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 helps prevent dangerous complications. Diagnosing pleurisy is not difficult for a professional doctor. The patient’s task is to seek medical help in a timely manner. Let's take a closer look at what signs indicate developing pleurisy and what forms of treatment exist for this pathological condition.
Characteristics of the disease and types of pleurisy
Pleurisy is an 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. 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 often. Pleurisy can also be dry - in this case, fibrin protein is deposited on the surface of the pleura, and the membrane thickens. However, as a rule, dry (fibrinous) pleurisy is only the first stage of the disease, which precedes further formation of exudate. In addition, when the pleural cavity is infected, the exudate can 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. Based on 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 disease of the respiratory system.
So, depending on the state of the pleural fluid, the following are distinguished:
- purulent pleurisy;
- serous pleurisy;
- serous-purulent pleurisy.
The purulent form is the most dangerous, since it is accompanied by intoxication of the entire body 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 on only one side;
- development is often provoked by infection, in which case it is called infectious.
There is a wide list of non-infectious causes of pulmonary pleurisy:
- connective tissue diseases;
- vasculitis;
- thromboembolism pulmonary artery;
- chest injuries;
- 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 leaks into the pleural cavity. It is possible to close the lumen of a large bronchus, which lowers the pressure in the pleural cavity, and therefore provokes the accumulation of exudate.
In non-small cell lung cancer (NSCLC), pleurisy is diagnosed in more than half of the cases. In adenocarcinoma, the frequency of metastatic pleurisy reaches 47%. For squamous cell lung cancer - 10%. Bronchiolo-alveolar cancer leads to pleural effusion already at early stage, and in this case, pleurisy may be the only signal of the presence of a malignant tumor.
Vary depending on the shape clinical manifestations pleurisy. However, as a rule, it is not difficult to determine pulmonary pleurisy. Much harder to find the real reason, which caused inflammation of the pleura and the appearance of pleural effusion.
Symptoms of pleurisy
The main symptoms of pulmonary pleurisy are pain in the chest, especially when inhaling, a cough that does not bring relief, shortness of breath, and a feeling of tightness in the chest. Depending on the nature of the pleural inflammation and location, 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 possible. The temperature remains normal or increases 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, and prevents them from expanding. The patient cannot breathe fully. 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 intensify. The skin becomes pale. A large accumulation of fluid prevents the outflow of blood from the neck 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 symptoms: up to 39–40° in the evening and 36.6–37° in the morning. This indicates the need to urgently consult a doctor, since the purulent form is fraught with serious consequences.
Diagnosis of pleurisy takes place in several stages:
- Examination and interview of the patient. The doctor finds out the clinical manifestations, how long ago it occurred and the patient’s level of well-being.
- Clinical examination. Various methods are used: auscultation (listening with a stethoscope), percussion (tapping with special instruments for the presence of fluid), palpation (palpation to identify painful areas).
- X-ray and CT scan. X-ray allows you to visualize pleurisy, assess the volume of fluid, and in some cases, identify metastases in the pleura and lymph nodes. Computed tomography helps to determine the extent of prevalence more accurately.
- Blood analysis. During the inflammatory process in the body, the ESR, the number of leukocytes or lymphocytes increases. This study is necessary to diagnose infectious pleurisy.
- Pleural puncture. This is the collection of fluid from the pleural cavity for laboratory research. The procedure is carried out in cases where there is no threat to the patient’s life. If too much fluid has accumulated, thoracentesis (thoracentesis) is immediately performed - removal of exudate through a puncture using a long needle and electric suction, or a port system is installed, which is the preferred solution. The patient's condition improves, and some of the fluid is sent for analysis.
If after all the stages the exact picture remains unclear, the doctor may prescribe a video thoracoscopy. A thoracoscope 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 collect 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 pulmonary pleurisy should be comprehensive, aimed at eliminating the disease that caused it. Therapy for pleurisy itself is usually symptomatic, designed to accelerate the resorption of fibrin, prevent the formation of adhesions in the pleural cavity and fluid “bags,” and alleviate the patient’s condition. The first step is to remove pleural edema. At high temperatures, the patient is prescribed antipyretics, and for pain, analgesic NSAIDs. All these actions make it possible to stabilize the patient’s condition, normalize respiratory function and effectively treat the underlying disease.
Treatment of pleurisy in a mild form is possible at home, in a complex form - exclusively in a hospital. It may include different methods and techniques.
- Thoracentesis . This is a procedure in which accumulated fluid is removed from the pleural cavity. Prescribed for all cases of effusion pleurisy in the absence of contraindications. Thoracentesis is performed with caution in the presence of 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 guidance and exudate is collected. The compression of the lung tissue decreases, making it easier for the patient to breathe.
- Often the procedure needs to be repeated, for this purpose modern and completely safe intrapleural port systems
, providing constant access to the pleural cavity both for evacuation of exudate and for insertion medicines, including during 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 installed in the soft tissue of the chest wall, under the skin. In the future, it does not cause any inconvenience to the patient. The manipulation takes no more than an hour. The patient can go home the very next day after the port is installed. When you need to evacuate the exudate again, it is enough to pierce the skin and the silicone membrane under it. It's fast, safe and painless. In the event of a sudden need and lack of access to medical care, with a certain skill and knowledge of the rules of the procedure, even relatives are able to independently empty the patient’s pleural cavity of fluid through a port. - Another type of intervention is pleurodesis . This is an operation to artificially create adhesions between the layers of the pleura and destroy the pleural cavity so that there is nowhere for fluid to accumulate. The procedure is usually prescribed for cancer patients when chemotherapy is ineffective. 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 may be immunomodulators (for example, interleukins), glucocorticosteroids, antimicrobial agents, radioisotopes and alkylating cytostatics (derivatives of oxazaphosphorine and bis-β-chloroethylamine, nitrosourea or ethylenediamine, platinum preparations, alkyl sulfonates, triazines or tetrazines), which depends solely on the specific clinical case .
- If the above methods do not work, it is shown removal of the pleura and installation of a shunt . After shunting, fluid from the pleural cavity passes into the abdominal cavity. However, these methods are considered radical and can cause serious complications, so they are used as a last resort.
- Drug treatment . In cases where pleurisy is of an infectious nature or complicated by an infection, antibacterial drugs are used, the choice of which depends entirely on the type of pathogen and its sensitivity to a specific antibiotic. Medicines, depending on the nature of the pathogenic flora, may include:
- natural, synthetic, semi-synthetic and combined penicillins (benzylpenicillin, phenoxymethylpenicillin, methicillin, oxacillin, nafcillin, ticarcillin, carbpenicillin, Sultasin, Oxamp, Amoxiclav, mezlocillin, azlocillin, mecillam);
- cephalosporins (“Mefoxin”, “Ceftriaxone”, “Keyten”, “Latamoccef”, “Cefpirome”, “Cefepime”, “Zeftera”, “Ceftolozane”);
- fluoroquinolones (“Microflox”, lomefloxacin, norfloxacin, levofloxacin, sparfloxacin, moxifloxacin, gemifloxacin, gatifloxacin, sitafloxacin, trovafloxacin);
- carbapenems (“Tienam”, doripenem, meropenem);
- glycopeptides (“Vancomycin”, “Vero-Bleomycin”, “Targotsid”, “Vibativ”, ramoplanin, decaplanin);
- macrolides (“Sumamed”, “Yutacid”, “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, Minolexin);
- amphenicols (“Levomycetin”);
- other synthetic antibacterial agents (hydroxymethylquinoxaline dioxide, fosfomycin, dioxidine).
To treat inflammation of the pleura, anti-inflammatory and desensitizing drugs are also prescribed. medicines(electrophoresis of a 5% solution of novocaine, analgin, diphenhydramine, a 10% solution of calcium chloride, a 0.2% solution of platyphylline hydrotartrate, indomethacin, etc.), regulators of water and electrolyte balance (saline and glucose solution), diuretics (“Furosemide” ), lidase electrophoresis (64 units every 3 days, 10–15 procedures per course of treatment). They may prescribe drugs for dilation of the bronchi and cardiac glycosides that enhance myocardial contraction (Eufillin, Korglykon). Pleurisy of the lungs in oncology responds well to chemotherapy - after it, swelling and symptoms usually go away. Medications are administered systemically - by injection or intrapleurally through the membrane valve of the port system.
According to statistics, chemotherapy courses in combination with other treatment methods help eliminate pleurisy in approximately 60% of patients sensitive to chemotherapy.
During the course of treatment, the patient must be constantly under medical supervision and receive supportive care. After completing the course, it is necessary to conduct an examination, and after a few weeks it is necessary to schedule it again.
Disease prognosis
Advanced forms of pulmonary pleurisy can have severe complications: the occurrence of pleural adhesions, bronchopleural fistulas, circulatory disorders due to compression of blood vessels.
During the development of pleurisy, under fluid pressure, arteries, veins and even the heart can shift in the opposite direction, which leads to an increase in intrathoracic pressure and disruption of blood flow to the heart. In this regard, preventing pulmonary heart failure is the central task of all therapeutic measures for pleurisy. If displacement is detected, the patient is indicated for emergency thoracentesis.
A dangerous complication is empyema - the formation of a “pocket” of pus, which can ultimately lead to scarring of the cavity and the final sealing of the lung. A breakthrough of purulent exudate into the lung tissue can be fatal. Finally, pleurisy can cause amyloidosis of parenchymal organs or kidney damage.
Special attention is paid to pleurisy when diagnosing it in cancer patients. Effusion in the pleural cavity aggravates the course lung cancer, increases weakness, gives additional shortness of breath, provokes pain. When the vessels are compressed, tissue ventilation is disrupted. 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 later stages of cancer. This makes treatment difficult and the prognosis is often poor. In other cases, if the fluid from the pleural cavity is removed in time and adequate treatment is prescribed, there is no threat to the patient’s life. However, patients need regular monitoring in order to promptly diagnose a relapse when it occurs.
The main respiratory organ in human body are light. The unique anatomical structure of the human lungs fully corresponds to the function they perform, which is difficult to overestimate. Pulmonary pleurisy is caused by inflammation of the pleural layers for infectious and non-infectious reasons. The disease does not belong to a number of independent nosological forms, as it is a complication of many pathological processes.
What is pulmonary pleurisy
Pulmonary pleurisy is one of the most complex inflammatory diseases, most severely occurring in children and the elderly. The pleura is the serous membrane of the lung. It is divided into visceral (pulmonary) and parietal (parietal).
Each lung is covered with pulmonary pleura, which along the surface of the root passes into the parietal pleura, lining the walls of the chest cavity adjacent to the lung and delimiting the lung from the mediastinum. The pleura that covers the lungs allows them to painlessly come into contact with the chest during breathing.
The lungs are a paired organ. Every person has two lungs - right and left. The lungs are located in the chest and occupy 4/5 of its volume. Each lung is covered with pleura, the outer edge of which is tightly fused with the chest. Lung tissue resembles a finely porous sponge Pink colour. With age, as well as with pathological processes of the respiratory system, long-term smoking, the color of the pulmonary parenchyma changes and becomes darker.
Breathing is a largely uncontrolled process carried out at a reflex level. A certain zone is responsible for this – the medulla oblongata. It regulates the pace and depth of breathing, focusing on the percentage of carbon dioxide concentration in the blood. The rhythm of breathing is affected by the work of the whole organism. Depending on the breathing rate, the heart rate slows down or speeds up.
Classification of the disease
Depending on the cause of the disease, the forms of manifestation of the disease may also differ and are divided into:
- Purulent pleurisy is a disease, the occurrence of which is provoked by the accumulation of purulent effusion in the pleural cavity. At the same time, the parietal and pulmonary membranes are damaged by the inflammatory process.
- pleurisy is characterized by damage to the pleura of an infectious, tumor or other nature.
- Dry pleurisy is usually a complication of painful processes in the lungs or other organs located near the pleural cavity, or serves as a symptom of general (systemic) diseases.
- Tuberculous pleurisy affects the serous membranes that form the pleural cavity and cover the lungs. The main symptom of the disease is increased fluid secretion or fibrin deposits on the surface of the pleura.
By distribution area:
- Diffuse pleurisy (exudate moves through the pleural cavity).
- Enclosed pleurisy (fluid accumulates in one of the areas of the pleural cavity). It can be apical, parietal, basal, interlobar.
According to the nature of the lesion, pleurisy is divided into:
- escudative – fluid is formed and retained between the layers of the pleura;
- fibrous - fluid secretion is scanty, but the surface of the pleural walls itself is covered with a layer of fibrin (protein).
Pleurisy is also divided according to the nature of its spread:
- it can only affect one lung
- both lobes (unilateral and bilateral).
Causes
It must be said that the disease in its pure form is rare. For example, its development can be caused by trauma to the chest or hypothermia. In most cases, it accompanies any disease or occurs as a complication of it.
Pulmonary pleurisy is characterized by the formation of fibrinous deposits on the surface of the pleural layers and/or accumulation of exudate in the pleural cavity. Symptoms depend on the form of the disease.
Infectious pleurisy is the most common. Sensitization of the body also plays a major role in the mechanism of development of pathology. Microbes and their toxins lead to changes in the body's reactivity and allergization of the pleura. The immune system begins to “send” produced antibodies to the site of inflammation, which, when combined with antigens, affect the production of histamines.
About 70% of forms of pathology are caused by bacterial agents:
- Streptococci;
- Pneumococci;
- Mycobacterium tuberculosis;
- Anaerobes;
- Mushrooms;
- Legionella;
- Tuberculosis.
The causes of non-infectious pulmonary pleurisy are as follows:
- malignant tumors of the pleural layers,
- metastasis to the pleura (in breast cancer, lung cancer, etc.),
- connective tissue lesions of a diffuse nature (systemic vasculitis, scleroderma, systemic lupus erythematosus),
- pulmonary infarction.
Is pleurisy contagious? To answer this question unambiguously, you need to know the cause of pleurisy itself. If the suffering is associated with a chest injury, then, naturally, such pleurisy is not contagious. With a viral etiology, it can be quite contagious, although the degree of contagiousness is low.
Symptoms of pulmonary pleurisy
Patients often miss the onset of pleurisy because its symptoms are similar to the common cold. However, the signs of this pathology still differ from other respiratory diseases. You should know that the signs different types pleurisy is also different.
The very first and most obvious sign of pulmonary pleurisy is:
- Heavy, fleeting, sharp pain in the chest, often on only one side, when breathing deeply, coughing, moving, sneezing or even talking.
- When pleurisy appears in certain places on the lungs, pain may be felt in other parts of the body, such as the neck, shoulder, or abdomen.
- Painful breathing often provokes a dry cough, which, in turn, increases pain.
The rate at which symptoms increase also plays a big role:
- Acute periods of pleural damage are characterized by a rapid clinical rise;
- for tumor and chronic forms – a calmer course of the disease
How does pulmonary pleurisy occur in older people? In old age, there is a sluggish course and slow resorption of the source of inflammation.
| Types of pleurisy | Description and symptoms |
| Dry | Dry pleurisy develops on initial stage inflammatory lesion of the pleura. Often on at this stage pathology in the lung cavity there are no infectious agents yet, and the changes that occur are due to the reactive involvement of blood and lymphatic vessels, as well as the allergic component.
|
| Purulent | Purulent pleurisy can form either due to direct damage to the pleura by infectious agents, or due to the spontaneous opening of an abscess (or other accumulation of pus) of the lung into the pleural cavity. Patients with purulent pleurisy complain of:
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| Exudative | During the period of exudate accumulation, intense pain in the chest occurs. Symptoms intensify with deep breathing, coughing, and movements. Increasing respiratory failure is manifested by pallor of the skin, cyanosis of the mucous membranes, and acrocyanosis. Typically the development of compensatory tachycardia and a decrease in blood pressure. |
| Tuberculous | The clinical picture of tuberculous pleurisy is diverse and is closely related to the characteristics of tuberculous inflammation in the pleural cavity and lungs. In some patients, simultaneously with pleurisy, other manifestations of tuberculosis, especially primary tuberculosis (paraspecific reactions, specific damage to the bronchi), are noted. |
Stages
Inflammation of the pleura develops in response to the introduction of pathogenic microbes and consists of 3 stages: exudation, formation of purulent discharge and recovery.
Exudate is a liquid coming out of microvessels, containing a large amount of protein and, as a rule, blood elements. Accumulates in tissues and/or body cavities during inflammation.
Stage 1
At the first stage, under the influence of the pathogen, the blood vessels dilate, the degree of their permeability increases, and the process of fluid production intensifies.
Stage 2
The exudation stage gradually turns into the stage of formation of purulent discharge. This occurs during the further development of the pathology. Fibrin deposits appear on the pleural layers, which create friction between them during breathing. This leads to the formation of adhesions and pockets in the pleural cavity, complicating the normal outflow of exudate, which becomes purulent in nature. Purulent discharge consists of bacteria and their waste products.
Stage 3 pleurisy
At the third stage, the symptoms gradually subside, the patient either recovers, or the disease becomes chronic. Despite the fact that the external symptoms of the disease subside and cease to annoy the patient, internal pathological processes gradually develop further.
Complications
Why is pulmonary pleurisy dangerous? As a result of the formation of scars (moorings), individual blocks of the lung are blocked, which contributes to less air intake during inhalation, resulting in increased breathing.
Advanced forms of pleurisy can lead to the development of health and life-threatening complications - pleural adhesions, local circulatory disorders due to compression of blood vessels by exudate, bronchopleural fistulas.
The main complications of pleurisy:
- Purulent melting of the pleura (empyema);
- Adhesions of the pleural cavity are a consequence of exudative pleurisy;
- Thickening of leaves, fibrosis;
- Decreased respiratory excursion of the lungs;
- Respiratory, cardiovascular failure.
The prognosis for such complications is very serious: mortality reaches 50%. The percentage of dying patients is even higher among elderly and frail people and young children.
Diagnostics
If symptoms are detected, you should immediately consult a doctor: if there is no temperature, contact your local general practitioner; in case of unstable health or associated infectious disease - go to the emergency department
Upon examination, the diseased half of the chest lags behind in the act of breathing, this can be seen by the movement of the shoulder blades. When listening to the lungs, a very characteristic sound of pleural friction is detected. Radiography for acute dry pleurisy does not provide sufficient information. Lab tests will characterize the underlying disease.
After the patient has been diagnosed, fluid is collected from the pleura to determine what fluid is accumulating in it. Most often it is exudate or pus, in rare cases it is blood. It is noteworthy that the purulent form of the disease is more common in children.
The following examinations are used to diagnose pleurisy:
- examination and interview of the patient;
- clinical examination of the patient;
- X-ray examination;
- blood analysis;
- pleural effusion analysis;
- microbiological research.
Treatment of pulmonary pleurisy
If you have been diagnosed with “pulmonary pleurisy,” your doctor will explain what it is and how to treat the disease. If pulmonary pleurisy is suspected, the symptoms and all previous treatments are analyzed and the patient is hospitalized.
Depending on the type of disease, certain medications are prescribed that help eliminate inflammation and reduce symptoms. But you need to not only take the pills: you will need proper nutrition, physical exercise to restore organs completely.
Drug treatment depends on the cause of pulmonary pleurisy, namely:
- If the disease is caused by pneumonia or acute bronchitis, then it must be treated with antibiotics;
- Tuberculosis requires a special regime.
- For the pain of pleurisy, medications containing acetaminophen or anti-inflammatory drugs such as ibuprofen are used.
The type of drug depends on the cause of the disease. If it is infectious in nature, antibiotics are used, if it is allergic, anti-allergenic drugs are used.
In the early stage of fibrinous pleurisy of the lungs, semi-alcoholic warming compresses and electrophoresis with calcium chloride are recommended.
When treating exudative pleurisy of the lungs, physiotherapy is carried out in the resolution phase (resorption of exudate) in order to accelerate the disappearance of exudate and reduce pleural adhesions.
In case of exacerbation, patients are prescribed warming of the chest with infrared rays, ultraviolet irradiation of the chest, and daily paraffin applications. After acute inflammation subsides, calcium and iodine electrophoresis is performed. A month after recovery, water procedures, exercise therapy, manual and vibration massage are indicated.
Patients need to eat a balanced diet and drink plenty of fluids. The patient is also prescribed special diet, which is based on a lot of vitamins and proteins.
After discharge from the hospital, patients must perform breathing exercises prescribed by a doctor to restore full lung function. Moderate physical activity, long walks in the fresh air are recommended, and yoga is very useful. Being in a coniferous forest is especially useful for those recovering.
How to treat pleurisy with folk remedies
It is important to understand that treating pleurisy only folk remedies it is impossible, since the disease can quickly progress and lead to respiratory failure and suppuration of the effusion.
Treatment of pulmonary pleurisy with folk remedies involves the use of compresses and the use of infusions, decoctions, and tinctures.
- Beetroot juice helps with pleurisy. It is squeezed from fresh root vegetables and mixed with honey. For 100 g of juice, 2 tablespoons of honey are required. Take the product 2 times a day after meals. Each time you need to prepare a fresh portion, the composition does not need to be stored.
- Try to treat pleurisy with an infusion of herbs such as: mint, cudweed, coltsfoot, take a glass three times a day.
- Boil the roots (0.5 tsp) and rhizomes (0.5 tsp) of the Caucasian hellebore in 0.5 liters of water so that after evaporation you get a glass of liquid. Take 0.5 tsp. three times a day. The decoction is useful for the treatment of pleurisy, tuberculosis, and heart failure.
- Mix honey and onion juice in equal portions (you can take black radish juice instead of onions) - one tablespoon twice a day to treat pleurisy.
- Infusion of plantain leaf or common plantain. For half a liter of boiling water add 2 tbsp. l. dried plant. The liquid is filtered and drunk warm, 100-120 ml 4 times a day. The drink is harmless, has a healing and antibacterial character.
Prevention
Very simple: it is necessary to adequately treat the primary infectious disease, monitor nutrition, alternate physical activity with quality rest, not overheat and not succumb to excessive cooling.
Remember that pleurisy is a consequence of another disease. Never stop treatment halfway due to laziness or lack of time, and always try to avoid situations that could provoke an infection.
– dangerous due to its complications, which can significantly worsen a person’s condition. These are serious conditions that require treatment in a hospital setting, often using surgical techniques. The article will discuss the most common complications of pleurisy and methods of treating them.
Formation of adhesions in the pleural cavity
The pleural cavity is the space surrounding each lung and bounded by the parietal, or parietal (lining the chest from the inside), and pulmonary, or visceral (covering each lung), layers of the pleura.
Components of exudate and fibrin can cause the formation of adhesions in the pleural cavity
Normally, the pleural cavity contains 2-5 ml of synovial fluid, which performs a shock-absorbing function during breathing. With various lung diseases, the disease sometimes affects the pleural cavity, then inflammatory fluid (exudate) can accumulate in it; in this case, exudative pleurisy develops. Or fibrin is deposited on the walls of the pleural cavity (dry fibrinous pleurisy). As you recover, the inflammation in the pleural cavity subsides, the fluid (if it was present in small quantities and did not require its removal) resolves. However, exudate and fibrin components may be retained in the pleural cavity. In this case, they are the cause of the formation of adhesions in the pleural cavity - adhesions between the visceral and parietal layers of the pleura.
Adhesions prevent the lungs from functioning fully during breathing Adhesions prevent the lungs from working fully during breathing: expanding as you inhale and collapsing as you exhale. This affects the breathing function and the person’s well-being: shortness of breath occurs when performing physical activity, which was previously tolerated well, a feeling of “incomplete inhalation”, something prevents the word from “breathing deeply.” Due to insufficient breathing, the body experiences hypoxia, which is manifested by weakness, drowsiness, dizziness, and fainting.
To prevent the formation of adhesions in the pleural cavity, you can perform simple exercise: after a deep inhalation, exhale deeply, spreading your straight arms to the sides as much as possible and hold your breath (as you exhale) for 15-20 seconds. By performing this exercise, you move the visceral and parietal layers of the pleura away from each other and increase the distance between them, thereby preventing them from gluing and the formation of adhesions.
Already formed adhesions in the pleural cavity can only be removed surgically.
Circulatory disorder
A large amount of fluid compresses the vessels of the lungs, disrupting the flow of blood through them This complication is characteristic primarily of exudative pleurisy. The volume of fluid in the pleural cavity may vary. There are cases when up to 2 liters of exudate were removed during pleural puncture.
A large amount of fluid compresses the vessels of the lungs, disrupting the flow of blood through them. Clinically, this manifests itself as shortness of breath with physical activity(or at rest), cough with sputum (there may be streaks of blood), pain in the chest, a feeling of inability to take a “deep breath,” a feeling of “bloating” in the chest. Large volumes of fluid are removed from the pleural cavity by performing a pleural puncture.
The essence of the operation: the surgeon pierces the chest and uses a syringe to pump out fluid from the pleural puncture.
A small amount of fluid in the pleural cavity, which does not require removal, usually resolves on its own. But there is an exercise that helps speed up this process: take a deep breath, clasp your knees with your hands and hold your breath (as you inhale) for 15-20 seconds. In this position you create high blood pressure in the pleural cavity, thereby enhancing the absorption of fluid by the layers of the pleura.
Fluid is removed from the pleural cavity by performing a pleural puncture Empyema of the pleura
Pleural empyema is inflammation of the pleura with accumulation of pus in the pleural cavity. In 88% of cases, empyema is the result of an infectious lesion of the lungs that occurs with the collapse of lung tissue (abscess,
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Pleurisy is a disease characterized by the development of inflammation of the pulmonary and parietal pleural lobes. This pathology is typically characterized by the formation of exudative effusion in the cavity of the serous membrane surrounding the lungs. In some cases, fibrinous plaque appears on its surface. Pleurisy rarely acts as a primary disease; more often it is a consequence of complications of other pathologies of the respiratory system.
The normal state of the pleura is a thin transparent connective tissue membrane. The outer layer lines the wall of the chest and is called parietal or parietal; the inner (visceral or pulmonary) layer covers the lungs. In a healthy person, there is a small amount of fluid between the two layers of the pleura.
Causes of pleurisy
The causes of pleurisy are distinguished depending on the form of the disease itself. Pathological inflammation of the pleural lobes has non-infectious and infectious etiologies.
Reasons for the development of non-infectious forms of pleurisy:
- myocardial infarction and pulmonary infarction (therapy by a cardiologist);
- diseases that destroy the connective tissue of the lungs;
- cancer metastases affecting the pleural layers (oncologist consults);
- renal failure.
Non-infectious pleurisy has pronounced symptoms, which allows specialists to make accurate diagnoses, using additional examinations to clarify the degree and type of the disease.
Infectious pleurisy develops for completely different reasons:
- lung tissue is affected by nonspecific bacterial strains, for example, pathogens of syphilis, typhoid, Protea or mycoplasma; and specific microorganisms - pneumococci, tuberculosis bacillus, Haemophilus influenzae and Klebsiella pneumoniae;
- the lungs are attacked by viruses, fungi, blastomycetes, actinomycetes, coccidia, amoebas, echinococci, etc. that are dangerous to the respiratory system.
Any of the pathogenic microorganisms can enter the pleural tissue in several ways:
- through the bloodstream;
- through the lymph circulation system;
- with chest trauma;
- due to contact between the lung and pleura.
The infectious form of pleurisy can be contagious (with tuberculous or fungal pleurisy), in which case the patient is isolated from others. This disease is characterized by paroxysmal pain in the chest on the affected side, often in the lower parts, aggravated by breathing movements and coughing, which can only be relieved with anesthetic drugs.
In both acute and chronic pleurisy, the causes of development are almost identical. But fluid accumulates in the pleural cavity only with the exudative type of inflammation.
Types of pleurisy
Classification of pleurisy according to Putov and Fomina:
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According to etiology |
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By content |
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According to the nature of the disease |
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Common types of pleural inflammation are presented in the table below. Each of them is a consequence of either dry (fibrous) pleurisy or exudative (effusion).
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Disease |
Characteristics |
Features of the flow |
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Dry pleurisy |
There is no accumulation of fluid in the pleural cavity, but fibrin accumulates on the surface. It is a consequence of many diseases of the lower respiratory system. It can be a complication of engorgement of the intrathoracic lymph nodes, malignant tumors, collagenosis, rheumatism, and viral infections. The quantitative content of effusion is minimal; fluid continues to be excreted through the lymphatic vessels. However, fibrin threads cause an increase in the coefficient of friction between the pleural lobes. There are many nerve endings located on the surface of the pleura, so the greater the friction, the greater the pain. |
Precedes the appearance of the exudative form. Develops as First stage pleural inflammation. Blood and lymphatic vessels are reactively involved in the inflammatory process, and an allergic component appears. Vascular permeability increases, which allows some of the proteins and the liquid component of the plasma to leak into the pleural cavity. Fibrin molecules combine to form the basis of very sticky and very strong “threads” that entangle the surface of the serosa. Cough receptors located in the thickness of the pleural tissues are also affected, which reduces the threshold of their sensitivity and provokes prolonged coughing attacks. |
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Exudative pleurisy |
Fluid accumulates in the pleural cavity. The inflammatory process develops reactively, the area of the affected membrane increases. Changes occur in the rate of lymphatic drainage, fluid secretion increases, this leads to intrapleural effusion. The effusion compresses the lower segment of the lung, which causes a reduction in its vital volume. |
Often complicated by pneumothorax. Requires immediate medical attention. Enzymes that previously contributed to the breakdown of fibrin threads lose their activity. When a large amount of fluid appears between the layers of the pleura, the exudate rushes into the pleural recesses (pockets). With this form of pleurisy, respiratory failure develops. The pain is not as intense as with dry pleurisy, since the accumulated fluid reduces the coefficient of friction between the petals. |
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Serous-fibrous pleurisy |
The fluid is of unknown or non-inflammatory origin. As the symptoms of intoxication increase, the body temperature reaches febrile levels, shortness of breath and a feeling of heaviness appear. |
It begins as a manifestation of weakness and general malaise. Afterwards pain in the sternum and dry cough appear. The elevated subfebrile body temperature persists for several weeks. The patient is comfortable only in a semi-sitting position, tilting towards the diseased lobe. |
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Purulent pleurisy |
Epiema of the pleura. Instead of fluid, purulent contents begin to accumulate in the pleural cavity. It develops both when pleural tissue is directly damaged by infection, and when a pulmonary abscess opens into the pleural cavity. |
Often complicated by hemopneumothorax. Requires immediate medical attention. The pathology is classified as severe and is complicated by severe intoxication. Purulent pleurisy is typical for patients in extreme exhaustion and with decreased immunity. |
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Tuberculous pleurisy |
It proceeds slowly and has a chronic form. General intoxication develops, there are signs of damage to the lung tissue. |
The effusion contains many lymphocytes. May be complicated by the formation of fibrous threads on the surface of the membrane. The source of infection is a curdled purulent exudate that enters the pleural cavity after melting of the bronchi. |
Signs and symptoms of pleurisy
Clinical symptoms will depend on the causes that provoked the disease, the intensity inflammatory process, stage, type and form of pathology, volume of exudate and its characteristic features.
The following signs (generalized for all forms) are typical for pleural inflammation:
- dyspnea;
- coughing attacks;
- chest pain;
- increase in temperature to subfebrile and febrile values;
- displacement of the trachea (with unilateral pleurisy).
Dyspnea can be thought of as the most typical symptom, developing as a consequence of initial damage to lung tissue and a decrease in lung volume.
The cough is characterized by medium intensity, it is unproductive and dry. Caused by irritation of the nerve endings located in the tissues of the pleura. It becomes stronger if the patient changes position or takes a deep breath. During a coughing attack, chest pain intensifies.
The pain itself is a consequence of irritation of pain receptors and increased friction of the pleural lobes. It is acute in nature, intensifies with inhalation or coughing, and decreases if you hold your breath.
Usually, but discomfort may radiate to the shoulder or abdomen. The more fluid accumulates in the pleural cavity, the less pain the patient feels and the more severe the respiratory failure.
An increase in body temperature is a nonspecific reaction to infectious invasion. And the trachea is displaced as a result of excessive pressure from the lung. This condition is a dangerous complication of massive pleural effusion.
The manifestation of other symptoms depends on the pathology that became the original cause of the inflammatory process.
Diagnostics
Diagnostic algorithm. In case of pleurisy, the first thing to exclude is turerculosis and oncological process. This is caused by an analysis of the statistics of the causes of the disease, as well as alertness regarding individual diseases. The patient undergoes a CT or MRI of the lungs, after which it is much easier to determine the diagnosis. Next, sputum is cultured to identify the pathogen and determine sensitivity to drugs, including tuberculosis.
Microscopy of sputum and its general analysis- this will show what kind of character it is - purulent or mucous, the presence of specific inclusions, microorganisms. In case of exudative pleurisy, a puncture of the pleural cavity can be performed. It not only eliminates fluid, but is also a diagnostic procedure, because... the effusion is sent for analysis. It may contain atypical cells, signs of inflammation, as well as an infectious or other causative agent of pleurisy. In addition to the above specific examination methods, a urine test, a blood test (general and biochemical), and, if necessary, an ultrasound of internal organs are performed.
Treatment methods
In the process of treating pleural inflammation, doctors pursue two main goals: to stabilize the general condition of the patient and normalize respiratory function. And only after that the cause that provoked pleurisy is eliminated. In most cases, inflammation is treated with medication. In severe cases with extensive damage, surgical intervention may be performed to remove the source of infection and necrotic tissue.
Because the disease is usually infectious in origin, it is treated with a wide range of antibiotics. But the therapeutic regimen is drawn up purely individually, and may include other drugs - with anti-inflammatory and desensitizing effects.
The antibiotic is selected empirically, i.e. the one that most often helps is prescribed. Treatment includes a combination of 1-2 representatives from several groups of the strongest of a wide spectrum. The dosage and course duration of taking medications depends on the stage, form and severity of the disease.
Pleurisy is inflammation of the membranes surrounding the lungs(pleural petals). With it, fluid accumulates in the pleural cavity, which makes it difficult for the lungs to expand and interferes with the mobility of the chest. This deteriorates the functioning of the respiratory and cardiovascular systems, and subsequently others.
Pleurisy can be a complication after pneumonia, tuberculosis or surgical intervention in the chest. If it is not treated, inflammation of the pleura can lead to hypertrophy of the myocardium of the right ventricle of the heart(the so-called pulmonary heart) or respiratory failure, and then to death.
Types of disease
- Purulent pleurisy is a disease that provokes the accumulation of purulent effusion in the pleura of the lungs. At the same time, the parietal and pulmonary membranes become inflamed.
- At exudative type Fluid is formed and retained between the layers of the pleura. This may be due to damage of an infectious, tumor or other nature.
- Dry (fibrous) type is often a complication of other diseases of the lungs or organs located near the pleural cavity, or serves as a symptom of general diseases. There may be a slight secretion of fluid, and the surface of the pulmonary pleura is covered with a layer of fibrin (protein).
- Tuberculous pleurisy affects the serous membranes that form the pleural cavity and cover the lungs. The main symptom of the disease is increased fluid secretion or fibrin deposits on the surface of the pleura.
The disease is called unilateral with damage to one lung(left-handed or right-handed), bilateral with two.
Acute pleurisy is usually accompanied by the accumulation of pus in the pleura, and is a secondary disease when inflammatory diseases lungs, including lobar and post-influenza pneumonia. With contributing factors, the acute form of the disease becomes chronic.
This classification is quite arbitrary, since one type can transform into another. Moreover, dry and exudative (effusion) pleurisy are considered by most pulmonologists as different stages of the same disease. It is believed that dry pleurisy first forms, and effusion develops only with the further development of the inflammatory reaction.
The pleural cavity of the lungs - what is it?
The pleural cavity is a narrow gap located between the pulmonary pleura (the membrane that covers the lungs) and the mural pleura. It contains a small volume of pleural fluid, which serves as a kind of lubricant; it reduces friction during breathing. The pleural cavity is closed from above by the chest wall (with ribs), and from the base by the diaphragm.
Causes of the disease
Pleurisy can be primary in nature - when the inflammation is isolated and includes only the pleura (without occupying the pulmonary parenchyma). However, most often it is a complication of diseases occurring in surrounding tissues, such as:
- pneumonia;
- tuberculosis;
- pulmonary embolism;
- lung cancer.
The disease can also be caused by heart, liver and kidney failure, hormonal imbalance, pancreatitis and gastrointestinal diseases. Its development can be facilitated by chest trauma with rib fractures.
Symptoms
Symptoms of pleurisy may appear suddenly. Initially, there is an acute, burning pain in the chest, which is located in a certain part of it. Characterized by pain that intensifies at the top of inspiration (which makes it impossible to take a correct, deep and free breath), as well as with any vibrations in the chest area, for example, when coughing or sneezing. The pain disappears when breathing stops, and also when the patient assumes a lying position on the painful side.
Associated symptoms are usually a dry cough and low-grade fever or fever. As fluid accumulates in the cavity, the pain disappears, but shortness of breath appears, breathing becomes difficult and speeds up.
Diagnostic methods
If inflammation of the pleura is suspected, an examination by a specialist with a stethoscope, blood tests and a chest x-ray are carried out. The doctor may also refer the patient for an ultrasound and tomography. The final diagnosis is made after puncture of the pleural cavity and examination of the loaded fluid.
Treatment of pleurisy
Medication
The treatment method is selected according to the cause of the disease. One of the primary tasks is to reduce and eliminate the inflammatory process. In case of accumulation of a large volume of fluid in the lungs, puncture and drainage are used.
Antibiotics are effectively used to treat pleurisy. Most often, drugs such as cefazolin and abactal.
Any treatment should be carried out under the guidance of a physician.
Folk remedies
Pleurisy can be treated at home if the disease is mild. They may be useful, but they also need to be used with caution.
Recipe with aloe for pleurisy
Aloe can be an excellent remedy for treating mild forms of the disease.
Fresh aloe leaves need to be washed and the thorns cut off. After this, finely chop. Take 300 grams of crushed aloe leaves and add 250 grams of badger fat and 300 grams of natural honey. Mix everything thoroughly and put in the oven for 15-20 minutes. As a result, a liquid should appear, which must be drained, strained and poured into a glass container.
Take this liquid after meals 3 times a day, 1/3 cup.
Radish recipe
Radish juice is also used to treat pleurisy at home. This is how you get it: chop the radish and squeeze out the juice. Mix juice with natural honey in equal proportions. Take medicinal syrup 3 times a day, 1 tbsp. spoon.
Grind 150 grams of horseradish and add the juice of 3 lemons. Mix. For treatment, take 1 teaspoon in the morning and evening.
However, I repeat: all these means must be used only after consultation with a doctor and are considered mild forms of the disease. More severe forms, as well as purulent pleurisy can only be treated in a hospital medications such as antibiotics.
Prevention
- Keep your lungs up. Chemical contamination of the respiratory system is considered one of the main causes of tuberculosis, which in turn can lead to inflammation of the pleura.
- Practice breathing exercises: a few deep breaths after waking up fill your lungs with oxygen, strengthen your tone and... This significantly reduces the risk of respiratory diseases.
- Watch your immunity. Temper yourself, breathe fresh air, eat well.
- To avoid infecting the mucous membranes of the respiratory tract, and then into the pleural cavity, try at the first symptoms of their appearance.
- If this is not uncommon for you, then try not the time to change the climate. Sea, forest and mountain air can play a good role in the prevention of pleurisy and other diseases.
- If you have symptoms of serious diseases, consult a doctor, do the necessary tests, fluorography and examinations. Proper treatment reduces the risk of complications.
Disease code according to ICD 10 ( International classification diseases): R09.1
