Pleurisy is an inflammatory process that affects the serous membrane lining the chest and the surface of the lungs. The etiology of the disease can be different, and treatment is prescribed in accordance with the causes. Often it accompanies other inflammations of the internal organs or is a consequence of the formation of malignant neoplasms. Pleurisy is a fairly common pathology (especially among men), with a protracted nature, it can give various complications.

The serous membrane forms a closed cavity in the chest. One part of it (visceral) covers the lungs and is tightly fused with them, and the other, parietal, is adjacent to the diaphragm, ribs, and mediastinal organs. The pleural cavity is filled with a small amount of fluid, which ensures the sliding of its walls among themselves. Its main functions are to protect the lungs and ensure the respiratory process.

Inflammation of the serous membrane - pleurisy - has a code according to ICD-10 R09.1, however, some types of pathology are designated differently. For example, A15-A16 in the case of tuberculous origin. And pleurisy with effusion (accumulation of fluid in the cavity) has its own J90 encoding.

The picture shows a left-sided pleural effusion

The danger of any form of this disease lies in the fact that the inflammatory process occurs in the zone of vital organs. Purulent pleurisy is especially difficult, and with exudative pleurisy, the heart rhythm and breathing are disturbed. The most common consequences of a protracted disease are obliteration of the pleural cavity, impaired mobility of the diaphragm, and respiratory failure. Cancer focal or metastatic pleurisy has the most unfavorable prognosis for recovery.

Classification of pleurisy

For more than 30 years, the classification of Professor N.V. Putov has been used to determine the specific form of this disease. First of all, the inflammatory process can be acute, subacute or become chronic, respectively, the severity of symptoms at each stage gradually weakens. If the pleura is affected only on the right or left, we are talking about right- or left-sided pleurisy, and when the membrane of both lungs is involved in the process, it is bilateral.

Dry pleurisy, also called fibrinous, is distinguished from exudative by the absence of fluid in the pleural cavity. In the second case, there is an effusion of a purulent, serous, hemorrhagic, chylous, cholesterol or mixed nature. The effusion can be localized in a certain area or spread over the entire surface of the pleura, so the pleurisy of the lungs can be encysted (parietal, interlobar, apical, diaphragmatic, etc.) or diffuse.

Causes

Pleurisy is rarely diagnosed as an independent pathology. It usually accompanies or is a consequence of other diseases. For example, the development of pleurisy after pneumonia is observed in at least 5% of cases and is called metapneumonic. Parapneumonic pleurisy occurs with greater frequency, which precedes and then accompanies pneumonia.

The latter is detected in a fifth of patients with inflammation of the pleura, and more than half of those who suffer from an exudative form of inflammation. In this regard, a logical question arises: is tuberculous pleurisy contagious or not? Since its cause in most cases is pulmonary tuberculosis, and the pathogen is transmitted by airborne droplets, prolonged contact with the patient can lead to infection. The maximum risk of infection is noted in patients with reduced immunity, diabetes, cardiovascular pathologies, etc.

Aseptic or non-infectious inflammatory process develops for other reasons:

• Malignant tumors localized both in the pleura itself (mesothelioma) and in other organs. In the second case, metastases affect the pleura in cancer of the breast, lungs, ovaries, and skin. Oncology is the cause of pleurisy in 25% of patients.
• Pulmonary or myocardial infarction, PE.
• Pleurisy of the lungs can be the result of a systemic lesion of the connective tissue - vasculitis, SLE, scleroderma.

Other likely causes of inflammation of the pleura include leukemia, hemorrhagic diathesis, pancreatitis and other pathologies.

Development mechanisms

Infectious pleurisy develops as a result of pathogens entering directly into the pleural cavity with blood or lymph or by contact from foci of inflammation. This happens with tuberculosis, pneumonia, cysts, abscesses, bronchiectasis. Direct infection is carried out as a result of a violation of integrity (surgery, wounds and other injuries).

Diagnostics

A preliminary diagnosis can be made already at the initial examination: the chest is asymmetric, the intercostal spaces on the affected side are protruded, moreover, it lags behind the rhythm during breathing. When tapping (percussion), the sound above the exudate is muffled, and breathing during auscultation is not heard there or is very weak.

To clarify the boundaries of the effusion, ultrasound and radiographic examination are used. A puncture of the pleural fluid is performed, the composition, density and volume of which can be judged as the cause of the pathology. Bacteriological analysis allows you to determine the pathogen, and a general blood test shows an increase in ESR, leukocytosis. A biopsy of the pleura is also performed using the thoracoscopy method.

Pleurisy of the lungs - symptoms and treatment

Symptoms of inflammation of the pleura depend on the type - dry or exudative, the cause of the pathology, the localization of the effusion. Treatment is prescribed based on the results of a diagnostic examination and can take from several weeks to many months (with the tuberculosis form, for example).

Symptoms of dry pleurisy

The defining signs of pleurisy in adults, which occurs in a fibrinous form, are stabbing pains localized in the chest, which are aggravated by coughing, bending over and simply breathing movements. At the same time, the patient is forced to take a supine position on the affected side of the body in order to limit the maximum mobility of the chest. For the same reason, breathing becomes shallow, there is a lagging behind the respiratory rhythm of one of the halves of the chest. The temperature rises to subfebrile values, there is increased sweating, chills at night. When listening, a characteristic rustle is determined - a consequence of the friction of the pleura sheets against each other.

Signs of exudative pleurisy

It begins in the same way as acute (pain, cough), but as the exudate accumulates in the cavity, the following symptoms of pulmonary pleurisy in adults appear:

• feeling of heaviness on the affected side;
• smoothing and then protrusion of the spaces between the ribs;
• moderate cyanosis of the skin and increasing shortness of breath;
• persistent febrile temperature (and with empyema - hectic, with significant fluctuations during the day);
• tachycardia, lowering blood pressure;
• weakness, sweating, loss of appetite.

Some forms of inflammation have specific symptoms. For example, serous may be accompanied by hemoptysis, and with encysted paramediastinal, the neck and face swell, the voice becomes hoarse, and dysphagia appears. With SLE, lesions of the joints and kidneys, pericarditis join. The course of pleurisy without temperature and other pronounced signs is characteristic of a metastatic variety of oncology.

Treatment in a hospital

In the conditions of a medical institution, complex therapy of severe cases of inflammation is carried out, aimed at eliminating their cause and alleviating symptoms. Along with medication, the treatment of exudative pleurisy may include punctures (thoracocentesis) or drainage to remove exudate, washing the cavity with antiseptics for empyema. According to indications in the chronic course of the disease (especially its tuberculous variety), surgical intervention is performed - pleurectomy.

How to treat pleurisy at home

All treatment should be prescribed exclusively by a specialist, self-medication is unacceptable.

The patient, first of all, is provided with rest and bed rest. In the dry form of the inflammatory process, tight bandaging and warming of the chest, setting cans or mustard plasters are indicated. Mandatory drug therapy, including the following groups of drugs:

• antibiotics for pleurisy of infectious origin, selected according to the type of pathogen;
• anti-tuberculosis drugs for the corresponding form of pleurisy (, isoniazid, rifampicin);
• NSAIDs and glucocorticosteroids - for rheumatic inflammation;
• treatment of pleurisy also includes taking antitussive drugs for fibrinous varieties of pathology.
• Antipyretics are indicated with a significant increase in temperature.
• Specific chemotherapy is prescribed in case of an oncological cause of the disease.

Respiratory gymnastics after pleurisy is included in the complex of therapeutic measures for fibrinous varieties. As soon as the symptoms of dry inflammation decrease, it is necessary to perform special exercises to prevent adhesive pleurisy - gluing and obliteration of the parietal and visceral pleura.

Treatment of pleurisy of the lungs with folk remedies

The use of alternative medicine prescriptions for any disease is possible only after a diagnosis has been made and with the approval of the attending physician. The use of herbal infusions, decoctions, warming compresses, ointments, inhalations is advisable only as an aid, if there are no contraindications. The main treatment for pleurisy is drug therapy. Moreover, it is unacceptable to rely on folk remedies if the cause of the disease is a malignant tumor.

Pleurisy of the lungs in oncology

As already mentioned, in a quarter of cases of inflammation of the serous membrane of the lungs, its cause is cancer. Mesothelioma of the pleura itself is not so common, but the secondary lesion - metastatic or secondary pleurisy - is common. Metastases of the primary tumor in any of its localization affect primarily the liver and lungs.

The basis of the treatment of pulmonary pleurisy in oncology is chemotherapy and radiation therapy, as well as surgery, which will help to cope with the cause of the disease. In parallel, drugs are taken to relieve the painful symptoms of inflammation. The prognosis for recovery depends on the stage of the cancer process and the effectiveness of the treatment of the underlying disease.

Consequences of pleurisy

Timely diagnosis of the disease in an acute form and the appointment of adequate therapy help to quickly cope with inflammation. However, the duration and success of treatment depend on the form and nature of the disease. So, with a fibrinous variety, it will take about 2 weeks, and the treatment of pulmonary pleurisy of tuberculous origin may take a year.

The negative consequences of the disease usually appear when it flows into a chronic form. Most often, an adhesive process is observed, leading to fusion of interlobar fissures, obliteration of the cavity, and, accordingly, respiratory failure. Pleurisy of the lungs is especially dangerous in the elderly: severe symptoms and treatment for a long time often lead to a chronic process, frequent relapses, and a general deterioration in health.

Prevention

As a preventive measure, doctors recommend strengthening the immune system, treating any infectious diseases in a timely manner. Of particular importance is regular testing for tumor markers for people at risk. Periodic examinations will help to detect cancer at an early stage.

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For the implementation of respiratory movements, the lungs and chest cavity are covered with sheets of a special membrane called the pleura.

When inhaling and exhaling, the pleura provides unhindered sliding of the lungs along the inner wall of the chest cavity, as it consists of two sheets: the visceral pleura covers the lungs, the parietal pleura lines the chest cavity from the inside.

Between these sheets there is a slit-like cavity, which normally contains a small amount of fluid that minimizes the friction of the pleura during respiratory movements.

Pleurisy is an inflammatory reaction of the pleura to a pathological process or disease of the lungs, as well as other organs.

Dry and exudative pleurisy

Depending on the presence of inflammatory fluid in the pleural cavity, dry and exudative pleurisy are isolated. In their course, they can pass into each other.

Dry or fibrinous pleurisy occurs at the beginning of the disease, when the inflammatory process leads to the drying of the pleura and the appearance of fibrin protein on its surface.

The pleura sheets become sticky and lose their ability to easily slide relative to each other. Pleurisy may remain dry if a large amount of fluid is not secreted from the inflamed pleura. Otherwise, an inflammatory fluid, called exudate, begins to enter the pleural cavity.

With the accumulation of a large amount of exudate, pleurisy becomes exudative or effusion. In the future, when the fluid is resorbed, the pleura sheets become sticky again, which can lead to adhesions and adhesions between them.

With exudative pleurisy a complication is pleural empyema or purulent pleurisy. Purulent pleurisy occurs when suppuration of the exudate. It is caused by the appearance of microorganisms in the exudative fluid.

To eliminate them, leukocytes and active substances begin to flow into the exudate, which leads to the formation of a purulent effusion. In the absence of treatment, fibrin plaque appears on the pleura sheets, which leads to adhesions of the sheets and "encapsulation" of the purulent focus.

Purulent inflammation can also occur with chest trauma and direct entry of microorganisms into the pleural cavity, without previous exudative pleurisy.

By site location inflamed pleura, the following types of pleurisy are distinguished:

• Apical or apical;
• Costal, that is, located at the ribs;
• Costo-diaphragmatic, which are formed at the junction of the ribs with the diaphragm;
• Diaphragmatic;
• Located in the mediastinum - behind the sternum;
• Interlobar;
• Unilateral: left-sided or right-sided pleurisy;
• Bilateral.

Main reasons occurrence of both types of pleurisy:

Pleurisy is characterized by the appearance of pain, shortness of breath and dry cough.

1. Dry pleurisy most often has a sudden, acute onset. It is manifested by point stabbing pain in the area of ​​​​the location of the inflammatory process, which occurs during respiratory movements due to friction of the pleura sheets against each other.

Therefore, the patient tries to limit these movements: in a sitting position, he leans towards the side of pleurisy, lies on his sore side, and reduces the depth of inspiration. When examining the chest, the lagging of the diseased half during breathing is noticeable.

If pleurisy is localized at the apex of the lung, then muscle tension in the neck and above the collarbone on the side of the lesion can be detected. When listening to the lungs, a pleural friction noise is detected, which is characteristic of dry pleurisy. With the appearance of exudate in the pleural cavity, this noise disappears.

• Body temperature with dry pleurisy usually does not exceed 37.5 -380C, that is, it is subfebrile.

Lungs - the symptoms of this type of pleurisy are expressed in an increase in shortness of breath, respectively, an increase in the volume of fluid in the pleural cavity. Gradually, the volume of respiratory movements on the side of the lesion decreases.

If the pleural effusion is significant, then compression of the lung tissue by fluid occurs, which leads to atelectasis: the lung cannot carry out respiratory movements and loses its airiness.

The development of atelectasis causes aggravation of shortness of breath and the appearance of a cough without sputum, which does not bring relief. Pain with effusion pleurisy may be absent, the accumulation of fluid often gives a feeling of heaviness and stiffness when breathing.

• The development of effusion pleurisy is gradual. The temperature reaches febrile numbers, especially with an increase in the severity of inflammation, and can be above 390C.

The transition of exudative pleurisy to purulent pleurisy is manifested either by an increase in symptoms and a worsening of the condition with exudative pleurisy, or by a resumption of the missing symptoms against the background of an improvement in the condition and subsidence of the manifestations of the disease. The patient has an aggravation of intoxication and impaired respiratory function: body temperature and shortness of breath increase, chills appear, cough becomes more frequent, sputum appears.

The onset of pain is usually uncharacteristic or minor. The appearance of sharp pain, cold sweat, chills, fainting indicates the development of pleural shock.

Tuberculous pleurisy is not isolated from other symptoms of this infectious disease, but appears against the background of an active tuberculous process. There are the following options for inflammation of the pleura in tuberculosis:

• Tuberculosis of the pleura leads to the appearance of the classic picture of exudative pleurisy with a large amount of fluid. It is manifested by shortness of breath and symptoms of atelectasis. Often complicated by pleural empyema. Identification of mycobacteria in a pleural exudate is characteristic;
• Allergic pleurisy has a quick onset with pain and fever, but the same quick cure within a month. Occurs in patients with fresh infection with mycobacterium tuberculosis, with a chronic course of the primary form of tuberculosis. It is accompanied by such manifestations as polyarthritis, conflicts, the appearance of erythema nodosum, characteristic of primary tuberculosis. Tuberculosis pathogens are not found in the exudate;
• Perifocal pleurisy occurs on the pleura, located next to the tuberculous focus. Manifested sluggish, chronic course. Its detection is sometimes possible only with the help of x-rays. The nature of the inflammatory fluid is serous, the tubercle bacillus is usually absent;

With fluoroscopy, dry pleurisy is manifested by a high standing dome of the diaphragm, lagging behind the diseased half of the chest during breathing, and a decrease in the mobility of the lower edges of the lungs.

Exudative pleurisy in the picture has a well-defined fluid boundary. With limited pleurisy, a small amount of effusion is best determined using ultrasound. This method can detect as little as 5 ml of exudate, unlike X-ray, which will only show volumes over 200 ml.

Purulent pleurisy has the appearance of limited dark areas with a characteristic upper level of fluid in the form of a crescent.

Tuberculous pleurisy is combined with the identification of caverns, areas of compaction and foci of tuberculosis.

Pleurisy treatment - methods and preparations

1. The main treatment of pleurisy is the therapeutic effect on the underlying disease that caused inflammation of the pulmonary membranes. Against the background of proper therapy, the severity of symptoms of pleurisy decreases. For example, after radiation therapy, the number of tumor pleurisy is reduced by 40%.

2. With dry pleurisy, to reduce pain, the chest is tightly wrapped with an elastic bandage, which is bandaged 1-2 times a day.

An increase in the immobility of the chest can be achieved if a semi-rigid pillow is attached to the sore side. A painful and unproductive dry cough is eliminated by prescribing drugs that suppress the cough reflex: codeine, codterpine, libexin, etc.

3. If X-ray signs characteristic of fluid accumulation and symptoms accompanying exudative pleurisy of the lungs are identified, treatment should begin with a pleural puncture. This procedure is also diagnostic, clarifying the nature and cause of pleurisy.

4. The appointment of antibiotic therapy is carried out if the cause of the effusion is an infectious disease. The best is the appointment of a specific antibiotic after identifying the type of pathogen in the pleural fluid.

A modern laboratory has such a type of research as PCR diagnostics. This method allows you to determine the pathogen on the day of the study (as opposed to bak. sowing on a nutrient medium) and immediately prescribe the desired drug.

5. Additional treatment for exudative pleurisy includes diuretics and anti-inflammatory drugs. Of the diuretics, furosemide and veroshpiron are usually used. Anti-inflammatory therapy is represented by both nonsteroidal drugs (ibuprofen) and steroid hormones (prednisolone).

6. Treatment of pleural empyema consists in the mandatory establishment of drainage through the chest wall in combination with active antibiotic therapy. Through the drainage, pus is evacuated and the pleural cavity is washed. When an encysted empyema occurs, an operation is performed: an empyemectomy, in which the entire purulent sac is removed.

7. In the treatment of pleurisy of a tuberculous nature, 2-3 anti-tuberculosis drugs are prescribed simultaneously.

8. Physiotherapy treatment has a resolving effect and accelerates recovery. Dry pleurisy with moderate temperature is treated with compresses with vodka, electrophoresis is performed with calcium chloride.

When the exudate is resorbed, to prevent the formation of adhesions, electrophoresis with heparin, paraffin treatment, and decimeter waves are used. After the elimination of inflammation, general and vibrational massage is recommended, as well as sanatorium treatment in forest and sea climatic zones.

Forecast

With timely evacuation of the contents and the appointment of an effective antibiotic, pleurisy is completely cured.

Without treatment, encysted purulent pleurisy can spontaneously break through to the surface of the chest or through the bronchus, which leads to a sharp appearance of a large amount of purulent sputum.

With pleurisy, a complication can be the appearance of adhesions between the layers of the pleura, which lead to restriction of respiratory movements and the appearance of respiratory failure.

If the treatment of purulent pleurisy is absent or is ineffective, acute pleurisy can become chronic. This happens within 2-3 months with a sluggish course of the process, poor functioning of the immune system.

Pleurisy is one of the most common pathological conditions of the respiratory system. It is often called a disease, but this is not entirely true. Pleurisy of the lungs is not an independent disease, but rather a symptom. In women, in 70% of cases, pleurisy is associated with malignant neoplasms in the mammary gland or reproductive system. Very often, the process develops in cancer patients against the background of metastases in the lungs or pleura.

Timely diagnosis and treatment of pleurisy can prevent dangerous complications. Diagnosis of pleurisy for a professional doctor is not difficult. The task of the patient is to seek medical help in a timely manner. Let us consider in more detail what signs indicate developing pleurisy and what forms of treatment for this pathological condition exist.

Characteristics of the disease and types of pleurisy

Pleurisy is called inflammation of the pleura - the serous membrane that envelops the lungs. The pleura looks like translucent sheets of connective tissue. One of them is adjacent to the lungs, the other lines the chest cavity from the inside. A fluid circulates in the space between them, which ensures the sliding of the two layers of the pleura during inhalation and exhalation. Its amount normally does not exceed 10 ml. With pleurisy of the lungs, fluid accumulates in excess. This phenomenon is called pleural effusion. This form of pleurisy is called effusion, or exudative. It occurs most frequently. Pleurisy can also be dry - in this case, fibrin protein is deposited on the surface of the pleura, the membrane thickens. However, as a rule, dry (fibrinous) pleurisy is only the first stage of the disease, which precedes the further formation of exudate. In addition, when the pleural cavity is infected, the exudate can also be purulent.

As already mentioned, medicine does not classify pleurisy as an independent disease, calling it a complication of other pathological processes. Pleurisy may indicate lung disease or other diseases that do not cause damage to the lung tissue. According to the nature of the development of this pathological condition and the cytological analysis of the pleural fluid, along with other studies, the doctor is able to determine the presence of the underlying disease and take adequate measures, but pleurisy itself requires treatment. Moreover, in the active phase, it is able to come to the fore in the clinical picture. That is why in practice pleurisy is often called a separate respiratory disease.

So, depending on the state of the pleural fluid, there are:

• purulent pleurisy;
• serous pleurisy;
• serous-purulent pleurisy.

The purulent form is the most dangerous, since it is accompanied by intoxication of the whole organism and, in the absence of proper treatment, threatens the life of the patient.

Pleurisy can also be:

• acute or chronic;
• severe or moderate;
• affect both parts of the chest or appear only on one side;
• development often provokes an infection, in which case it is called infectious.

The list of non-infectious causes of pleurisy of the lungs is also wide:

• connective tissue diseases;
• vasculitis;
• pulmonary embolism;
• chest trauma;
• allergy;
• oncology.

In the latter case, we can talk not only about lung cancer itself, but also about tumors of the stomach, breast, ovaries, pancreas, melanoma, etc. When metastases penetrate into the lymph nodes of the chest, the outflow of lymph occurs more slowly, and the pleura becomes more permeable. Fluid seeps into the pleural cavity. It is possible to close the lumen of the large bronchus, which lowers the pressure in the pleural cavity, which means it provokes the accumulation of exudate.

With non-small cell lung cancer (NSCLC), pleurisy is diagnosed in more than half of the cases. With adenocarcinoma, the frequency of metastatic pleurisy reaches 47%. With squamous cell lung cancer - 10%. Bronchiolo-alveolar cancer leads to pleural effusion already at an early stage, and in this case, pleurisy may be the only signal of the presence of a malignant tumor.

Depending on the form, the clinical manifestations of pleurisy differ. However, as a rule, it is not difficult to determine pleurisy of the lungs. It is much more difficult to find the true cause that caused inflammation of the pleura and the appearance of pleural effusion.

Symptoms of pleurisy

The main symptoms of pleurisy of the lungs are pain in the chest, especially when inhaling, a cough that does not bring relief, shortness of breath, a feeling of tightness in the chest. Depending on the nature of inflammation of the pleura and localization, these signs may be obvious or almost absent. With dry pleurisy, the patient feels pain in the side, which intensifies when coughing, breathing becomes difficult, weakness, sweating, and chills are not excluded. The temperature remains normal or rises slightly - no more than 37 ° C.

With exudative pleurisy, weakness and poor health are more pronounced. Fluid accumulates in the pleural cavity, compresses the lungs, prevents them from expanding. The patient cannot take a full breath. Irritation of nerve receptors in the inner layers of the pleura (there are practically none in the lungs themselves) causes a symptomatic cough. In the future, shortness of breath and heaviness in the chest only increase. The skin becomes pale. A large accumulation of fluid prevents the outflow of blood from the cervical veins, they begin to bulge, which eventually becomes noticeable. The part of the chest affected by pleurisy is limited in movement.

With purulent pleurisy, noticeable temperature fluctuations are added to all the above signs: up to 39–40 ° in the evening and 36.6–37 ° in the morning. This indicates the need for urgent medical attention, since the purulent form is fraught with serious consequences.

Diagnosis of pleurisy takes place in several stages:

1. Examination and questioning of the patient. The doctor finds out the clinical manifestations, the duration of occurrence and the level of well-being of the patient.
2. Clinical examination. Different methods are used: auscultation (listening with a stethoscope), percussion (tapping with special instruments for the presence of fluid), palpation (palpation to determine painful areas).
3. X-ray examination and CT. X-ray allows you to visualize pleurisy, assess the volume of fluid, and in some cases - to identify metastases in the pleura and lymph nodes. Computed tomography helps to establish the degree of prevalence more accurately.
4. Blood analysis. With an inflammatory process in the body, the ESR, the number of leukocytes or lymphocytes increases. This study is necessary for the diagnosis of infectious pleurisy.
5. Pleural puncture. This is the collection of fluid from the pleural cavity for laboratory testing. The procedure is carried out in the case when there is no threat to the life of the patient. If too much fluid has accumulated, a pleurocentesis (thoracocentesis) is immediately performed - removal of exudate through a puncture using a long needle and electric suction, or a port system is installed, which is an advantageous solution. The patient's condition improves, and part of the fluid is sent for analysis.

If after all the stages the exact picture remains unclear, the doctor may prescribe a videothoracoscopy. A thorascope is inserted into the chest - this is an instrument with a video camera that allows you to examine the affected areas from the inside. If we are talking about oncology, it is necessary to take a fragment of the tumor for further research. After these manipulations, it is possible to make an accurate diagnosis and begin treatment.

Treatment of the condition

Treatment of pleurisy of the lungs should be comprehensive, aimed at eliminating the disease that caused it. Therapy of pleurisy itself, as a rule, is symptomatic, designed to accelerate the resorption of fibrin, prevent the formation of adhesions in the pleural cavity and liquid "bags", and alleviate the patient's condition. The first step is to remove the pleural edema. At a high temperature, the patient is prescribed antipyretics, with pain - analgesic NSAIDs. All these actions allow to stabilize the patient's condition, normalize the respiratory function and effectively treat the underlying disease.

Treatment of pleurisy in a mild form is possible at home, in a complex one - exclusively in a hospital. It may include different methods and techniques.

1. Thoracocentesis . This is a procedure in which accumulated fluid is removed from the pleural cavity. Assign in all cases of effusion pleurisy in the absence of contraindications. Thoracocentesis is performed with caution in the presence of a pathology of the blood coagulation system, increased pressure in the pulmonary artery, severe obstructive pulmonary disease, or the presence of only one functional lung. Local anesthesia is used for the procedure. A needle is inserted into the pleural cavity on the side of the scapula under ultrasound control and exudate is taken. Compression of the lung tissue decreases, the patient becomes easier to breathe.
2. Often, the procedure needs to be repeated; for this, modern and completely safe interpleural port systems , providing constant access to the pleural cavity both for the evacuation of exudate and for the administration of drugs, including as part of chemotherapy.
   We are talking about a system consisting of a catheter, which is inserted into the pleural cavity, and a titanium chamber with a silicone membrane. Installation requires only two small incisions, which are later sutured. The port is placed in the soft tissues of the chest wall, under the skin. In the future, it does not cause any inconvenience to the patient. Manipulation takes no more than an hour. The very next day after the installation of the port, the patient can go home. When it is necessary to evacuate the exudate again, it is enough to pierce the skin and the silicone membrane under it. It's fast, safe and painless. With a sudden need and lack of access to medical care, with a certain skill and knowledge of the rules for the procedure, even relatives are able to independently release the patient's pleural cavity from fluid through the port.
3. Another type of intervention pleurodesis . This is an operation to artificially create adhesions between the sheets of the pleura and destroy the pleural cavity so that there is nowhere for fluid to accumulate. The procedure is prescribed, as a rule, for oncological patients with the ineffectiveness of chemotherapy. The pleural cavity is filled with a special substance that prevents the production of exudate and has an antitumor effect - in the case of oncology. These can be immunomodulators (for example, interleukins), glucocorticosteroids, antimicrobials, radioisotopes and alkylating cytostatics (derivatives of oxazaphosphorine and bis-β-chloroethylamine, nitrosourea or ethylenediamine, platinum preparations, alkylsulfonates, triazines or tetrazines), which depends solely on the specific clinical case. .
4. If the above methods fail, the pleura removal and shunt placement . After shunting, the fluid from the pleural cavity passes into the abdominal cavity. However, these methods are classified as radical, capable of causing serious complications, so they are resorted to last.
5. Medical treatment . In the case when pleurisy is of an infectious nature or is complicated by an infection, antibacterial drugs are used, the choice of which depends entirely on the type of pathogen and its sensitivity to a particular antibiotic. Medicines, depending on the nature of the pathogenic flora, can be:

• natural, synthetic, semi-synthetic and combined penicillins (benzylpenicillin, phenoxymethylpenicillin, methicillin, oxacillin, nafcillin, ticarcillin, carbpenicillin, Sultasin, Oxamp, Amoxiclav, mezlocillin, azlocillin, mecillam);
• cephalosporins ("Mefoxin", "Ceftriaxone", "Katen", "Latamoccef", "Cefpir", "Cefepim", "Zeftera", "Ceftolosan");
• fluoroquinolones ("Microflox", lomefloxacin, norfloxacin, levofloxacin, sparfloxacin, moxifloxacin, gemifloxacin, gatifloxacin, sitafloxacin, trovafloxacin);
• carbapenems ("Tienam", doripenem, meropenem);
• glycopeptides ("Vancomycin", "Vero-Bleomycin", "Targocid", "Vibativ", ramoplanin, decaplanin);
• macrolides ("Sumamed", "Utacid", "Rovamycin", "Rulid");
• ansamycins ("Rifampicin");
• aminoglycosides (amikacin, netilmicin, sisomycin, isepamycin), but they are incompatible with penicillins and cephalosporins during simultaneous therapy;
• lincosamides (lincomycin, clindamycin);
• tetracyclines (doxycycline, "Minoleksin");
• amphenicols ("Levomycetin");
• other synthetic antibacterial agents (hydroxymethylquinoxaline dioxide, fosfomycin, dioxidine).

For the treatment of inflammation of the pleura, anti-inflammatory and desensitizing drugs are also prescribed (electrophoresis of a 5% solution of novocaine, analgin, dimedrol, a 10% solution of calcium chloride, a 0.2% solution of platyfillin hydrotartrate, indomethacin, etc.), regulators of water and electrolyte balance ( saline and glucose solution), diuretics ("Furosemide"), lidase electrophoresis (64 IU every 3 days, 10-15 procedures per course of treatment). They can prescribe agents for expanding the bronchi and cardiac glycosides that enhance myocardial contraction (Eufillin, Korglikon). Pleurisy of the lungs with oncology lends itself well to chemotherapy - after it is carried out, the swelling and symptoms usually go away. Drugs are administered systemically - by injection or intrapleurally through the membrane valve of the port system.

According to statistics, courses of chemotherapy in combination with other methods of treatment help to eliminate pleurisy in about 60% of patients who are sensitive to chemotherapy drugs.

During the course of treatment, the patient must be constantly under the supervision of a physician and receive supportive therapy. After the end of the course, it is necessary to conduct an examination, and after a few weeks, appoint it again.

Disease prognosis

Advanced forms of pleurisy of the lungs can have severe complications: the occurrence of adhesions of the pleura, bronchopleural fistulas, circulatory disorders due to squeezing of blood vessels.

In the process of developing pleurisy under fluid pressure, the arteries, veins and even the heart can move in the opposite direction, which leads to an increase in intrathoracic pressure and a violation of blood flow to the heart. In this regard, the prevention of pulmonary heart failure is the central task of all therapeutic measures for pleurisy. If a displacement is detected, the patient is shown an emergency pleurocentesis.

A dangerous complication is empyema - the formation of a "pocket" with pus, which ultimately can lead to scarring of the cavity and the final blockage of the lung. A breakthrough of purulent exudate into the lung tissue is fatal. Finally, pleurisy can cause amyloidosis of parenchymal organs or kidney damage.

Special attention is paid to pleurisy in its diagnosis in cancer patients. Pleural effusion aggravates the course of lung cancer, increases weakness, gives additional shortness of breath, provokes pain. When the vessels are squeezed, the ventilation of the tissue is disturbed. Given immune disorders, this creates a favorable environment for the spread of bacteria and viruses.

The consequences of the disease and the chances of recovery depend on the underlying diagnosis. In cancer patients, fluid in the pleural cavity usually accumulates in the advanced stages of cancer. This makes treatment difficult and the prognosis is often poor. In other cases, if the fluid from the pleural cavity was removed in time and adequate treatment was prescribed, there is no threat to the life of the patient. However, patients need regular monitoring in order to diagnose a relapse in time when it occurs.

Pleurisy, what is it? Causes and Treatments

Pleurisy is an inflammation of the serous membranes that cover the outside of the lungs. This disease is very common. This is the most commonly diagnosed pathology of the lungs. In the general structure of the incidence of the population, pleurisy accounts for 5-15%. The incidence rate varies from 300 to 320 cases per 100 thousand people. Men and women suffer from this disease equally often. Pleurisy in children is diagnosed less frequently than in adults.

An interesting fact is that women are most often diagnosed with the so-called tumor pleurisy. It develops against the background of various neoplasms of the genital organs and breasts. As for men, effusion pleurisy often occurs with pathology of the pancreas and rheumatoid arthritis. In most cases, bilateral or unilateral pleurisy is secondary.

What it is?

Pleurisy - inflammation of the pleural sheets, with the loss of fibrin on their surface (dry pleurisy) or the accumulation of exudate of a different nature in the pleural cavity (exudative pleurisy).

The same term denotes processes in the pleural cavity, accompanied by an accumulation of pathological effusion, when the inflammatory nature of pleural changes does not seem indisputable. Among its causes are infections, chest injuries, tumors.

Causes

The causes of pleurisy can be conditionally divided into infectious and aseptic or inflammatory (non-infectious).

Noninfectious pleurisy usually occurs

• at ,
• with (vascular damage),
• with rheumatism,
• at ,
• at ,
• as a result of pulmonary embolism and pulmonary edema,
• with pulmonary infarction
• when lung cancer mathestasis into the pleural cavity,
• with a primary malignant tumor of the pleura - mesothelioma,
• lymphoma,
• during hemorrhagic diathesis (coagulation disorders),
• during leukemia,
• in the tumor process of the ovaries, breast cancer as a result of cancer cachexia (terminal stage of cancer),
• with myocardial infarction due to congestion in the pulmonary circulation.
• with acute.

Infectious diseases include:

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.

1. Dry (fibrinous) pleurisy. It develops at the initial stage of inflammatory lesions 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. Due to the increase in vascular permeability under the action of pro-inflammatory substances, the liquid component of the plasma and some of the proteins, among which fibrin is of the greatest importance, begin to seep into the pleural cavity. 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.
2. Purulent pleurisy. 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 independent opening of an abscess (or other accumulation 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.
3. Exudative (effusion) pleurisy. It 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 layers of the pleura, at this stage, the irritation of the serous membranes and, accordingly, the intensity of the pain sensation is somewhat reduced.
4. Tuberculous pleurisy. Often it 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.

This division in most cases is rather arbitrary, since one type of pleurisy can often turn into another. Moreover, dry and exudative (effusion) pleurisy are considered by most pulmonologists as different stages of the same pathological process. It is believed that dry pleurisy is initially formed, and effusion develops only with further progression of the inflammatory reaction.

Symptoms

The clinical picture of pleurisy is divided into dry and exudative.

Symptoms of exudative pleurisy:

• general malaise, lethargy, subfebrile fever;
• chest pain, shortness of breath increase, gradual increase in heat - this is due to the collapse of the lung, the mediastinal organs are squeezed.

Acute serous pleurisy usually has a tuberculous origin, is characterized by three stages:

1. In the initial period (exudative) smoothing or even swelling of the intercostal space is noted. The mediastinal organs are displaced to the healthy side under the influence of a large amount of fluid in the pleural space.
2. The stabilization period is characterized by a decrease in acute symptoms: the temperature drops, chest pains and shortness of breath disappear. At this stage, pleural friction may appear. In the acute phase, a blood test shows a large accumulation of leukocytes, which gradually returns to normal.
3. It often happens that fluid accumulates above the diaphragm, so it is not visible on a vertical x-ray. In this case, it is necessary to conduct a study in a position on the side. Free fluid moves easily in accordance with the position of the patient's torso. Often, its accumulations are concentrated in the gaps between the lobes, as well as in the area of ​​the dome of the diaphragm.

Symptoms of dry pleurisy:

• chest pain;
• general unhealthy condition;
• subfebrile body temperature;
• local pain (depending on the location of the lesion);
• with palpation of the ribs, deep breathing, coughing, pain intensifies.

In the acute course of the disease, the doctor diagnoses pleural murmur by auscultation, which does not stop after pressing with a stethoscope or coughing. Dry pleurisy, as a rule, passes without any negative consequences - of course, with an adequate treatment algorithm.

Acute symptoms, in addition to the described serous pleurisy, include purulent forms - pneumothorax and pleural empyema. They can be caused by tuberculosis and other infections.

Purulent pleurisy is caused by pus entering the pleural cavity, where it tends to accumulate. It should be noted that non-tuberculous empyema is relatively well treatable, however, with an inadequate algorithm of actions, it can turn into a more complex form. Tuberculous empyema is severe and may be chronic. The patient significantly loses weight, suffocates, experiences constant chills, suffers from coughing fits. In addition, the chronic form of this type of pleurisy causes amyloidosis of the internal organs.

In case of not providing optimal assistance, complications arise:

• stop breathing;
• spread of infection throughout the body with blood flow;
• development of purulent mediastinitis.

Diagnostics

The first task in diagnosing pleurisy is finding out the location and cause of inflammation or swelling. To make a diagnosis, the doctor examines the medical history in detail and conducts an initial examination of the patient.

The main methods for diagnosing pleurisy of the lungs:

1. Blood tests can help determine if you have an infection, which could be the cause of pleurisy. In addition, blood tests will show the state of the immune system.
2. A chest x-ray will determine if there is any pneumonia. A chest x-ray may also be taken while lying down to allow free fluid in the lungs to form a layer. A recumbent chest x-ray should confirm if there is any fluid buildup.
3. Computed tomography is already performed if any abnormalities are found on the chest x-ray. This analysis presents a series of detailed, transverse sectional images of the chest. The images produced by a CT scan create a detailed picture of the inside of the breast, allowing the attending physician to obtain a more detailed analysis of the irritated tissue.
4. During a thoracentesis, your doctor will insert a needle into your chest area to test for fluid. The fluid is then removed and analyzed for infections. Due to its aggressive nature and associated risks, this test is rarely done for a typical case of pleurisy.
5. During a thoracoscopy, a small incision is made in the chest wall and then a tiny camera attached to a tube is inserted into the chest cavity. The camera locates the irritated area, allowing a tissue sample to be taken for analysis.
6. A biopsy is useful in the development of pleurisy in oncology. In this case, sterile procedures are used and small incisions are made in the skin of the chest wall. An x-ray or CT scan can confirm the exact location of the biopsy. The doctor may use these procedures to insert the lung biopsy needle between the ribs and into the lung. Then a small sample of lung tissue is taken and the needle is removed. The tissue is sent to a laboratory where it will be analyzed for infections and abnormal cells compatible with cancer.
7. Using ultrasound, high-frequency sound waves create an image of the inside of the chest cavity, which will allow you to see if there is any inflammation or fluid buildup.

As soon as the symptoms of pleurisy are identified, treatment is prescribed immediately. In the first place in the treatment are antibiotics against infection. In addition, anti-inflammatory drugs or other pain medications are prescribed. Sometimes cough medicine is prescribed.

Pleurisy treatment

Effective treatment of pleurisy depends entirely on the cause of its occurrence and consists mainly in eliminating the unpleasant symptoms of the disease and improving the patient's well-being. In the case of a combination of pneumonia and pleurisy, antibiotic treatment is indicated. Pleurisy accompanying systemic vasculitis, rheumatism, scleroderma is treated with glucocorticoid drugs.

Pleurisy, which arose against the background of the disease, is treated with isoniazid, rifampicin, streptomycin. Typically, this treatment lasts for several months. In all cases of the disease, diuretic, analgesic and cardiovascular drugs are prescribed. Patients who do not have special contraindications are shown physiotherapy exercises and physiotherapy. Often, in the treatment of pleurisy, in order to prevent recurrence of the disease, obliteration of the pleural cavity or pleurodesis is performed - the introduction of special preparations “gluing” sheets of drugs into the pleural cavity.

The patient is prescribed analgesics, anti-inflammatory drugs, antibiotics, cough suppressants and allergic manifestations. With tuberculous pleurisy, specific therapy with anti-tuberculosis drugs is carried out. With pleurisy resulting from a tumor of the lung or intrathoracic lymph nodes, chemotherapy is prescribed. Glucocorticosteroids are used in collagen diseases. With a large amount of fluid in the pleural cavity, a puncture is indicated to suck out the contents and administer drugs directly into the cavity.

During the rehabilitation period, respiratory gymnastics, physiotherapy, general strengthening therapy are prescribed.

Prevention

Of course, it is impossible to predict how the body will react to the action of a particular factor. However, any person is able to follow simple recommendations for the prevention of pleurisy:

1. First of all, complications should not be allowed in the development of acute respiratory infections. So that pathogenic microflora does not penetrate the mucous membrane of the respiratory tract, and then into the pleural cavity, colds should not be left to chance!
2. With frequent infections of the respiratory tract, it is good to change the climate for a while. Sea air is an excellent means of preventing respiratory infections, including pleurisy.
3. If pneumonia is suspected, it is better to take a chest x-ray in a timely manner and begin adequate therapy. Improper treatment of the disease increases the risk of complications in the form of inflammation of the pleura.
4. Try to strengthen your immune system. In the warm season, harden, spend more time in the fresh air.
5. Quit smoking. Nicotine becomes the first cause of the development of pulmonary tuberculosis, which in turn can provoke inflammation of the pleura.
6. Do breathing exercises. A couple of deep breaths after waking up will serve as an excellent prevention of the development of inflammatory diseases of the respiratory system.

Forecast

The prognosis of pleurisy is favorable, although it directly depends on the leading disease. Inflammatory, infectious, post-traumatic pleurisy is successfully cured and does not affect the quality of later life. Unless, during later life, pleural adhesions will be noted on radiographs.

The exception is dry tuberculous pleurisy, as a result of which fibrous deposits can calcify over time, the so-called armored pleurisy is formed. The lung is enclosed in a "stone shell", which interferes with its full functioning and leads to chronic respiratory failure.

To prevent the formation of adhesions that form after the removal of fluid from the pleural cavity, after treatment, when the acute period subsides, the patient should undergo rehabilitation procedures - this is physiotherapy, manual and vibration massage, daily breathing exercises are mandatory (according to Strelnikova, using the Frolov breathing simulator) .

Pleurisy is one of the most common diseases of the human respiratory system. According to medical statistics, it occurs in 10% of patients in therapeutic hospitals. This disease very often accompanies pneumonia (up to 95% of cases), tuberculosis, connective tissue diseases, and malignant neoplasms - the incidence of pleurisy in cancer of the lungs, breast, ovaries, and hematopoietic system reaches 50%. A large number of causes that cause this disease, as well as the difficulties that arise in the diagnosis of the disease, often complicate the treatment of a patient with pleurisy.

Pleurisy of the lungs - what is it; how to treat the disease?

In the body of a healthy person, 10-15 liters of pleural fluid is formed every day. Most of this fluid is absorbed back into the tissues, and 3-5 ml remains between the pleura. This small amount of liquid plays an important role - it lubricates the pleura during breathing. Inflammation of the pleura with the formation of plaque (fibrin) or excess accumulation of fluid (exudate) on it is called pleurisy. Accordingly, in the first case, dry pleurisy is diagnosed, and in the second - exudative, or effusion. Dry pleurisy in modern medical practice is considered the initial stage of effusion.

Some diseases practically do not have an independent cause of their appearance, but accompany other serious diseases. These include pleurisy: ICD 10 (International Classification of Diseases) classifies it as a group of symptoms and signs of other diseases associated with the respiratory and circulatory systems, along with asphyxia and breath holding.

Since pleurisy in most cases is a secondary disease, its treatment should be carried out in a complex manner along with the elimination of the underlying disease. Otherwise, therapy will be ineffective and repeated relapses are possible.

Types of pleurisy and causes of the disease

In medicine, pleural effusion is divided into two types - transudate and exudate. This helps determine the cause of the increased effusion. If excess fluid accumulates as a result of a change in the capillary pressure of the blood, then they speak of a transudate; in case of blockage of the lymphatic vessels or increased vascular permeability - about exudate.

The causes of transudate may be:

1. Heart failure and inflammation of the serosa of the heart (pericarditis).
2. Cirrhosis of the liver.
3. Kidney disease, accompanied by edema.
4. Blockage of the urinary tract.
5. Diseases of the thyroid gland, leading to edema.
6. Medical manipulations in the abdominal and chest cavity: blood purification from toxins (peritoneal dialysis through a catheter), heart surgery; bone marrow transplant operations.
7. Low levels of albumin in the blood.
8. Thrombi in the pulmonary artery, blockage of the superior vena cava.

According to the degree of localization of the lesion, diffuse (general) and encysted pleurisy are distinguished. In the latter case, the accumulation of fluid occurs in local areas, between the adhesions of the pleura. Adhesive isolated cavities arise as a result of a prolonged inflammatory process in the pleural region.

Pleurisy of the lungs: symptoms and treatment

Dry pleurisy of the lungs: symptoms

Symptoms of dry pleurisy are the following manifestations:

• pain in the chest (in the shoulder area or under the ribs), aggravated by coughing, breathing, hiccups, belching, swallowing and abdominal breathing;
• short dry cough;
• temperature up to 38 degrees (often at the normal level);
• general weakness, poor appetite, night chills;
• severe hiccups, which disappears 1-2 days after the transition of the disease to the exudative stage;
• dyspnea.

Painful sensations occur periodically, due to friction of the pleural sheets. They can pass within 3 days, but this does not mean that the inflammatory process is over. During the period of attenuation of inflammation, the pleural tissue is covered with fibrin, as a result of which its sensitivity decreases, and friction also decreases due to the accumulation of exudate. Dry pleurisy may resolve spontaneously within a few days.

Exudative pleurisy: symptoms

Symptoms of exudative pleurisy depend on the manifestations of the underlying disease. In many patients at an early stage, pleurisy goes unnoticed and develops gradually. The most common complaints are cough, a feeling of heaviness in the chest, and shortness of breath, which increase as fluid accumulates in the pleural cavity. But a direct relationship between them may not be observed. In people with severe heart and lung disease, even a small amount of effusion leads to severe shortness of breath.

In the supine position, the fluid does not press on the lung and heart, so pain and shortness of breath decrease. Some patients feel a transfusion of fluid in the affected part of the chest.

There are 3 stages in the development of the disease:

1. The accumulation of effusion.
2. Stabilization.
3. Reabsorption of exudate. The fluid may be completely absorbed within 2-4 weeks.

Pleurisy can appear and develop almost asymptomatically, a person continues to engage in daily activities, and only the growing general weakness makes him see a doctor.

Acute pleurisy: causes; clinical manifestations; treatment of complications

Acute pleurisy is accompanied by:

• high temperature;
• painful bouts of coughing for a long time;
• a high fever that may last for several months;
• acute pain;
• severe weakness and weight loss. The patient tends to lie on the side where the inflammation progresses.

Severe cases of pleurisy are characterized by the following complications:

• displacement of organs located between the right and left pleural cavities;
• severe intoxication of the body;
• acute pulmonary insufficiency (severe shortness of breath);
• cardiovascular insufficiency (cyanosis, rapid pulse, drop in blood pressure).

Comprehensive treatment of acute pleurisy is carried out in intensive care units and intensive care units.

The acute course of the disease is characteristic of pneumonia and tuberculous pleurisy. Purulent pleurisy can lead to the formation of fistulas and the outflow of exudate into neighboring organs. Purulent pleurisy is often a consequence of bacterial pneumonia, the causative agents of which can be pneumococcus, Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli, Klebsiella. In the case of rapid accumulation of pleural fluid after its forced evacuation, the presence of a tumor in the pleural cavity is possible.

Often, after a disease, an adhesive process develops that prevents the normal functioning of the lungs, as well as an irreversible replacement of pleural tissue with fibrous tissue, its thickening, deformation and limitation of chest mobility.

Diagnosis of pleurisy

To diagnose the disease, the following examinations are carried out:

1. General and biochemical blood tests. In the results of the analyzes, an increase in ESR, the number of neutrophils and leukocytes, seromucoid, sialic acids, fibrin is observed.
2. X-ray examination in two projections.
3. Ultrasound examination, which allows to determine the amount of fluid in the pleural cavity and fibrin deposits.
4. Computed tomography of the lungs.
5. Thoracocentesis is the insertion of hollow needles into the chest to examine exudate.

Since the specific symptoms of the disease are very poor, pleurisy often has to be differentiated from other acute pathologies of the abdominal cavity (appendicitis, cholecystitis), intercostal neuralgia, gastric and duodenal ulcers, angina pectoris, myocardial infarction, pericarditis. The most true symptom is pain during respiratory movements.

Treatment of the disease

The tactics of treating pleurisy is associated primarily with the elimination of the underlying disease:

• Antibacterial therapy taking into account the causative agent of the disease and its sensitivity to antibiotics.
• Detoxification therapy with purulent pleurisy (droppers with isotonic salt solutions, glucose, the use of diuretics).
• Correction of protein metabolism in severe cases of pleurisy (intravenous administration of albumin, plasma, hormones).
• Anti-inflammatory treatment non-steroidal drugs (nise, movaliz, voltaren, diclofenac).
• The use of analgesics and antitussive drugs.
• Local treatment: removal of pus, cleaning, administration of antibiotics and reduction of adhesions of the pleural cavity with the help of fibrinolytic agents. These procedures are performed by inserting needles, chest tubes, and thoracars into the chest. If necessary, surgical removal of the focus of infection is performed.

In the acute period of the disease, bed rest is indicated.

Pleurisy of the lungs: symptoms and treatment in the elderly

Pleurisy occurs most often in middle-aged and elderly men against the background of developing infectious pneumonia. This is due to a drop in the overall resistance of the body and the presence of many concomitant diseases. Bed patients are especially susceptible to the disease, in which an unfavorable factor is the formation of stagnant processes and edema due to a sedentary lifestyle, as well as impaired metabolic functions.

Pleurisy in the elderly most often occurs in a sluggish form and is difficult to diagnose, since the disease is “masked” by symptoms of other diseases. The symptomatology is the same in most cases, but some manifestations may not be present (patients with Alzheimer's disease do not cough; the level of leukocytes in the blood may not rise).

In the acute and severe course of the disease, the nature of the sputum is somewhat different - they are green in color, with streaks of blood. Acute disease has a poor prognosis - up to 50% of deaths. Complications of the disease are manifested in acute pulmonary and heart failure.

The treatment of such patients is longer, and the disease often becomes chronic with periodic relapses.

Since pleurisy is a consequence of not only pulmonary diseases, but also many others, its prevention should be aimed at general strengthening and healing of the body, prevention and timely treatment of tuberculosis, pancreatitis, rheumatism, diseases of the kidneys and the cardiovascular system, as well as chest injuries. cells.