cavity to be detectable on a normal direct x-ray. When the patient is lying on his back, the fluid moves through the pleural space, lowering the transparency of the lung field on the side of the lesion.

Small effusions should be differentiated from pleural thickening. X-rays in the supine position (with the fluid moving under the influence of gravity), as well as ultrasound (ultrasound) or X-ray computed tomography (CT) can help.

Both ultrasonography and CT are valuable techniques that are increasingly being used to differentiate between pleural fluid, enveloped lung (pleural plaques commonly associated with asbestos exposure) and tumor. These methods also make it possible to determine whether the pleural fluid is encysted and to identify the optimal site for pleural puncture and biopsy.

Pleural puncture with aspiration and biopsy are indicated in all patients with effusion, providing much more diagnostic information than aspiration alone and avoiding a second invasive procedure (see Fig. 1).

Other investigations to assist in establishing the diagnosis include repeat chest x-ray after aspiration to look for underlying lung pathology, CT, lung isotope scanning (with ventilation-to-perfusion ratio), tuberculin intradermal testing, serology for rheumatoid and antinuclear factors.

If the above methods do not allow to identify the cause of pleural effusions, thoracoscopy is performed using video technology. It allows not only to examine the pleura, but also to identify tumor nodes and carry out targeted biopsy. This procedure is most valuable for diagnosing mesothelioma. Be that as it may, in 20% of patients with exudative pleural effusions, conventional studies fail to diagnose the cause of this condition.

• Treatment. Symptomatic relief of dyspnea is achieved with thoracocentesis and drainage of the pleural cavity with effusion. Drainage of uninfected effusions is initially recommended to be limited to 1 L due to the risk of reactive edema of the expanding lung.

Treatment of the pathology that provokes the development of pleural effusion, such as heart failure or pulmonary embolism, often leads to its disappearance. Some conditions, including empyema and malignant tumors, require special care, which will be discussed below.

Parapneumonic effusions and empyema

Approximately 40% of patients with bacterial pneumonia develop concomitant pleural effusion; in such cases, a pleural puncture should be performed to make sure that there is no empyema and to prevent or reduce the degree of subsequent thickening of the pleura.

However, in 15% of patients, parapneumonic effusions become secondarily infected, developing empyema, that is, pus is formed in the pleural cavity (see Fig. 2).

Other causes of empyema include surgery (20%), trauma (5%), esophageal perforations (5%), and subdiaphragmatic infections (1%).

With empyema, most of the sown crops are represented by aerobic microorganisms. Anaerobic bacteria are cultured in 15% of cases of empyema, which are usually a complication of aspiration pneumonia; the remaining cases are due to a variety of other microorganisms (see Table 3). If antibiotics were prescribed before the pleural puncture, the cultures often fail to grow.

• clinical picture. In pneumonia, empyema should be considered if the patient's condition, despite adequate antibiotic therapy, improves slowly, with persistent or recurrent fever, weight loss, and malaise, or with persistent polymorphonuclear leukocytosis or elevated C-reactive protein.

The diagnosis is confirmed on the basis of radiographic signs of encysted pleurisy or in case of detection of pus in the pleural punctate (see).

• Treatment. If the presence of a pleural infection is established, it is necessary to start treatment with large doses of antibiotics. If culture results are not known, the potentially most effective combination of antibiotics should be used: penicillin or cephalosporin (second or third generation) plus metronidazole.

In addition, under ultrasound or CT guidance, drainage should be established from the lowest part of the empyema and connected to an underwater valve mechanism. In the past, the use of relatively large diameter drains was recommended, but narrower tubes are now found to be effective with less trauma to patients.

If adhesions are detected on ultrasound or CT, suction should be carried out along the drain, which should be regularly flushed with saline. In such cases, some experts advise daily intrapleural infusions of fibrinolytic drugs such as streptokinase or urokinase. The last of these drugs is recommended in cases where streptokinase has been administered to the patient over the past year or antibodies to streptokinase have been detected in him.

Recommendations regarding the appropriateness of the use of fibrinolytics are based on the results of small, uncontrolled studies, according to which the frequency of adhesion elimination was 60-95%, and the need for surgical interventions was significantly reduced. The lack of controlled studies to date explains some uncertainty about when, for how long and at what doses fibrinolytic drugs should be used. Currently, under the auspices of the Medical Research Council, work is underway, the results of which will help answer these questions.

If as a result of drainage from the intercostal access (with or without fibrinolytics) it is not possible to achieve adequate fluid removal, if the empyema persists, organizes and is accompanied by thickening of the pleura and compression of the lung, then surgical intervention is indicated.

Thoracoscopy is usually successful in the early stages of the disease, but may fail with extensive pleural adhesions. In these cases, thoracotomy and decortication are indicated. Although such surgery is highly effective in the treatment of empyema (>90%), it is associated with significant operative risk, especially in debilitated patients.

Open drainage, which requires a rib resection, is a rather unattractive procedure and is performed only when the patient cannot tolerate more invasive surgery.

Untreated, an empyema may rupture outward through the chest wall (a "perforating" empyema) or into the bronchial tree to form a bronchopleural fistula, or cause extensive pleural fibrosis that restricts lung mobility. Rare complications include brain abscess and amyloidosis, and clubbing may also occur.

Pleural lesions in malignant neoplasms

Lung cancer is the most common cause of malignant pleural effusion, especially in smokers. Lymphoma can occur at any age and accounts for 10% of all malignant effusions. Pleural metastases are most common in breast (25%), ovarian (5%), or gastrointestinal (2%) cancers (see Fig. 3). In 7% of cases, the primary tumor remains unknown.

• Treatment. The defeat of the pleura by a malignant tumor is usually associated with a far-reaching disease, and, consequently, with an unfavorable prognosis.

It is important to understand that in primary bronchogenic cancer, the presence of a pleural effusion does not necessarily rule out operability. In 5% of these patients, effusion develops due to bronchial obstruction and distal infection, and the disease remains potentially curable.

Therefore, when the question arises of the possibility of an operation, it is extremely important to establish the cause of the pleural effusion.

The exudates caused by malignant infiltration of a pleura usually quickly accumulate again. In order to avoid the need for repeated pleural punctures, the effusion must be completely ("dry") removed during the initial drainage through the intercostal tube, and the pleural cavity must be obliterated with the introduction of inflammatory drugs, such as talc, tetracycline or bleomycin, while eventually pleurodesis develops. Currently, talc is considered the most effective remedy in this regard: with its use, success is achieved in 90% of patients.

However, effective pleurodesis leads to significant pain in the postoperative period, which often requires the use of strong analgesics; it is recommended to avoid non-steroidal anti-inflammatory drugs, as they reduce the effectiveness of the operation.

Direct abrasion of the pleura during surgery, with or without pleurectomy, is used in young patients with relatively long survival who have failed chemical pleurodesis.

With extensive, painful pleural effusion for the patient and the ineffectiveness of chemical pleurodesis, an alternative method is the installation of a pleuroperitoneal shunt according to Denver. Surprisingly, with such an operation, seeding of the tumor along the peritoneum is not observed, however, the development of infection and occlusion of the shunt can result in a real problem.

Pleural pathology associated with asbestos

• Benign plaques of the pleura. This pathology most often occurs in contact with asbestos, it manifests itself in the form of areas of thickening of the parietal and diaphragmatic pleura. The formation of benign pleural plaques due to asbestos exposure is asymptomatic, more often they are discovered incidentally, on a routine chest x-ray. Often these plaques are calcified.
• Benign pleural effusion. This is a specific disease associated with asbestos exposure, which can be accompanied by pleural pain, fever and leukocytosis. The effusion is often bloody, making it difficult to differentiate from mesothelioma. The disease is self-limiting, but may cause pleural fibrosis.
• Diffuse fibrosis of the pleura. This is a serious disease that occurs when asbestos fibers are inhaled. In contrast to benign pleural plaques, it can restrict the movement of the chest during inhalation, which causes shortness of breath. The disease progresses and can lead to severe disability. Table 4 provides details of when such patients are eligible for compensation.
• Mesothelioma. The majority (>70%) of this pleural cancer is thought to be caused by inhalation of asbestos fibres, especially crocidolite, amosite and chrysolite. The long latent period of mesothelioma development (30-40 years) may explain the fact that the increase in the incidence of this pathology continues today, that is, many years after the introduction of strict laws on the use of asbestos.

In 2002, mesothelioma deaths in the UK are projected to peak in 2020 at 3,000.

In most countries, men predominate among the sick, which confirms the leading role of the occupational factor in the development of this disease.

Age at the time of exposure to asbestos, as well as the duration and intensity of this exposure, are also important. Occupations that require direct contact with asbestos, especially workers in the construction industry, are most at risk, while people living in buildings containing asbestos are much less at risk.

The disease is manifested by chest pain and pleural effusion, which is bloody and causes shortness of breath. In the UK, patients with this disease are entitled to compensation, as with other diseases and injuries received at work (see).

In all cases, a histological examination is necessary, during which either material obtained by aspiration of pleural contents and biopsy under ultrasound control (which allows confirming the diagnosis in 39% of such patients) or tissue taken during thoracoscopy (the diagnosis is confirmed in 98% of patients) is used. . Thoracoscopy also makes it possible to determine the extent of the tumor in the pleural cavity, since a very limited disease at an early stage can be cured by surgery, while the prognosis is poor if the visceral pleura is affected.

After such diagnostic interventions, seeding of the tumor along the pleura is often observed, the prevention of this condition involves irradiation of the biopsy or drainage area.

Most patients first come to the doctor with an inoperable tumor. In such a situation, none of the methods provides the possibility of curing the patient, however, today attempts are being made to use radical surgery, photodynamic therapy, intrapleural systemic chemotherapy and radiation therapy. And although gene therapy has not yet been successful, immunotherapy may be recognized as promising. Unfavorable diagnostic factors are: low functional reserves of the cardiovascular and respiratory systems, leukocytosis, degeneration into sarcoma (according to histological examination) and male sex. Within one year, from 12 to 40% of patients survive, depending on the listed prognostic factors.

Spontaneous pneumothorax

Spontaneous pneumothorax may be primary (without obvious prior lung disease) or secondary (when there are signs of pulmonary disease, such as pulmonary fibrosis). Less common causes of pneumothorax include pulmonary infarction, lung cancer, rheumatoid nodules, or lung abscess with cavity formation. Subpleural emphysematous bullae, usually located in the region of the apex of the lung, or pleural bullae are found in 48-79% of patients with supposedly spontaneous primary pneumothorax.

Among smokers, the incidence of pneumothorax is much higher. The relative risk of developing pneumothorax is nine times higher in female smokers and 22 times higher in male smokers. Moreover, a dose-effect relationship has been found between the number of cigarettes smoked per day and the frequency of pneumothorax.

• clinical picture. If it is known from the anamnesis that the patient suddenly developed shortness of breath with pain in the chest or in the supraclavicular region, then spontaneous pneumothorax can be suspected with a high probability. With a small amount of pneumothorax, physical examination may not reveal any pathological signs, in which case the diagnosis is made on the basis of chest x-ray data (see Fig. 4).

In the diagnosis of small in volume, mainly apical, pneumothorax, exhalation images can help, which, however, are rarely used. It is necessary to distinguish between large emphysematous bullae and pneumothorax.

• Treatment. Treatment of pneumothorax depends mainly on how much it affects the patient's condition, and not on its volume according to x-ray.

The treatment algorithm is presented on. Percutaneous aspiration is a simple, well-tolerated, alternative procedure to intercostal tube drainage and should be preferred in most cases. Aspiration achieves satisfactory expansion of the lung in 70% of patients with normal lung function and only in 35% of patients with chronic lung disease.

The median recurrence rate after a single primary spontaneous pneumothorax, regardless of primary treatment, is 30%, most occurring within the first 6–24 months.

Patients should be warned about the possibility of developing recurrent pneumothorax: in particular, they are not recommended to fly on airplanes for six weeks after the complete resolution of pneumothorax. Surgery is usually required in cases where persistent accumulation of air is observed during the week.

Recurrent pneumothorax, especially if both lungs are affected, should be treated either by chemical pleurodesis or, more preferably, by parietal pleurectomy or pleural abrasion.

The last of these operations can be performed using video-guided thoracoscopy, which allows you to follow the progress of the procedure using a monitor, reduce hospital stays and speed up the return of the patient to a normal lifestyle. Surgical treatment can reduce the recurrence rate to 4% compared to 8% after talcum pleurodesis.

In this article, we talked about several aspects related to pleural diseases, including the latest advances in this area. Pleural effusion is the most common manifestation of pleural pathology, requiring a thorough examination. If, after conventional research methods, the cause of the disease remains unclear, all necessary measures should be taken to exclude pulmonary embolism, tuberculosis, drug reactions and subdiaphragmatic pathological processes.

Helen Parfrey, MBH, BS Chemistry, FRC
West Suffolk Hospital
Edwin R. Childers, B.M., B.S., Ph.D., Professor
University of Cambridge, School of Clinical Medicine, Department of Internal Medicine, Addenbrooke and Papworth Hospital

Note!

• Effusions can be unilateral or bilateral. The latter are often detected in heart failure, but can also occur in hypoproteinemic conditions and in vascular lesions caused by collagenoses. A thorough history of occupation, foreign travel history, and risk factors for thromboembolism, as well as a thorough physical examination, are very important.
• The most common symptom of a pleural effusion is shortness of breath; pain from pleurisy may be an early sign, it is due to inflammation or infiltration of the parietal pleura. Physical examination reveals restriction of respiratory movements of the chest, percussion - "stone" dullness on percussion, muffled breathing on auscultation, and often the presence of a zone of bronchial breathing above the liquid level.
• Pleural puncture with aspiration and biopsy are indicated in all patients with unilateral effusion. Be that as it may, in 20% of cases of exudative pleural effusions, conventional studies fail to identify their cause.
• Approximately 40% of patients with bacterial pneumonia develop concomitant pleural effusion; in such cases, to exclude empyema, it is necessary to perform a pleural puncture.
• Lung cancer is the most common cause of metastatic pleural effusion (36%), especially in smokers. The defeat of the pleura by a malignant tumor usually means a far advanced disease, and therefore an unfavorable prognosis.

The prognosis for pleurisy depends on the cause of this disease, as well as on the stage of the disease ( at the time of diagnosis and initiation of therapeutic procedures). The presence of an inflammatory reaction in the pleural cavity, which accompanies any pathological processes in the lungs, is an unfavorable sign and indicates the need for intensive treatment.

Since pleurisy is a disease that can be caused by a fairly large number of pathogenic factors, there is no single treatment regimen shown in all cases. In the vast majority of cases, the goal of therapy is the initial ailment, after the cure of which the inflammation of the pleura is also eliminated. However, in order to stabilize the patient and improve his condition, they often resort to the use of anti-inflammatory drugs, as well as surgical treatment ( puncture and extraction of excess fluid).

Interesting Facts

• pleurisy is one of the most common pathologies in therapy and occurs in almost every tenth patient;
• it is believed that the cause of death of the French queen Catherine de Medici, who lived in the XIV century, was pleurisy;
• drummer for the Beatles The Beatles) Ringo Starr suffered from chronic pleurisy at the age of 13, because of which he missed two years of study without finishing school;
• first description of pleural empyema ( accumulation of pus in the pleural cavity) was given by an ancient Egyptian physician and dates back to the third millennium BC.

Pleura and its defeat

The pleura is a serous membrane that covers the lungs and consists of two sheets - parietal or parietal, covering the inner surface of the chest cavity, and visceral, directly enveloping each lung. These sheets are continuous and pass one into another at the level of the gate of the lung. The pleura is composed of special mesothelial cells ( squamous epithelial cells) located on a fibroelastic frame in which blood and lymphatic vessels and nerve endings pass. Between the pleura there is a narrow space filled with a small amount of fluid, which serves to facilitate the sliding of the pleural sheets during respiratory movements. This liquid results from leakage ( filtration) plasma through the capillaries in the area of ​​​​the tops of the lungs, followed by absorption by the blood and lymphatic vessels of the parietal pleura. In pathological conditions, excessive accumulation of pleural fluid may occur, which may be due to its insufficient absorption or excessive production.

Damage to the pleura with the formation of an inflammatory process and the formation of an excess amount of pleural fluid can occur under the influence of infections ( directly affecting the pleura or covering nearby lung tissues), injuries, mediastinal pathologies ( a cavity located between the lungs and containing the heart and important vessels, the trachea and main bronchi, the esophagus and some other anatomical structures), against the background of systemic diseases, as well as due to metabolic disorders of a number of substances. In the development of pleurisy and other lung diseases, the place of residence and occupation of a person is important, since these factors determine some aspects of the negative impact on the respiratory system of a number of toxic and harmful substances.

It should be noted that one of the main signs of pleurisy is pleural effusion - excessive accumulation of fluid in the pleural cavity. This condition is optional for inflammation of the pleural sheets, but occurs in most cases. In some situations, pleural effusion occurs without the presence of an inflammatory process in the pleural cavity. As a rule, such an ailment is considered precisely as a pleural effusion, but in some cases it can be classified as pleurisy.

Causes of pleurisy

Pleurisy is a disease that in the vast majority of cases develops on the basis of any existing pathology. The most common cause of the development of an inflammatory reaction in the pleural cavity are various infections. Often pleurisy occurs against the background of systemic diseases, tumors, injuries.

Some authors refer to pleurisy and cases of pleural effusion without a clear presence of an inflammatory response. This situation is not entirely correct, since pleurisy is an ailment that involves an obligatory inflammatory component.

There are the following causes of pleurisy:

• infection of the pleura;
• allergic inflammatory reaction;
• autoimmune and systemic diseases;
• exposure to chemicals;
• chest trauma;
• exposure to ionizing radiation;
• exposure to pancreatic enzymes;
• primary and metastatic tumors of the pleura.

Infection of the pleura

An infectious lesion of the pleura is one of the most common causes of the formation of an inflammatory focus in the pleural cavity with the development of purulent or other pathological exudate ( allocation).

Infection of the pleura is a serious ailment, which in many cases can threaten the life of the patient. Adequate diagnosis and treatment of this condition requires the coordinated actions of pulmonologists, internists, radiologists, microbiologists and, often, thoracic surgeons. The therapeutic approach depends on the nature of the pathogen, its aggressiveness and sensitivity to antimicrobials, as well as on the stage of the disease and the type of infectious and inflammatory focus.

Pleurisy of an infectious nature affects patients of all age categories, but most often they occur among the elderly and children. Men get sick almost twice as often as women.

The following comorbidities are risk factors for the development of an infectious lesion of the pleura:

• Diabetes. Diabetes mellitus develops as a result of a violation of the endocrine function of the pancreas, which produces an insufficient amount of insulin. Insulin is a hormone that is essential for the normal metabolism of glucose and other sugars. With diabetes, many internal organs are affected, and there is also some decrease in immunity. In addition, an excess concentration of glucose in the blood creates favorable conditions for the development of many bacterial agents.
• Alcoholism . In chronic alcoholism, many internal organs suffer, including the liver, which is responsible for the production of protein components of antibodies, the lack of which leads to a decrease in the body's protective potential. Chronic alcohol abuse leads to impaired metabolism of a number of nutrients, as well as to a decrease in the number and quality of immune cells. In addition, people who suffer from alcoholism are more prone to chest injuries as well as respiratory tract infections. This happens due to hypothermia against the background of reduced sensitivity and behavioral disorders, as well as due to the suppression of protective reflexes, which increases the risk of inhaling infected materials or one's own vomit.
• Rheumatoid arthritis. Rheumatoid arthritis is an autoimmune disease that can itself cause damage to the pleura. However, this disease is also a serious risk factor for the development of an infectious lesion of the pleura. This is due to the fact that often drugs that reduce immunity are used to treat this disease.
• Chronic lung diseases. Many chronic lung diseases, such as chronic bronchitis, chronic obstructive pulmonary disease, emphysema, asthma and some other pathologies create the preconditions for an infectious lesion of the pleura. This happens for two reasons. First, many chronic lung diseases are characterized by sluggish infectious and inflammatory processes that can progress over time and cover new tissues and areas of the lungs. Secondly, with these pathologies, the normal operation of the respiratory apparatus is disrupted, which inevitably leads to a decrease in its protective potential.
• Pathology of the gastrointestinal tract. Diseases of the dental apparatus can cause the accumulation of infectious agents in the oral cavity, which, after a deep breath ( e.g. while sleeping) can end up in the lungs and cause pneumonia with subsequent damage to the pleura. gastroesophageal reflux ( return of food from the stomach to the esophagus) contributes to respiratory tract infection by increasing the risk of inhaling gastric contents that can be infected and which reduce local immunity ( due to the irritating effect of hydrochloric acid).

An infectious lesion of the pleura occurs as a result of the penetration of pathogenic agents into the pleural cavity with the development of a subsequent inflammatory response. In clinical practice, it is customary to distinguish 4 main ways of penetration of pathogens.

Infectious agents can enter the pleural cavity in the following ways:

• Contact with an infectious focus in the lungs. When the infectious-inflammatory focus is located in close proximity to the pleura, a direct transition of pathogens with the development of pleurisy is possible.
• with lymph flow. The penetration of microorganisms along with the lymph flow is due to the fact that the lymphatic vessels of the peripheral regions of the lungs drain into the pleural cavity. This creates the prerequisites for the penetration of infectious agents from areas that do not come into direct contact with the serous membrane.
• With blood flow. Some bacteria and viruses are capable of penetrating into the bloodstream at a certain stage of their development, and at the same time into various organs and tissues.
• Direct contact with the external environment ( injuries). Any penetrating trauma to the chest cavity is considered as potentially infected and, accordingly, as a possible source of infection of the pleura. Openings and incisions in the chest wall, made for therapeutic purposes, but inappropriate conditions or in the absence of proper care, can also act as a source of pathogenic microorganisms.

It should be noted that in many cases pneumonia ( pneumonia) is accompanied by the appearance of pleural effusion without direct infection of the pleura. This is due to the development of a reactive inflammatory process that irritates the pleura, as well as a slight increase in fluid pressure and blood vessel permeability in the area of ​​​​the infectious focus.

Under the influence of these microorganisms, an inflammatory process develops, which is a special protective reaction aimed at eliminating infectious agents and limiting their spread. Inflammation is based on a complex chain of interactions between microorganisms, immune cells, biologically active substances, blood and lymphatic vessels, and tissues of the pleura and lungs.

In the development of pleurisy, the following successive stages are distinguished:

• exudation phase. Under the action of biologically active substances, which are released by immune cells activated as a result of contact with infectious agents, there is an expansion of blood vessels with an increase in their permeability. This leads to increased production of pleural fluid. At this stage, the lymphatic vessels cope with their function and adequately drain the pleural cavity - there is no excessive accumulation of fluid.
• The phase of formation of purulent exudate. As the inflammatory reaction progresses, deposits of fibrin, a “sticky” plasma protein, begin to form on the pleura sheets. This happens under the influence of a number of biologically active substances that reduce the fibrinolytic activity of pleural cells ( their ability to break down fibrin strands). This leads to the fact that friction between the pleural sheets increases significantly, and in some cases adhesions occur ( areas of "gluing" serous membranes). A similar course of the disease contributes to the formation of divided areas in the pleural cavity ( so-called "pockets" or "bags"), which greatly complicates the outflow of pathological contents. After some time, pus begins to form in the pleural cavity - a mixture of dead bacteria that have absorbed their immune cells, plasma and a number of proteins. The accumulation of pus contributes to the progressive swelling of mesothelial cells and tissues located near the inflammatory focus. This leads to the fact that the outflow through the lymphatic vessels decreases and an excess volume of pathological fluid begins to accumulate in the pleural cavity.
• Recovery stage. At the stage of recovery, either resorption occurs ( resorption) pathological foci, or, if it is impossible to independently eliminate the pathogenic agent, connective tissue ( fibrotic) formations that limit the infectious-inflammatory process with a further transition of the disease into a chronic form. Foci of fibrosis adversely affect lung function, as they significantly reduce their mobility, and in addition, increase the thickness of the pleura and reduce its ability to reabsorb fluid. In some cases, either separate adhesions are formed between the parietal and visceral pleura ( mooring lines), or complete fusion with fibrous fibers ( fibrothorax).

Tuberculosis

Despite the fact that tuberculosis is a bacterial infection, this pathology is often considered separately from other forms of microbial damage to the organs of the respiratory system. This is due, firstly, to the high contagiousness and prevalence of this disease, and secondly, to the specificity of its development.

Tuberculous pleurisy occurs as a result of penetration into the pleural cavity of Mycobacterium tuberculosis, also known as Koch's bacillus. This disease is considered as the most common form of extrapulmonary infection, which can occur when the primary foci are located both in the lungs and in other internal organs. May develop against the background of primary tuberculosis, which occurs upon first contact with the pathogen ( typical for children and adolescents), or secondary, which develops as a result of repeated contact with a pathogenic agent.

The penetration of mycobacteria into the pleura is possible in three ways - lymphogenous and contact when the primary focus is located in the lungs or spine ( rarely), and hematogenous if the primary infectious focus is located in other organs ( gastrointestinal tract, lymph nodes, bones, genitals, etc.).

The development of tuberculous pleurisy is based on an inflammatory response supported by the interaction between immune cells ( neutrophils during the first few days and lymphocytes thereafter) and mycobacteria. During this reaction, biologically active substances are released that affect the tissues of the lung and serous membranes, and which maintain the intensity of inflammation. Against the background of dilated blood vessels within the infectious focus and reduced outflow of lymph from the pleural cavity, a pleural effusion is formed, which, unlike infections of a different nature, is characterized by an increased content of lymphocytes ( over 85%).

It should be noted that a certain unfavorable set of circumstances is necessary for the development of tuberculosis infection. Most people are not infected by simple contact with Koch's bacillus. Moreover, it is believed that in many people, Mycobacterium tuberculosis can live in the tissues of the lungs without causing disease and any symptoms.

The following factors contribute to the development of tuberculosis:

• High density of infectious agents. The likelihood of developing an infection increases with the number of inhaled bacilli. This means that the higher the concentration of mycobacteria in the environment, the higher the chances of infection. Such a development of events is facilitated by being in the same room with patients with tuberculosis ( at the stage of isolation of pathogenic agents), as well as the lack of adequate ventilation and the small volume of the room.
• Long contact time. Prolonged contact with infected people or prolonged exposure to a room in which mycobacteria are in the air is one of the main factors contributing to the development of infection.
• Low immunity. Under normal conditions, with periodic vaccinations, the human immune system copes with tuberculosis pathogens and prevents the development of the disease. However, in the presence of any pathological condition in which there is a decrease in local or general immunity, the penetration of even a small infectious dose can cause infection.
• High aggressiveness of the infection. Some mycobacteria have greater virulence, that is, an increased ability to infect humans. The penetration of such strains into the human body can cause infection even with a small number of bacilli.

Decreased immunity is a condition that can develop against the background of many pathological conditions, as well as with the use of certain medicinal substances.

The following factors contribute to a decrease in immunity:

• chronic diseases of the respiratory system ( infectious and non-infectious nature);
• diabetes;
• chronic alcoholism;
• treatment with drugs that suppress the immune system ( glucocorticoids, cytostatics);
• HIV infection ( especially in AIDS).

allergic inflammatory response

An allergic reaction is a pathological excessive response of the immune system that develops when interacting with foreign particles. Since the tissues of the pleura are rich in immune cells, blood and lymphatic vessels, and are also sensitive to the effects of biologically active substances that are released and support the inflammatory response during allergies, after contact with the allergen, the development of pleurisy and pleural effusion is often observed.

Pleurisy can develop with the following types of allergic reactions:

• Exogenous allergic alveolitis. Exogenous allergic alveolitis is a pathological inflammatory reaction that develops under the influence of external foreign particles - allergens. In this case, often there is a lesion of the lung tissue immediately adjacent to the pleura. The most common allergens are fungal spores, plant pollen, house dust, and some medicinal substances.
• drug allergy. Allergy to drugs is a common occurrence in the modern world. A fairly large number of people are allergic to certain antibiotics, local anesthetics and other pharmacological drugs. A pathological response develops within minutes or hours after drug administration ( depending on the type of allergic reaction).
• Other types of allergies . Some other types of allergies that do not directly affect lung tissue can cause the activation of pleural immune cells with the release of biologically active substances and the development of edema and exudation. After the action of the allergen is eliminated, the scale of inflammation decreases, and the reabsorption of excess fluid from the pleural cavity begins.

It should be noted that true allergic reactions do not develop at the first contact with a foreign substance, since the body's immune cells are not "familiar" with it, and cannot quickly respond to its intake. During the first contact, the allergen is processed and presented to the immune system, which forms special mechanisms that allow rapid activation upon repeated contact. This process takes several days, after which contact with the allergen inevitably causes an allergic reaction.

It must be understood that the inflammatory response underlying an allergy is not significantly different from the inflammatory response that develops during an infectious process. Moreover, in most cases, microorganisms provoke an allergic reaction in the pleura, which contributes to the development of pleurisy and the formation of exudate.

Autoimmune and systemic diseases

Pleurisy is one of the most common forms of lung damage in autoimmune and systemic diseases. This pathology occurs in almost half of patients with rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis and other connective tissue diseases.

Autoimmune diseases are pathologies in which the immune system begins to attack its own tissues ( usually connective tissue fibers). As a result, a chronic inflammatory reaction develops, which covers many organs and tissues ( mainly joints, skin, lungs).

Pleurisy can develop with the following systemic pathologies:

• rheumatoid arthritis;
• systemic lupus erythematosus;
• dermatomyositis;
• Wegener's granulomatosis;
• Churg-Strauss syndrome;
• sarcoidosis.

It must be understood that the autoimmune reaction is based on an inflammatory process that can either directly affect the pleural tissues, which leads to the development of classic pleurisy, or indirectly when the function of other organs is impaired ( heart, kidneys), which leads to the formation of a pleural effusion. It is important to note that clinically pronounced pleurisy is quite rare, however, a detailed examination of such patients suggests a rather widespread occurrence of this phenomenon.

Exposure to chemicals

The direct effect of certain chemicals on the pleural sheets can cause their inflammation and, accordingly, can cause the development of dry or effusion pleurisy. In addition, chemical damage to peripheral lung tissues also contributes to the formation of an inflammatory process that can also involve the serous membrane.

Chemicals can enter the pleural cavity in the following ways:

• With open trauma. With an open chest injury, various chemically active substances, such as acids, alkalis, etc., can enter the pleural cavity.
• With closed injuries of the chest. Closed injuries of the chest can cause rupture of the esophagus with subsequent entry of food or gastric contents into the mediastinum and parietal pleura.
• By inhaling chemicals. Inhalation of some hazardous chemicals can cause burns to the upper and lower respiratory tract, as well as an inflammatory process in the tissues of the lungs.
• Chemical injections. When administered intravenously, substances not intended for such use can enter the tissues of the lungs and pleura and cause serious impairment of their function.

Chemicals provoke the development of the inflammatory process, violate the structural and functional integrity of tissues, and also significantly reduce local immunity, which contributes to the development of the infectious process.

Chest injury

Chest trauma is a factor that in some cases is the cause of the development of an inflammatory reaction and the formation of pleural effusion. This may be due to damage to both the pleura itself and nearby organs ( esophagus).

In case of damage to the pleural sheets as a result of exposure to a mechanical factor ( with closed and open injuries), an inflammatory response occurs, which, as described above, leads to increased production of pleural fluid. In addition, the traumatic effect disrupts the lymph circulation in the damaged area, which significantly reduces the outflow of pathological fluid and contributes to the development of pleural effusion. The penetration of pathogenic infectious agents is another additional factor that increases the risk of developing post-traumatic pleurisy.

Damage to the esophagus, which can occur with a strong blow to the chest cavity, is accompanied by the release of food and gastric contents into the mediastinal cavity. Due to the frequent combination of rupture of the esophagus with a violation of the integrity of the pleural sheets, these substances can enter the pleural cavity and cause an inflammatory reaction.

Exposure to ionizing radiation

Under the action of ionizing radiation, the function of mesothelial cells of the pleura is disrupted, a local inflammatory reaction develops, which in combination leads to the formation of a significant pleural effusion. The inflammatory process develops due to the fact that, under the influence of ionizing radiation, some molecules change their function and structure and provoke local tissue damage, which leads to the release of biological substances with pro-inflammatory activity.

Effects of pancreatic enzymes

Pleurisy and pleural effusion develop in about 10% of patients with acute pancreatitis ( inflammation of the pancreas) within 2-3 days after the onset of the disease. In most cases, a small amount of pathological fluid accumulates in the pleural cavity, which resolves on its own after normalization of pancreatic function.

Pleurisy develops due to the destructive effect on the serous membranes of pancreatic enzymes, which enter the blood when it becomes inflamed ( normally they are transported directly to the duodenum). These enzymes partially destroy blood vessels, the connective tissue basis of the pleura, and activate immune cells. As a result, exudate accumulates in the pleural cavity, which consists of leukocytes, blood plasma and destroyed red blood cells. Amylase concentration ( pancreatic enzyme) in the pleural effusion can be several times higher than the concentration in the blood.

Pleural effusion in pancreatitis is a sign of severe damage to the pancreas and, according to a number of studies, is more common in pancreatic necrosis ( death of a significant part of the body's cells).

Primary and metastatic tumors of the pleura

Pleurisy, which arose against the background of malignant tumors of the pleura, is a fairly common pathology that doctors have to deal with.

Pleurisy can develop with the following types of tumors:

• Primary tumors of the pleura . A primary tumor of the pleura is a neoplasm that has developed from cells and tissues that make up the normal structure of this organ. In most cases, these tumors are formed by mesothelial cells and are called mesothelioma. They occur in only 5-10% of cases of pleural tumors.
• Metastatic foci in the pleura. Pleural metastases are tumor fragments that have separated from the primary focus located in any organ, and which migrated to the pleura, where they continued their development. In most cases, the tumor process in the pleura is of a metastatic nature.

The inflammatory reaction in the tumor process develops under the influence of pathological metabolic products produced by the tumor tissues ( since the function of the tumor tissue differs from the norm).

Pleural effusion, which is the most common manifestation of neoplastic pleurisy, develops as a result of the interaction of several pathological mechanisms on the pleura. Firstly, the tumor focus, which occupies a certain volume in the pleural cavity, reduces the area of ​​the effectively functioning pleura and reduces its ability to reabsorb fluid. Secondly, under the action of products produced in tumor tissues, the concentration of proteins in the pleural cavity increases, which leads to an increase in oncotic pressure ( proteins are able to "attract" water - a phenomenon called oncotic pressure). And, thirdly, the inflammatory reaction that develops against the background of primary or metastatic neoplasms enhances the secretion of pleural fluid.

Types of pleurisy

In clinical practice, it is customary to distinguish several types of pleurisy, which differ in the nature of the effusion formed in the pleural cavity, and, accordingly, in the main clinical manifestations. This division in most cases is rather arbitrary, since one type of pleurisy can often turn into another. Moreover, dry and exudative ( effusion) pleurisy is considered by most pulmonologists as different stages of one pathological process. It is believed that dry pleurisy is initially formed, and effusion develops only with further progression of the inflammatory reaction.


In clinical practice, the following types of pleurisy are distinguished:

• dry ( fibrinous) pleurisy;
• exudative pleurisy;
• purulent pleurisy;
• tuberculous pleurisy.

Dry ( fibrinous) pleurisy

Dry pleurisy develops at the initial stage of an inflammatory lesion of the pleura. Often, at this stage of the pathology, there are still no infectious agents in the lung cavity, and the resulting changes are due to the reactive involvement of blood and lymphatic vessels, as well as an allergic component.

With dry pleurisy, due to an increase in vascular permeability under the action of pro-inflammatory substances, the liquid component of the plasma and some of the proteins begin to seep into the pleural cavity, among which fibrin is of the greatest importance. Under the influence of the environment in the inflammatory focus, fibrin molecules begin to combine and form strong and sticky threads that are deposited on the surface of the serous membrane.

Since with dry pleurisy the amount of effusion is minimal ( the outflow of fluid through the lymphatic vessels is slightly impaired), fibrin threads significantly increase friction between the pleura. Since there are a large number of nerve endings in the pleura, increased friction causes a significant pain sensation.

The inflammatory process in fibrinous pleurisy affects not only the serous membrane itself, but also the cough nerve receptors located in its thickness. Due to this, the threshold of their sensitivity decreases, and a cough reflex occurs.

Exudative ( effusion) pleurisy

Exudative pleurisy is the next phase of the development of the disease after dry pleurisy. At this stage, the inflammatory reaction progresses, the area of ​​the affected serous membrane increases. The activity of enzymes that break down fibrin threads decreases, pleural pockets begin to form, in which pus can accumulate in the future. The outflow of lymph is disturbed, which, against the background of increased secretion of fluid ( filtration from dilated blood vessels in the focus of inflammation) leads to an increase in the volume of intrapleural effusion. This effusion compresses the lower segments of the lung from the affected side, which leads to a decrease in its vital volume. As a result, with massive exudative pleurisy, respiratory failure may develop - a condition that poses an immediate threat to the life of the patient.

Since the fluid accumulated in the pleural cavity to some extent reduces the friction between the pleural layers, at this stage, the irritation of the serous membranes and, accordingly, the intensity of the pain sensation is somewhat reduced.

Purulent pleurisy

With purulent pleurisy ( pleural empyema) purulent exudate accumulates between the sheets of the serous membrane of the lung. This pathology is extremely severe and is associated with intoxication of the body. Without proper treatment, it poses a threat to the life of the patient.

Purulent pleurisy can form both with direct damage to the pleura by infectious agents, and with the self-opening of an abscess ( or other collection of pus) of the lung into the pleural cavity.

Empyema usually develops in malnourished patients who have serious damage to other organs or systems, as well as in people with reduced immunity.

Tuberculous pleurisy

Often, tuberculous pleurisy is distinguished into a separate category due to the fact that this ailment is quite common in medical practice. Tuberculous pleurisy is characterized by a slow, chronic course with the development of a syndrome of general intoxication and signs of lung damage ( in rare cases, other organs). The effusion in tuberculous pleurisy contains a large number of lymphocytes. In some cases, this disease is accompanied by the formation of fibrinous pleurisy. When the bronchi are melted by an infectious focus in the lungs, a specific curdled pus, characteristic of this pathology, can enter the pleural cavity.

Symptoms of pleurisy

The clinical picture of pleurisy depends on the following factors:

• cause of pleurisy;
• the intensity of the inflammatory reaction in the pleural cavity;
• stage of the disease;
• type of pleurisy;
• volume of exudate;
• the nature of the exudate.

Pleurisy is characterized by the following symptoms:

• increased body temperature;
• displacement of the trachea.

Dyspnea

Dyspnea is the most common symptom associated with pleurisy and pleural effusion. There is shortness of breath as against the background of the initial lesion of the lung tissue ( most common cause of pleurisy), and due to a decrease in the functional volume of the lung ( or lungs with bilateral lesions).

Shortness of breath is manifested as a feeling of lack of air. This symptom can occur during physical activity of varying intensity, and in the case of a severe course or massive pleural effusion, at rest. With pleurisy, shortness of breath may be accompanied by a subjective feeling of insufficient expansion or filling of the lungs.

Usually, shortness of breath due to an isolated lesion of the pleura develops gradually. It is often preceded by other symptoms ( chest pain, cough).

Shortness of breath that persists after treatment of pleurisy and drainage of pleural effusion indicates a decrease in the elasticity of the lung tissue or that adhesions have formed between the pleura ( mooring lines), which significantly reduce mobility and, accordingly, the functional volume of the lungs.

It should be borne in mind that shortness of breath can also develop with other pathologies of the organs of the respiratory system that are not associated with pleurisy, as well as with impaired heart function.

Cough

Cough with pleurisy is usually of medium intensity, dry, unproductive. It is caused by irritation of the nerve endings located in the pleura. The cough is aggravated by changing the position of the body, and also during inhalation. Chest pain during coughing may increase.

The appearance of sputum purulent or mucous) or spotting during coughing indicates the presence of an infectious ( most often) lung injury.

Chest pain

Chest pain occurs due to irritation of the pain receptors of the pleura under the action of pro-inflammatory substances, as well as due to increased friction between the pleura in dry pleurisy. Pleurisy pain is acute, aggravated during inhalation or coughing, and decreases when holding the breath. Pain sensation covers the affected half of the chest ( or both for bilateral pleurisy) and extends to the area of ​​the shoulder and abdomen from the corresponding side. As the volume of pleural effusion increases, the intensity of pain decreases.

Increased body temperature

An increase in body temperature is a non-specific reaction of the body to the penetration of infectious agents or certain biological substances. Thus, elevated body temperature is characteristic of infectious pleurisy and reflects the severity of the inflammatory process and indicates the nature of the pathogen.

With pleurisy, the following options for elevated body temperature are possible:

• Temperature up to 38 degrees. Body temperature up to 38 degrees is typical for small infectious and inflammatory foci, as well as for some pathogenic agents with low virulence. Sometimes this temperature is observed at some stages of systemic diseases, tumor processes, as well as pathologies of other organs.
• The temperature is within 38 - 39 degrees. An increase in body temperature to 38 - 39 degrees is observed with pneumonia of a bacterial and viral nature, as well as with most infections that can affect the pleura.
• Temperature above 39 degrees . A temperature above 39 degrees develops with a severe course of the disease, with the accumulation of pus in any cavity, as well as with the penetration of pathogens into the blood and with the development of a systemic inflammatory response.

An increase in body temperature reflects the degree of intoxication of the body with the waste products of microorganisms, therefore it is often accompanied by a number of other manifestations, such as headache, weakness, pain in the joints and muscles. During the entire period of fever, reduced performance is noted, some reflexes slow down, and the intensity of mental activity decreases.

In addition to the body temperature itself, the nature of its increase and decrease is important. In most cases of acute infection, the temperature rises rapidly within the first few hours of onset, accompanied by chills ( reflects the process of activation of mechanisms aimed at preserving heat). A decrease in temperature is observed with a decrease in the scale of the inflammatory process, after the eradication of infectious agents, as well as when the accumulation of pus is eliminated.

Separately, mention should be made of fever in tuberculosis. This infection is characterized by subfebrile temperature values ​​( within 37 - 37.5), which are accompanied by a feeling of chills, night sweats, a productive cough with sputum production, and weight loss.

Tracheal displacement

Displacement of the trachea is one of the signs indicating excessive pressure from one of the lungs. A similar condition occurs with a massive pleural effusion, when a large volume of accumulated fluid presses on the mediastinal organs, causing them to shift to the healthy side.

With pleurisy, some other symptoms may also be present, which depend on the pathology underlying the inflammation of the pleura. These manifestations are of great diagnostic value, as they allow you to establish the cause of the disease and begin adequate treatment.

Diagnosis of pleurisy

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.

The following examinations are used to diagnose pleurisy:

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

Examination and questioning of the patient

During the interview of the patient, the doctor identifies the main clinical symptoms, the time of their onset, their characteristics. Factors that could provoke the disease to one degree or another are determined, comorbidities are clarified.

During the examination, the doctor visually assesses the general condition of the patient, determines the existing deviations from the norm.

On examination, the following pathological signs can be detected:

• deviation of the trachea in a healthy direction;
• bluish skin ( indicates serious respiratory failure);
• signs of closed or open chest injury;
• swelling in the intercostal spaces on the affected side ( due to the large volume of accumulated liquid);
• tilt of the body to the affected side reduces the movement of the lung and, accordingly, irritation of the pleura during breathing);
• bulging neck veins due to increased intrathoracic pressure);
• lag of the affected half of the chest during breathing.

Clinical examination of the patient

During a clinical examination, the doctor performs the following manipulations:

• Auscultation . Auscultation is a method of examination in which the doctor listens to the sounds that occur in the human body using a stethoscope ( before its invention - directly by ear). During auscultation of patients with pleurisy, a pleural friction noise can be detected, which occurs when the pleural sheets covered with fibrin threads are rubbed. This sound is heard during respiratory movements, does not change after coughing, persists when breathing is simulated ( performing several respiratory movements with a closed nose and mouth). With effusion and purulent pleurisy in the area of ​​fluid accumulation, there is a weakening of respiratory noises, which sometimes may not be heard at all.
• Percussion. Percussion is a method of clinical examination of patients, in which the doctor, using his own hands or special devices ( hammer and a small plate - plessimeter) taps organs or formations of various densities in the patient's cavities. The percussion method can be used to determine the accumulation of fluid in one of the lungs, since percussion over the fluid produces a higher, dull sound, which is different from the sound that occurs over healthy lung tissue. When tapping the boundaries of this percussion dullness, it is determined that the fluid in the pleural cavity forms not a horizontal, but a somewhat oblique level, which is explained by uneven compression and displacement of the lung tissue.
• Palpation. With the help of the method of palpation, that is, when “feeling” the patient, zones of distribution of painful sensations can be identified, as well as some other clinical signs. With dry pleurisy, there is pain when pressed between the legs of the sternocleidomastoid muscle, as well as in the cartilage of the tenth rib. When applying the palms at the symmetrical points of the chest, there is some lag in the affected half in the act of breathing. In the presence of pleural effusion, there is a weakening of the voice trembling.

In most cases, the data obtained as a result of clinical examination and interviews are sufficient to diagnose pleurisy. However, the information obtained does not allow to reliably determine the cause of the disease, and besides, it is not sufficient to differentiate this condition from a number of other diseases in which fluid also accumulates in the pleural cavity.

X-ray examination

X-ray examination is one of the most informative diagnostic methods for pleurisy, as it allows you to identify signs of inflammation of the pleura, as well as determine the amount of fluid accumulated in the pleural cavity. In addition, with the help of an x-ray of the lungs, signs of some pathologies that could cause the development of pleurisy ( pneumonia, tuberculosis, tumors, etc.).

With dry pleurisy on x-rays, the following signs are determined:

• on the affected side, the dome of the diaphragm is above normal;
• a decrease in the transparency of the lung tissue against the background of inflammation of the serous membrane.

With effusion pleurisy, the following radiological signs are revealed:

• smoothing of the diaphragmatic angle ( due to accumulation of fluid);
• uniform darkening of the lower region of the lung field with an oblique border;
• shift of the mediastinum towards the healthy lung.

Blood analysis

In the general blood test, signs of an inflammatory reaction are revealed ( increased erythrocyte sedimentation rate (ESR)), as well as an increased content of leukocytes or lymphocytes ( with an infectious nature of pleural lesion).

A biochemical blood test reveals a change in the ratio of proteins in the blood plasma due to an increase in the content of alpha globulins and C-reactive protein.

Pleural effusion analysis

The analysis of pleural effusion allows to judge the initial cause of the pathology, which is of utmost importance for diagnosis and subsequent treatment.

Laboratory analysis of pleural effusion allows you to determine the following indicators:

• amount and type of proteins;
• glucose concentration;
• lactic acid concentration;
• the number and type of cellular elements;
• the presence of bacteria.

Microbiological research

Microbiological examination of sputum or pleural fluid allows you to identify infectious agents that could cause the development of an inflammatory reaction in the pleural cavity. In most cases, direct microscopy of smears made from these pathological materials is performed, but they can be sown on favorable media for further identification.

Pleurisy treatment

The treatment of pleurisy has two main goals - the stabilization of the patient and the normalization of his respiratory function, as well as the elimination of the cause that caused this ailment. For this purpose, various medications and medical procedures are used.

Treatment of pleurisy with medicines

In the vast majority of cases, pleurisy is of an infectious nature, so it is treated with antibacterial drugs. However, some other drugs may be used to treat inflammation of the pleura ( anti-inflammatory, desensitizing, etc.).

It should be borne in mind that the choice of pharmacological drugs is based on previously obtained diagnostic data. Antibiotics are selected taking into account the sensitivity of pathogenic microorganisms ( determined by microbiological examination or detected by any other method). The dosage regimen of medications is set individually, depending on the severity of the patient's condition.

Drugs used to treat pleurisy

Drug group	Main Representatives	Mechanism of action	Dosage and method of application
Antibiotics	Ampicillin with sulbactam	Interacts with the cell wall of sensitive bacteria and blocks their reproduction.	It is used in the form of intravenous or intramuscular injections at a dose of 1.5 - 3 to 12 grams per day, depending on the severity of the disease. Not applicable for nosocomial infections.
	Imipenem in combination with Cilastatin	Suppresses the production of bacterial cell wall components, thereby causing their death.	It is prescribed intravenously or intramuscularly at a dose of 1-3 grams per day in 2-3 doses.
	Clindamycin	Inhibits bacterial growth by blocking protein synthesis.	It is used intravenously and intramuscularly at a dose of 300 to 2700 mg per day. Oral administration is possible at a dose of 150-350 mg every 6-8 hours.
	Ceftriaxone	Violates the synthesis of components of the cell wall of sensitive bacteria.	The drug is administered intravenously or intramuscularly at a dose of 1-2 grams per day.
Diuretics	Furosemide	Increases the excretion of water from the body by acting on the tubules of the kidneys. Reduces the reverse absorption of sodium, potassium and chlorine.	It is administered orally at a dose of 20-40 mg. If necessary, it can be administered intravenously.
Regulators of water and electrolyte balance	Saline and glucose solution	Accelerates renal filtration by increasing the volume of circulating blood. Promotes the removal of toxic decay products.	Administered by slow intravenous infusion ( with drip infusions). The dosage is determined individually, depending on the severity of the condition.
Non-steroidal anti-inflammatory drugs	Diclofenac, ibuprofen, meloxicam	They block the enzyme cyclooxygenase, which is involved in the production of a number of pro-inflammatory substances. They have an analgesic effect.	The dosage depends on the drug chosen. They can be administered both intramuscularly and orally in the form of tablets.
Glucocorticosteroids	Prednisolone	Block the breakdown of arachidonic acid, thereby preventing the synthesis of pro-inflammatory substances. They reduce immunity, therefore they are prescribed only in conjunction with antibacterial drugs.	Orally or intramuscularly at a dose of 30-40 mg per day for a short period of time.

When is a puncture needed for pleurisy?

Pleural puncture ( thoracentesis) is a procedure in which a certain amount of fluid accumulated there is removed from the pleural cavity. This manipulation is carried out both for therapeutic and diagnostic purposes, therefore it is prescribed in all cases of effusion pleurisy.

Relative contraindications to pleural puncture are the following conditions:

• pathology of the blood coagulation system;
• increased pressure in the pulmonary artery system;
• chronic obstructive pulmonary disease in a severe stage;
• having only one functional lung.

Thoracocentesis is performed under local anesthesia by inserting a thick needle into the pleural cavity at the level of the eighth intercostal space on the side of the scapula. This procedure is carried out under the control of ultrasound ( with a small amount of accumulated liquid), or after a preliminary x-ray examination. During the procedure, the patient sits ( because it allows you to keep the highest level of liquid).

With a significant amount of pleural effusion, puncture allows drainage of part of the pathological fluid, thereby reducing the degree of compression of the lung tissue and improving respiratory function. Repeat the therapeutic puncture as needed, that is, as the effusion accumulates.

Is hospitalization necessary for the treatment of pleurisy?

In most cases, treatment of pleurisy requires hospitalization of patients. This is due, firstly, to the high degree of danger of this pathology, and secondly, to the possibility of constant monitoring of the condition of the patient by highly qualified personnel. In addition, in a hospital environment, it is possible to prescribe more powerful and effective drugs, and there is also the opportunity to carry out the necessary surgical interventions.

Can pleurisy be treated at home?

Home treatment for pleurisy is possible, although not recommended in most cases. Treatment of pleurisy at home is possible if the patient has passed all the necessary studies, and the cause of this disease has been reliably identified. The mild course of the disease, the low activity of the inflammatory process, the absence of signs of disease progression, combined with the patient's responsible attitude to taking prescribed drugs, allow home treatment.

Nutrition for pleurisy diet)

The diet for pleurisy is determined by the underlying pathology that caused the development of an inflammatory focus in the pleural cavity. In most cases, it is recommended to reduce the amount of incoming carbohydrates, as they contribute to the development of pathogenic microflora in the infectious focus, as well as fluid ( up to 500 - 700 ml per day), since its excess contributes to the more rapid formation of pleural effusion.

Salty, smoked, spicy and canned foods are contraindicated, as they provoke a feeling of thirst.

Vitamins must be consumed in sufficient quantities, as they are necessary for the normal functioning of the immune system. To this end, it is recommended to eat fresh vegetables and fruits.

Consequences of pleurisy

Pleurisy is a serious disease that significantly impairs the function of the organs of the respiratory system. In most cases, this pathology indicates a complication of the course of the underlying disease ( pneumonia, tuberculosis, tumor process, allergies). Correct and timely elimination of the cause of pleurisy allows you to fully restore lung function without any consequences.

However, in many cases, pleurisy can cause partial or complete structural and functional reorganization of the tissues of the pleura or lungs.

The consequences of pleurisy include:

• Adhesions between the pleura. Adhesions are connective tissue strands between the layers of the pleura. They are formed in the area of ​​inflammatory foci that have undergone organization, that is, sclerosis. Adhesions, called commissures in the pleural cavity, significantly limit lung mobility and reduce functional tidal volume.
• Overgrowth of the pleural cavity. In some cases, massive empyema of the pleura can cause complete "overgrowth" of the pleural cavity with connective tissue fibers. This almost completely immobilizes the lung and can cause serious respiratory failure.

Inflammation of the pleural membrane, which is accompanied by the accumulation of fluid and the presence of fibrous plaque, is called pleurisy. The disease can act as a concomitant pathology, or develop as a result of any diseases. The disease is most severe in children and the elderly.

Disease classification

Depending on the cause of the occurrence, pathology can be classified as follows:

1. Primary. This type of disease is independent, develop independently of other diseases.
2. Secondary. Acts as a complication of pulmonary inflammatory processes. Moreover, the latter can be acute or chronic.

According to the presence or absence of inflammatory fluid, the following classification is established:

• Dry pleurisy (otherwise - fibrinous).
• Exudative form (purulent, serous, hemorrhagic, serous-fibrinous).

According to the area of ​​\u200b\u200bdistribution of effusion, the disease happens:

• Diffuse (fluid moves throughout the pleural cavity).
• Encapsulated (effusion accumulates in any area).

Sometimes pathology indicates the course of systemic ailments. Pleurisy of the lungs usually develops with oncology or tuberculosis. However, specialists often begin the treatment of inflammation directly, forgetting about the root cause of its occurrence. The inflammatory process can manifest itself in both a child and an adult. Many remain undetected.

What causes the disease

Speaking about the causes of the disease, it is necessary to understand: what it is and what are the symptoms of the disease.

Pleurisy is one of the diseases of the respiratory system. The pathology is characterized by damage to the pulmonary and parietal pleura. The latter is a membrane covering the right and left lungs, and lining the chest.

The effusion form of the disease is accompanied by the accumulation of any exudate in the pleural cavity (between the sheets). There may be collected pus, blood, inflammatory fluid.

The conditional classification of the cause of the disease is as follows:

1. Infectious.
2. Inflammatory (aseptic).

The risk of developing the disease increases due to many factors. Here they are:

• Regular overwork, stressful situations.
• Hypothermia.
• Food containing a low amount of useful elements.
• Insufficient motor activity.
• Having an allergy to medications.

Hypothermia increases the risk of developing

If we talk about the infectious nature of pleurisy, then its causes may be:

• Syphilis.
• Tuberculosis.
• Bacterial infection (for example, staphylococcus aureus).
• Candidiasis (or any other fungal infection).
• Tularemia.
• Operational interventions.
• Any injury to the chest.

The following causes are characteristic of the aseptic form of the disease:

• Spread of metastases to the pleura (lung cancer, etc.).
• Lung infarction, systemic vasculitis, etc.
• Pulmonary embolism.
• Tumor-like formations of pleural sheets.

The development of pleurisy occurs at different speeds. The disease can persist for quite a long time..

The approximate classification is as follows:

• Acute course of the disease (up to 14-28 days).
• Subacute (from 30 days to six months).
• Chronic form (more than 6 months).

The ways of infection of the pleural cavity with microorganisms are different. Contact infection involves infection through the lymphatic fluid or blood. Direct contact with bacteria is possible with surgical intervention, or with injuries and injuries.

The question of whether pleurisy is contagious often worries relatives of the patient. An unequivocal answer can be given based on the cause of the lesion. Pleurisy developed as a result of an injury is not transmitted to others. If the root cause of the disease is viral, the disease may well be transmitted, although the likelihood of infection is low.

Dry pleurisy

It differs in the formation of fibrin on the surface of the pleura. There is no effusion in the pleural cavity. Usually this form of the disease occurs somewhat earlier than exudative.

Usually the disease is concomitant with diseases such as:

• Rheumatism.
• Collagenosis.
• Malignant tumors.
• Most pathologies of the intrathoracic lymph nodes and lower respiratory tract.
• Some viruses.

As an independent disease, dry pleurisy develops infrequently.

Tuberculous pleurisy

According to medical statistics, an increasing number of patients suffer from this type of disease.

Pathology can be any of three forms:

• Fibrous.
• Purulent.
• Exudative.

Depending on the characteristics of the pathology and its course, tuberculous pleurisy is subject to the following classification:

1. Perifocal.
2. Tuberculosis of the pleura.
3. Allergic.

Approximately half of the cases of dry pleurisy is a signal indicating the presence of a latent form of tuberculosis. Tuberculosis of the pleura is extremely rare. More often, lymph nodes or lungs are affected, and fibrous pleurisy in this case plays the role of a concomitant pathology.

Purulent pleurisy

Certain groups of microbes are capable of causing purulent pleurisy of the lung, namely:

• Streptococci.
• Pneumococcus.
• Pathogenic staphylococci.

Other types of sticks are much less common. Usually one group of microbes contributes to the development of the disease, but sometimes several varieties act at once.

The symptoms of this form of the disease, as well as the clinical picture, vary depending on the age of the patient. In children of the first year of life (usually up to 3 months), purulent pleurisy often proceeds similarly to umbilical sepsis or pneumonia, which is caused by staphylococci.

Visually, you can diagnose the bulge of the chest. There is a partial omission of the shoulder, and the arm becomes inactive. The disease in older children is characterized by symptoms of total inflammation of the pleura. The patient may be disturbed by a dry cough with sputum or purulent discharge.

Encapsulated pleurisy

One of the most severe forms of the disease is encysted pleurisy of the lung. Pathology develops against the background of prolonged inflammation in the pleura and lungs. Because of this, a large number of adhesions occur, and the exudate is separated from the pleural cavity. The pathology is characterized by fusion of the pleura, which leads to the accumulation of effusion in one area.

Exudative pleurisy

Its main difference is the accumulation of fluid in the pleural cavity.

Stagnation of effusion occurs due to:

• Injuries to the thoracic region, which is accompanied by bleeding.
• Hemorrhages.
• Outpouring of lymphatic fluid.

Depending on the nature of the fluid, pleurisy is classified into:

1. Serous-fibrinous.
2. Mixed.
3. Hemorrhagic.
4. Chile.

The origin of the effusion is usually difficult to establish. The accumulated fluid is fraught with breathing problems because it restricts the movement of the lungs.

Symptoms of the problem

The inflammatory process can proceed with the formation of exudate or without it. Depending on this, the symptoms of pleurisy vary.

The dry form of pathology corresponds to such signs as:

• Soreness of a stitching character in the region of the thoracic region. It is especially pronounced when coughing, sudden movements, deep breaths.
• The need for placement on the affected side.
• Breathing is superficial, and the affected half of the sternum visually lags behind the healthy one.
• When listening, you can determine weaker breathing in the area of ​​​​fibrin formation, as well as a pleural friction rub.
• Excessive sweating, chills, fever.

For the exudative type of the disease, the symptoms are as follows:

• Pain syndrome of dull nature in the damaged area.
• Prolonged cough without expectoration.
• A pronounced lag of the diseased sternum in breathing.
• Shortness of breath, heaviness, intercostal spaces swell.
• Increased body temperature, weakness and fatigue, excessive chills.

The clinical picture of purulent pleurisy in both adults and children is somewhat worse.

The disease is accompanied by such signs:

• Increase in body temperature.
• Increased pain in the chest.
• Trembling and aches.
• Cardiopalmus.
• The skin becomes earthy.
• Loss of body weight.

When pleurisy from an acute form flows into a chronic one, pleural adhesions begin to appear in the damaged lung. They prevent the lung from expanding normally, exacerbating existing breathing problems.

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Possible Complications

Timely treatment of pleurisy of the lungs will help prevent many consequences:

• The formation of adhesions in the pleural cavity.
• Obliteration of interlobar fissures.
• Adhesive pleurisy.
• Healing of the pleural cavities.
• Increase in the thickness of the pleura.
• The occurrence of pleurosclerosis.
• Empyema (accumulation of purulent discharge).
• Respiratory failure.
• Decreased diaphragm movement.

The presence or absence of complications is directly related to the cause of the pathology. Knowing how dangerous pleurisy of the lungs is, you should not postpone going to a specialist.

Problem Identification

Only a competent doctor can decide how to treat pleurisy of the lungs. The selection of therapy is based on the results of the examination of the patient. To diagnose pathology, certain examinations are carried out in the clinic.

Here is their list:

1. Visual inspection, history taking.
2. Clinical examination of the patient.
3. Carrying out radiography.
4. Microbiological research.
5. Blood sampling for analysis.
6. Examination of the pleural fluid.

Moreover, the diagnosis is usually not difficult. It is more problematic to determine the reasons due to which the pleura became inflamed and exudate began to accumulate.

Treatment of the disease

Having identified pleurisy of the lungs, its symptoms, the doctor prescribes a comprehensive treatment. The main direction is the elimination of the root cause of the inflammatory process.

Please note: only dry pleurisy can be treated at home. Patients with any other form of the disease should be in a therapeutic hospital. If the patient is diagnosed with pleural empyema, he should be placed in the surgical department.

To cure dry pleurisy, perform the following steps:

1. Taking painkillers to relieve pain. If tablet preparations do not bring the desired effect, it is permissible to replace them with narcotic painkillers. The latter is possible only on inpatient treatment.
2. The use of warm compresses based on alcohol, camphor. The result is the use of mustard plasters and iodine mesh.
3. Getting rid of cough by taking specialized drugs.
4. Since pleurisy usually occurs against the background of tuberculosis, the root cause of the disease should be eliminated. Patients with the tuberculosis form of the disease are treated in the appropriate dispensary.

With the development of the exudative form of the disease, a puncture is often performed. For one procedure, it is allowed to eliminate a maximum of 1.5 liters of inflammatory fluid. Otherwise, cardiac complications cannot be avoided. The purulent form of the disease is characterized by washing the cavity with antiseptic solutions.

If the stage of the disease is chronic, a pleurectomy may be performed. Removal of a small part of the pleura is acceptable in both adults and children. The procedure helps to prevent possible relapses of the pathology. As soon as the exudate resolves, the patient should do physiotherapy exercises, therapeutic and breathing exercises.

Folk methods

Elimination of the disease with folk remedies should be carried out in conjunction with taking medications. Please note: it is unacceptable to neglect the hospital when a kind of pathology requires being in it. If you adhere to the therapy of folk remedies at home, you can significantly aggravate the disease.

With pleurisy of the lungs, treatment with folk methods is based on the use of various compresses, as well as the intake of decoctions and tinctures.

Here are some recipes:

1. At home, you can get fresh beet juice, then mix it with honey in a ratio of 100 g / 2 tbsp. l. respectively. The mixture should be taken twice a day, after eating. It is not subject to storage, so each time it is necessary to prepare anew.
2. From pleurisy, an infusion of mint, cudweed and coltsfoot can help. Take 1 tbsp. 3 times a day.
3. Infuse plantain at home. For 0.5 liters of boiling water, take about 2 tbsp. l. dried leaf. Strain the resulting infusion and take warm 100 ml 4 times a day.
4. Therapy with folk remedies involves the use of onion juice with honey. Mix equal proportions of the components and take 1 tbsp. l. twice a day.

To cure pleurisy in adults and children, you can use not only drug therapy. Wisely selected folk remedies will also bring invaluable benefits.