Pleurisy: symptoms, treatment and causes of lung pleurisy

What is it - pleurisy is the development of the inflammatory process on the serous membrane covering the lung.

This disease rarely exists as an independent process: most often it develops as a complication of others - not only pulmonary and not only inflammatory - pathologies.

Pleurisy can be accompanied by fluid accumulation between two layers of the pleura( exudative pleurisy), but it can also proceed simply with the deposition of fibrin( blood coagulation product) inside the pleural cavity.

Causes of pleurisy

There are two main groups of causes, depending on which pleurisy can be contagious and non-infectious.

1) Infectious pleurisy caused by:

• nonspecific bacteria: Staphylococcus, Pseudomonas aeruginosa, pneumococcus and other streptococci, Mycoplasma, Proteus and other gram-negative flora;
  
• by specific bacteria: mycobacterium tuberculosis, causative agents of syphilis, brucellosis, typhus and typhoid fever, tularemia;
  
• viruses;
  
• parasites: amoebas, echinococci;
  
• mushrooms: candida, blastomycetes, actinomycetes, coccidia.

2) Microorganisms penetrate the pleura:

• by contact: from a patient with a lung( with abscess, pneumonia, festering lung cyst) or underlying organs( pancreas, liver), as well as chest injuries or operations on them;
  
• through the blood - from any source of infection in the body( osteomyelitis, sinuses of the nose, brain with meningitis and so on);
  
• through the lymphatic system - from the thoracic cavity.

3) The causes of non-infectious pleurisy are:

• tumors of the pleura itself;
  
• pleural metastases;
  
• connective tissue diseases( scleroderma, rheumatoid arthritis, systemic lupus erythematosus, vasculitis);
  
• infarction( death of a specific site) of the lung;
  
• myocardial infarction;
  
• pulmonary embolism;
  
• pancreatitis;
  
• leukemia;
  
• coagulation disorder;
  
• chronic renal failure.

Classification of

Pleurisy can be:

• exudate( exudative);
  
• pleural empyema - a cluster of purulent contents in the pleural cavity;
  
• dry( fibrinous).

Under the influence of the etiological factor( microbe, toxins, enzymes) develops or percolation of inflammatory or non-inflammatory fluid into the pleural cavity.

The first effusion is called exudate, the second is called an exudate. To distinguish one from another, as well as from purulent pleurisy is possible only by the results of a puncture. If such an effusion is not absorbed by the vessels of the pleura, pleurisy is called exudative. If it is absorbed, fibrin settles on the pleura sheets. This pleurisy is called fibrinous.

Symptoms of pleurisy

Exudative and exudate pleurisy differ in their clinical manifestations.

The first symptoms of dry pleurisy can be suspected on the following grounds:

1) Pain in one( less - two) half of the chest during breathing, worse with:

• cough;
  
• deep inspiration;
  
• tilts to the other side.

Because of this, a person tries to take a forced position on his side, his breathing becomes frequent and superficial.

2) Body temperature - no higher than 38 degrees, rises mainly in the evening.

3) Rapid fatigue.

4) Night sweats.

The main symptoms of pleurisy effusion:

• shortness of breath.
  
• cough.
  
• feeling of heaviness in half of the chest.
  
• skin, especially in the area of ​​the nasolabial triangle, becomes a bluish shade.
  
• markedly lagged one half of the thorax in the breath, while the gaps between the ribs can extend beyond the boundaries of the bone tissue( bulge).
  
• marked increase in body temperature, weakness, headache.
  
• a person must always be in such a position that he could breathe easier.

Empyema of the pleura - in this case, the body temperature rises to 39-40 degrees, accompanied by chills, people spend almost all the time motionless, in a forced position. His skin is cyanotic, cool and covered with sweat. He also has cough, shortness of breath, severe weakness, headache and muscle pain.

Diagnosis of pleurisy

Diagnosis is based on:

• of human complaints;
  
• of examination data, tapping of the chest and listening to the lungs;
  
• chest radiography;
  
• CT of the thoracic cavity - with small and encased( that is, bounded by the membrane) exudate pleurisy;
  
• ultrasound of the lungs.

The nature of effusion - exudate or transudate - can be determined by the results of pleural puncture. This is a procedure in which under local anesthesia the skin and underlying layers are punctured in the lateral region of the chest.

Then the contents of the cavity are sent to the laboratory( including bacteriological culture with the definition of sensitivity to antibiotics) study. In this case, a drainage can be installed in the pleural cavity.

In cases of suspected own pleural tumor or its metastatic lesion, a pleural biopsy is necessary. This is an invasive procedure that is performed under local anesthesia.

To diagnose the causes of pleurisy, the following can also be performed:

• bronchoscopy;
  
• angiography;
  
• of an ultrasound or CT of the abdominal organs.

Treatment of pleurisy

Treatment of pleurisy is performed by pulmonologist, oncologist and thoracic surgeon. The latter, if necessary, establishes in the pleural cavity a specific drainage along the Bylau, at the outer end of it a single-sided valve is made, and it is lowered into a sterile solution.

An antiseptic solution may be injected into this drainage with empyema of the pleura. Also, this specialist, if necessary, is surgically intervened.

Excess drainage is indicated with:

• if the surrounding organs are squeezed out;
  
• if the level of effusion according to roentgenological data reaches the II rib;
  
• if there is a possibility of suppuration of exudate.

At a time, you can remove no more than 1 liter of exudate, so that there is no sudden displacement of the aorta and heart that were squeezed before.

Drug medication for pleurisy

Conservative treatment for pleurisy consists of the appointment of such medications:

1. 1) Antibacterial drugs that are prescribed even before bacteriological examination results are obtained. These are preparations of a wide spectrum: "Ceftriaxone", "Cephepim", "Levofloxacin", "Bigaflon", "Sumamed".Further, the preparation is changed to more suitable for this microflora.
   
2. 2) Anti-inflammatory and analgesic drugs: Indomethacin, Nurofen, Mefenamic acid, and others.
   
3. 3) If the fungal nature of pleurisy is established, or with the appointment of massive antibacterial therapy( but on the 5th day), modern antifungal drugs are prescribed.
   
4. 4) In the tumor nature of pleurisy, the patient is administered antitumor drugs, glucocorticoid hormones.
   
5. 5) Diuretic drugs are needed to treat exudative pleurisy.
   
6. 6) If necessary, vascular drugs are prescribed.

Therapy for fibrinous pleurisy is complemented by:

• with warming methods of therapy: mustard, cans, thermal methods of physiotherapy;
  
• with tight bandaging of the chest;
  
• preparations, suppressing cough: Dionin, Codeine.

Complications of pleurisy

These include:

• adhesive process in the pleural cavity;
  
• cardiovascular failure due to compression of the heart and aorta by exudate;
  
• respiratory failure due to squeezing of the lungs;
  
• thickening of the pleura;
  
• infection of gaps between lobes of the lung;
  
• exudative pleurisy can be complicated by the development of pleural empyema.

Prevention

Pleurisy can be prevented with the help of such measures:

• quitting;
  
• supercooling prevention;
  
• when working in hazardous production do not neglect the methods of individual protection;
  
• timely treatment of pneumonia;
  
• treatment of chronic heart, kidney and lung diseases, observation by a doctor, a serious attitude towards the slightest change in your condition.

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