Pleura disorder. Pleurisy of the lungs: symptoms and treatment

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Pleurisy is a disease characterized by the development of inflammation of the pulmonary and parietal pleural lobes. For this pathology, the formation of an exudative effusion in the cavity of the serous membrane surrounding the lungs is typical. 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 sheet lines the wall chest and is called parietal or parietal, the inner (visceral or pulmonary) sheet covers the lungs. At healthy person there is a small amount of fluid between the two layers of the pleura.

Causes of pleurisy

There are causes for the development of pleurisy, depending on the form of the disease itself. Pathological inflammation of the pleural petals has a non-infectious and infectious etiology.

Reasons for the development of a non-infectious form of pleurisy:

• myocardial infarction and pulmonary infarction (treatment by a cardiologist);
• diseases that destroy the connective tissue of the lungs;
• oncological metastases that affected the pleural sheets (advised by an oncologist);
• kidney failure.

Non-infectious pleurisy has pronounced symptoms, which allows specialists to make unmistakable diagnoses, specifying the degree and type of the disease through additional examinations.

Infectious pleurisy develops for completely different reasons:

• lung tissues are affected by non-specific bacterial strains, for example, pathogens of syphilis, typhoid, proteus or mycoplasma; and specific microorganisms - pneumococci, tubercle bacillus, hemophilic infection and Klebsiella pneumonia;
• the lungs are attacked by viruses, fungi, blastomycetes, actinomycetes, coccidia, amoeba, echinococcus, dangerous for the respiratory system, etc.

Any of the pathogenic microorganisms can enter the pleural tissues in several ways:

• through the bloodstream
• through the lymphatic system
• with a chest injury;
• due to contact between the lung and the 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 side of the lesion, more often in the lower sections, aggravated by respiratory movements, coughing, which can only be stopped with anesthetics.

Both in acute and chronic pleurisy, the causes of development are almost identical. But the fluid in the pleural cavity accumulates only with an exudative type of inflammation.

Types of pleurisy

Classification of pleurisy according to Putov and Fomina:

According to etiology	Infectious: staphylococcus, pneumococcus, tuberculosis, etc. Aseptic: in autoimmune diseases, oncoprocesses.
By content	fibrous; serous fibrous; purulent and putrid; hemorrhagic; eosinophilic; chylous; cholesterol.
According to the nature of the course of the disease	chronic; spicy; subacute.
	encysted; diffuse; apical; parocostal; bone-diaphragmatic; interlobar; diaphragmatic.

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).

Disease	Characteristics	Features of the flow
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 with engorgement of the intrathoracic lymph nodes, with malignant tumors, collagenosis, rheumatism, and viral infections. The quantitative content of the effusion is minimal, the fluid continues to be excreted through the lymphatic vessels. However, fibrin threads cause an increase in the coefficient of friction between the pleural petals. There are many nerve endings on the surface of the pleura, so the more friction, the more pain.	Precedes the appearance of an exudative form. Develops as First stage pleural inflammation. Blood and lymphatic vessels are reactively involved in the inflammatory process, 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 become the basis of very sticky and very strong "threads" that entangle the surface of the serous membrane. The cough receptors located in the thickness of the pleural tissues are also affected, which reduces the threshold of their sensitivity and provokes protracted coughing fits.
Exudative pleurisy	Fluid accumulates in the pleural cavity. The inflammatory process reactively develops, the area of ​​the affected membrane increases. There are changes in the rate of lymph flow, the secretion of fluid increases, this leads to intrapleural effusion. The effusion compresses the lower segment of the lung, which provokes a reduction in its vital volume.	Often complicated by pneumothorax. Requires urgent medical care. Enzymes that previously contributed to the breakdown of fibrin strands lose their activity. When a large number fluid between the sheets of the pleura 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.
Serous fibrous pleurisy	The fluid is of unclear or non-inflammatory origin. With an increase in symptoms of intoxication, t of the body reaches febrile indicators, shortness of breath, a feeling of heaviness appear.	It begins as a manifestation of weakness and general malaise. After there are pains in the sternum, dry cough. For several weeks, the elevated low-grade t of the body lasts. The patient is comfortable only in a semi-sitting position, with an inclination towards the diseased lobe.
Purulent pleurisy	Epiema of the pleura. Purulent contents begin to accumulate in the pleural cavity instead of fluid. It develops both with direct infection of the pleural tissues with an infection, and with the opening of a lung abscess into the pleural cavity.	Often complicated by hemopneumothorax. Requires immediate medical attention. Pathology is classified as severe and complicated by severe intoxication. Purulent pleurisy is typical for patients in an extreme degree of exhaustion and with a decrease in immunity.
Tuberculous pleurisy	It proceeds slowly, 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 filaments on the surface of the shell. The source of infection is a curdled purulent exudate that enters the pleural cavity after the bronchi have melted.

Signs and symptoms of pleurisy

Clinical symptoms will depend on the causes that provoked the disease, the intensity of the inflammatory process, the stage, type and form of pathology, the volume of exudate and its characteristic features.

For pleural inflammation, the following symptoms are typical (generalized for all forms):

• dyspnea;
• coughing fits;
• pain in the chest;
• temperature rise to subfebrile and febrile values;
• displacement of the trachea (with unilateral pleurisy).

Shortness of breath can be thought of as the most typical symptom that develops as a result of the initial damage to lung tissues and a decrease in their volume.

The cough is characterized by moderate intensity, it is unproductive and dry. Caused by irritation of nerve endings located in the tissues of the pleura. It becomes stronger if the patient changes position or takes a deep breath. During an attack of coughing, the pain in the chest increases.

The pain itself is a consequence of irritation of pain receptors and increased friction of the pleural petals. It has an acute character, increases when inhaling or coughing, 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 the patient feels pain and the more respiratory failure manifests itself.

An increase in body t is a nonspecific reaction to an 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 has become the initial cause of the inflammatory process.

Diagnostics

Diagnostic algorithm. With pleurisy, first of all, turerculosis and oncoprocess are excluded. This is due to the analysis of the statistics of the causes of the disease, as well as alertness regarding individual diseases. The patient undergoes a CT scan 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.

Sputum microscopy is performed and its general analysis - this will show what kind of character it is - purulent or mucous, the presence of specific inclusions, microorganisms. With 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 urinalysis, a blood test (general and biochemical), and, if necessary, ultrasound are performed. internal organs.

Treatment Methods

In the process of treating pleural inflammation, doctors pursue two main goals: to stabilize the general condition of the patient and to 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, it is possible to perform surgery to remove the focus of infection and necrotic tissue.

Since 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 most frequently helping one 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.

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Pleurisy treatment

Causes of pleurisy

Pleurisy- an inflammatory process localized in the pleura and accompanied by accumulation of exudate (fluid) in the pleural cavity or loss of fibrin sheets on the surface. Depending on the presence of exudate, pleurisy is distinguished between exudative and fibrinous or dry, and depending on the nature - bacterial, viral and allergic. Often the nature of pleurisy remains unexplained. It is characteristic that this disease develops as a complicated form of other pathological conditions.

Causes of pleurisy called:

• infectious damage to the body by bacteria (staphylococcus aureus, pneumococcus), fungi (candidiasis, blastomycosis), viruses (amebiasis, echinococcosis), mycoplasma and mycobacteria (tuberculosis);
• complications of respiratory diseases;
• diffuse lesions connective tissue;
• malignant tumors (metastases to the pleura, cancer of the lungs, pleura, breast, ovaries, etc.);
• chest trauma;
• surgical interventions and complications after operations.

Symptoms of pleurisy are:

• expressive pain in the chest, accompanying breathing;
• cough;
• an increase in body temperature - from slight to fever;
• shortness of breath and difficulty breathing;
• pallor, and sometimes cyanosis of the skin;
• general weakness and fatigue.

Dry (fibrinous) pleurisy usually has no independent significance. Detected at various diseases lungs (pneumonia, suppurative lung diseases, pulmonary infarction, etc.), as a concomitant pathological process in extrapulmonary diseases (subdiaphragmatic abscess, cholecystitis, cholangitis), as well as in inflammatory diseases (tuberculosis, rheumatism, systemic lupus erythematosus, rheumatoid arthritis, systemic scleroderma).

How to treat pleurisy?

Pleurisy treatment appointed by a specialized specialist after reviewing the history of diseases and the characteristics of its course in a particular patient. Therapeutic therapy combines measures that promote resorption and elimination of exudate, symptomatic and restorative treatment, antibacterial and vitamin therapy. Therapy must certainly be comprehensive and aimed at eliminating the causes of pleurisy, because in the majority of cases, pleurisy is preceded by an untreated respiratory disease.

Symptomatic treatment does not produce an exhaustive effect, but is aimed only at pain relief and prevention of complications after pleurisy. Symptomatic treatment must certainly be accompanied by measures aimed at eliminating the disease preceding pleurisy (for example, tuberculosis or pneumonia) and eliminating the inflammatory process.

The appointment of antibacterial drugs should be carried out solely taking into account the variety of pathogenic flora and the sensitivity of the drug to it. You can reinforce the effect with immunostimulating therapy. Anti-inflammatory and desensitizing drugs are appropriate to reduce pleural pain, their use speeds up the healing process.

The underlying disease should be treated symptomatically. If dry pleurisy of tuberculous etiology is diagnosed, then specific anti-tuberculosis therapy is carried out. When a diffuse connective tissue disease is diagnosed, non-steroidal anti-inflammatory drugs and glucocorticoids are prescribed. If the underlying disease is pneumonia, antibiotic therapy is prescribed (penicillins, cephalosporins, carbapenems, aminoglycosides, tetracyclines, macrolides, chloramphenicol, fluoroquinolones).

With pleurisy of pneumococcal etiology, the antibacterial drug of choice is benzylpenicillin, which is administered intramuscularly at 1000,000-2,000,000 units every 4 hours. In cases of purulent inflammation, the dose is doubled. If the disease is caused by penicillin-resistant strains of pneumococcus, cephalosporins or carbapenems (thienam) or vancomycin are prescribed. Of the cephalosporins, cefoxitin (mefoxin), cefotetan (Katen), moxolactam (latamoxef) are used. Of the carbapenems, imipenem-cilastatin (thienam) is more commonly used. It is also a p-lactam antibiotic with a bactericidal effect.

Treatment streptococcal etiology is the same as pneumococcal. With pleurisy of staphylococcal etiology, broad-spectrum penicillins (ampicillin, amoxicillin), cephalosporins of III-IV generations are prescribed.

With legionella, mycoplasmal and chlamydial etiology of the disease, the drugs of choice are macrolides - azithromycin (sumamed), clarithromycin (yutacid), spiramycin (rovamycin), roxithromycin (rulid). For the treatment of patients with fibrinous pleurisy, non-steroidal anti-inflammatory drugs and desensitizing agents (calcium chloride, diphenhydramine, suprastin) are also used.

The main methods of treating patients with exudative pleurisy are etiotropic therapy (antimicrobial treatment), the use of anti-inflammatory and desensitizing agents, exudate evacuation, an increase in the overall reactivity of the body, immunocorrection, detoxification, physiotherapy rehabilitation, and spa treatment.

Antibacterial therapy of exudative pleurisy is based on the same principles as in pneumonia. Now, in the treatment of parapneumonic exudative pleurisy (as well as pneumonia), preference is given to modern macrolides. These include spiramycin, azithromycin, roxithromycin, clarithromycin.

Exudative pleurisy of tuberculous etiology is treated according to the principles of tuberculosis therapy. Etiotropic treatment lasts 10-12 months. In the acute period, anti-TB drugs are prescribed: isoniazid (10 mg/kg per day), streptomycin (1 g per day), ethambutol (25 mg/kg per day). With severe intoxication, confirmed by the pathomorphological picture (according to pleural biopsy) of a massive lesion with caseous necrosis, rifampicin is additionally prescribed orally (400-600 mg per day), and isoniazid is administered into the pleural cavity (every other day, 6 ml of 10% solution). After 3 months from the start of treatment, streptomycin is canceled.

Etiotropic treatment is combined with pathogenetic and desensitizing therapy. In case of severe pleural pain after exudate evacuation, electrophoresis of 5% novocaine solution, 10% calcium chloride solution, 0.2% platyfillin hydrotartrate solution is prescribed (for a course of 10-15 procedures). Inhalations with antibiotics and bronchodilators are also advisable. In order to prevent the organization of pleural effusion, lidase electrophoresis is used (64 IU every 3 days, 10-15 procedures per course of treatment).

The method of regular pleural punctures (every other day) with maximum exudate evacuation ensures recovery with favorable anatomical and functional consequences.

The use of glucocorticoids does not reduce the duration of treatment.

A positive effect is given by immunomodulators (levamisole, thymalin, T-activin, splenin).

Surgical treatment is indicated:

• with early folding and the formation of massive exudate;
• when serous or purulent exudates solidify without a tendency to melt the lungs and obliterate the pleural cavity;
• with pulmonary tuberculosis, which is treated surgically.

The optimal period of preoperative treatment should be considered 5-6 months from the start of etiotropic therapy, taking into account the characteristics of the course of the disease in each patient. Usually, a pleurectomy with decortication of the lungs or its resection with pleurectomy and decortication is performed.

The duration of treatment depends on the timeliness and adequacy of therapy: pleurisy can be overcome in a few days, or even in a few weeks. After that, you need to take time for the recovery period.

What diseases can be associated

• Hemorrhagic diathesis
• Lung infarction
• and pleura
• Systemic vasculitis

Treatment of pleurisy at home

Pleurisy treatment at home is possible, but medical monitoring of the patient's condition is required. In addition to taking all the drugs prescribed by the doctor and carrying out restorative procedures, the patient should be provided with appropriate conditions - bed rest and rest, good nutrition, vitamin therapy, antibiotic therapy, symptomatic and restorative treatment.

What drugs to treat pleurisy?

Medicines for therapy often include drugs that eliminate the causes of pleurisy - the infection or the disease that provokes it.

• - single dose from 40 mg to 1 g, daily - from 150 mg to 8 g; multiplicity of application - 2-6 times / day
• - 1-2 ml of a 50% solution 2-3 times a day, the maximum dose is 2 g / day
• - 3-4 g per day
• - intramuscularly 1000000-2000000 IU every 4 hours
• - 100 mg per day
• - 0.3 g 2-3 times a day
• - initial dose of 25 mg 2-3 times a day
• - intravenously drip (6 drops per minute), diluting 5-10 ml of a 10% solution in 100-200 ml of isotonic sodium chloride solution or 5% glucose solution
• - intravenously, 1-2 g of the drug is dissolved in 100 ml of isotonic sodium chloride solution or 5% glucose solution, injected drip for 30 minutes
• - administered both intravenously and intramuscularly every 8 hours, the average daily dose is 2 g (maximum daily dose is 12 g)
• - 250-500 mg 2 times a day orally
• - dosage is determined individually
• - 100 mg 2 times a day
• - intramuscularly 1-2 g every 6-8 hours
• - the initial daily dose is 20-30 mg, the maintenance daily dose is 5-10 mg
• - 600 mg 1 time / day or 10 mg / kg 2-3 times a week
• - 3000000-6000000 IU 2-3 times a day in the middle
• - 150-300 mg 2 times a day orally
• - on the first day, it is prescribed once orally at a dose of 500 mg, from the 2nd to the 5th day - 250 mg 1 time per day
• - intravenous drip in a daily dose of 1 g to 4 g, depending on the severity of the disease
• - 200 mg 2 times a day
• - intramuscularly or intravenously, 2 g 2 times a day (maximum daily dose - 6 g)
• - inside once, 20-25 mg / kg per day

Treatment of pleurisy with folk methods

Pleurisy treatment folk remedies can act as an addition to traditional drug therapy methods.

Compresses:

• combine 30 grams of camphor oil, 2.5 grams of lavender and eucalyptus oils, mix thoroughly; rub into the area of ​​the affected lung 2-3 times a day, apply a warming compress on top;
• 2 tbsp pour a glass of fresh marigolds olive oil and leave in a dark place for two weeks (you can cook for the future and store in a dark container in the refrigerator); 2 tbsp combine calendula oil in 2 tbsp. mustard powder, 6 tbsp. flour, 2 tbsp. lime blossom and 4 tbsp. vodka, mix well, heat for 5 minutes in a water bath; apply the ointment on gauze folded several times, put on the chest under the compressor paper and a warm scarf; leave for half an hour.

Decoctions inside:

• combine in equal proportions the grass of the highlander bird, the leaves of the coltsfoot and the flowers of the black elderberry; 1 tbsp brew the resulting mixture with a glass of boiling water, sweat in a water bath for 15 minutes, cool, strain; take 1/3 cup three times a day;
• combine in equal proportions peppermint, licorice root, elecampane root, marsh cudweed grass, add 2 parts of coltsfoot leaves; 1 tbsp brew the resulting mixture in a glass of boiling water, after cooling, strain and take 1/3 cup three times a day before meals.

Treatment of pleurisy during pregnancy

Pleurisy refers to those diseases, the occurrence of which during pregnancy is easier to prevent than to treat. If future mom belongs to the risk group, it is necessary to act proactively and treat the underlying disease, strengthen the immune system, protect your body from negative influences.

If it was not possible to avoid the disease, then the treatment should be carried out under the supervision of a specialized specialist who is aware of the situation of his patient. Therapy in this case will be aimed at alleviating the patient's condition, at eliminating the inflammatory process. The drugs of choice will be herbal ingredients and gentle synthetic drugs (possibly local antibiotics). Self-medication and spontaneous change in dosage is inappropriate.

Which doctors to contact if you have pleurisy

The pleural sheets are thickened, hyperemic, with a hard, sometimes granular surface (fibrin layers). Peeling of the mesothelium with exposure of the fibrous structures of the pleura is observed. With a favorable course, the layering of fibrin resolves. However, more often it is organized with the formation of pleural moorings.

The chest on the side of the lesion lags behind in the act of breathing. Most patients have a dry cough that worsens with movement. Percussion determines the limitation of mobility of the lower edge of the lungs. The decisive diagnostic sign is the auscultation of a pleural friction rub, which can be gentle (crepitus) or rough, resembling the creaking of snow or a new sole. Often, patients themselves experience a pleural friction rub. It is usually audible in the lateral and lower parts of the chest, where the excursion of the lungs is more pronounced.

Unlike small bubbling rales and crepitus, the pleural friction noise is heard throughout the entire inhalation and exhalation in the form of uneven noises, not changing after coughing. It can be felt with the palm of your hand. At the same time, small bubbling rales and crepitus are determined at the height of inspiration. If the mediastinal pleura is affected, it is necessary to differentiate the pleural friction rub from the pericardial friction rub. It should also be remembered that the pleural friction noise also occurs with exudative pericarditis - it is heard above the border of the exudate. Body temperature is normal or subfebrile, rarely exceeds 38 °C. In the course of a blood test, a slight leukocytosis is evident, a moderately increased ESR.

The X-ray picture is uncharacteristic: there is a slightly higher standing of the dome of the diaphragm on the side of the lesion, limitation of its mobility, sometimes a slight darkening of the lateral sections of the lung field is determined.

differential diagnosis is carried out in patients with pericarditis (noise pericardial friction, concordant elevation of the 5T segment on the ECG), intercostal neuralgia and myositis (local pain, no changes in the blood, etc.). Differential- diagnostic difficulties are possible with diaphragmatic dry. In cases of acute abdomen should be borne in mind the absence of increased pain with deep palpation of the abdomen compared with superficial palpation and pronounced leukocytosis, which is characteristic of the acute abdomen syndrome.

Treatment of other diseases with the letter - p

Treatment of pancreatitis

Treatment of pancreatic necrosis

Pleurisy is a disease that is characterized by inflammation of the two layers of the pleura - the pulmonary and parietal. In a healthy person, the lungs are covered with a thin film consisting of two layers, between which there is a negligible amount of fluid. Pleurisy is characterized by a significant formation of effusion (exudate) between the membranes. Fluid can accumulate if it is not excreted by the body (exudative pleurisy), or it can leave plaque on the walls of the pleura (fibrous pleurisy). In any case, this is a serious disease that rarely goes away on its own and without complications. Treatment of pleurisy of the lungs is successful if the patient was diagnosed in time and treatment started.

Pleurisy of the lungs is an inflammation of the two layers of the pleura.

Causes of the disease

Pleurisy can be of infectious and non-infectious origin, depending on its etiology, the causes and methods of treatment differ. Infectious pleurisy occurs as a result of inflammation pathogens entering the pleura directly from the lungs and bronchi or internal organs of the peritoneum.

The causative agents include:

• fungi;
• anaerobic bacteria;
• legionella;
• viruses;
• tubercle bacilli;
• pneumococci.

Infectious pleurisy is always a consequence of a neglected infectious disease. It is also sometimes found in patients with typhus and infected with echinococcus and mycoplasmosis.

Non-infectious pleurisy occurs as a result of unsuccessful surgical operations, lung injury, allergic reaction on some substances, and may also be a concomitant symptom of the following diseases:

• sarcoidosis;
• pulmonary embolism;
• pleural metholioma;
• ovarian tumor, etc.

Also, non-infectious pleurisy can be observed after or electric shock. Only a doctor can determine the exact cause of the onset of the disease. Treatment is prescribed depending on the type of disease.

Effusive pleurisy and its symptoms

This type of pleurisy is also called exudative, since a significant amount of fluid accumulates in the pleura. The disease affects only a localized part of the pleura, so the patient feels pain in a specific area on the right or left side. In this case, dry, shortness of breath and heaviness in the region of the left or right lung are often observed. The fluid compresses the lung, it swells, as a result of which the patient cannot fully breathe and feel very ill. Pain usually subsides if the patient lies on his side.

The following symptoms are also observed:

• general weakness;
• elevated temperature (usually subfebrile, but sometimes febrile is also observed);
• loss of appetite up to the complete refusal of food, nausea;
• swelling of the extremities, neck and face.

Pleurisy of the lungs can be infectious and non-infectious origin

Fibrous pleurisy and its symptoms

This disease does not lead to the accumulation of fluid in the pleura, since all of it is excreted from the body, but its dry residue remains on the pleura, which leads to increased inflammation. Such a disease is always an “addition” to inflammatory processes in the lungs, so the underlying disease must be treated first. It can also be difficult to determine the symptoms of fibrous pleurisy, as they are “lost” against the background or.

But there are some main features:

• the patient has a dry, accompanied by a sharp pain in the side or back;
• it is impossible to take a deep breath, when trying, severe pain is felt;
• breathing is difficult, shallow;
• constant tension of the abdominal muscles.

Running fibrous pleurisy threatens the formation of irreversible adhesions in the lungs, so treatment should be immediate.

Purulent pleurisy and its symptoms

This form of the disease is characterized by the accumulation of pus in the pleura and always proceeds in an acute form. Has the following features:

• temperature rise to febrile;
• increase and due to pus in the pleura on the heart;
• dry cough;
• constant pain and pressure in the chest;
• labored breathing.

Purulent pleurisy is treated exclusively in a hospital.

Manifestation of purulent pleurisy

Tuberculous pleurisy and its symptoms

This disease is often a companion of the lungs and manifests itself in the form of empyema, perfocal or allergic pleurisy. Sometimes it is possible to identify only because of inflammation of the pleura, since it can be hidden. Tuberculous pleurisy most often has no obvious symptoms.

It is characterized by:

• a slight increase in temperature;
• general fatigue, weakness, depression;
• shortness of breath and difficulty breathing;
• cough;
• mild chest pain.

This type of pleurisy can be chronic and last for years, pain may disappear for a while, but that does not mean a cure. Difficult to diagnose.

A snapshot of tuberculous pleurisy of the lungs

Different forms of the disease have different symptoms, but in any case, a person will feel pain in the chest, side or back, it will be difficult for him to breathe deeply. In advanced cases, the size of the chest increases, it seems swollen, the veins in the neck swell, and the face often swells. A change in skin color on the chest or face can also be a sign of pleural inflammation. Often, when squeezing the lung, it is observed, which is often confused with rheumatic. That is why it is important not to self-medicate, but to immediately consult a doctor if one of the above symptoms has been observed for more than two weeks.

Diagnosis of pleurisy

The therapist establishes the diagnosis on the basis of listening to the patient's breathing and feeling his chest for an increase in the size of the lungs. Also, the patient needs to take a blood and urine test to establish the presence of persistent inflammation in the body. An x-ray and ultrasound examination of the lungs help to make an accurate diagnosis and assess the size of the lesion.

After the patient has been diagnosed, fluid is taken from the pleura to determine what fluid accumulates in it. Most often it is exudate or pus, in rare cases - blood. It is noteworthy that the purulent form of the disease is more common in children.

If there is a suspicion of oncology or the patient is diagnosed with lung cancer, a pleura is performed, but such cases are extremely rare.

Important! Although pleurisy is a secondary disease, it is contagious. This applies exclusively to the infectious form of the disease. Therefore, the patient should avoid contact with others and wear a gauze bandage, which must be replaced every few hours. The disease is transmitted by airborne droplets. Tuberculous pleurisy is especially dangerous, as it is difficult to diagnose, weakly manifests itself and often has a chronic character.

Pleurisy treatment

After establishing the diagnosis, the patient is hospitalized and prescribed anti-inflammatory drugs, antibiotics. Most medications are aimed at relieving symptoms and inflammation, while the main forces are aimed at treating the disease, the consequence of which was pleurisy.

In addition to medication, patients are prescribed special diet, and after the condition improves, physiotherapy procedures that help the respiratory system restore its function. The patient needs to give up complex, hard to digest food, so as not to create an additional load on the stomach. The basis of nutrition should be food with a high content of vitamins - cereals, vegetables, fruits, herbs, broths. It is also worth avoiding stressful situations and unrest, sometimes it is necessary to take sedatives.

With pleurisy, it is imperative to consult a doctor who will prescribe antibiotics.

Medical treatment depends on the cause of pleurisy, namely:

• if the disease is caused or acute, then it must be treated with antibiotics;
• pleurisy caused by other chronic inflammatory processes and not accompanied by febrile temperature is treated with non-steroidal anti-inflammatory drugs;
• treatment of tuberculous pleurisy is carried out with the help of special medicines and lasts up to six months.

In all cases, patients are prescribed expectorants, painkillers and diuretics. If the liquid presses on the heart, then the attending physician prescribes means to maintain the heart muscle and blood vessels.

If the above therapy does not lead to a decrease in exudate in the lung, or its critical volume is high (sometimes it can reach several liters), then the patient is pumped out. To do this, the doctor inserts a needle into the inflamed area and pumps out the effusion or pus, after which he injects a small amount of anti-inflammatory drugs into the interpleural area. In rare cases, and with chronic tuberculous pleurisy, the patient needs regular drainage, sometimes it is necessary to excise part of the lung.

Treatment with folk remedies

Folk remedies cannot cure the disease on their own, but they will be a good addition to medications. Patients are shown a pulmonary collection that promotes expectoration and restoration of the alveoli, as well as a decoction of herbs such as wild rosemary, licorice root, plantain leaves. Patients are advised to drink fresh beet juice and regularly eat boiled beets. You can reduce swelling and remove excess fluid from the body with a decoction of horsetail and chamomile. You can take these funds only after consulting a doctor and only if there are no contraindications.

Important! If a child is ill with pleurisy, then it is impossible to treat him with folk remedies. His lung capacity is still very small, and even a slight accumulation of fluid can lead to a sharp deterioration in the condition and suffocation..

After curing pleurisy of the lungs, you need to regularly do breathing exercises and spend more time outdoors

Recovery after pleurisy and disease prevention

After discharge from the hospital, patients need to perform breathing exercises prescribed by a doctor to restore full lung activity. Showing moderate physical activity, long walks in the fresh air, yoga is very useful. It is especially useful for convalescents to be in a coniferous forest.

Strengthening, taking care of your health and refusing to bad habits especially smoking. In the cold season, it is necessary to regularly moisten the air dried up by heating devices and ventilate the room.

This article is posted solely for the general educational purposes of visitors and is not a scientific material, universal instruction or professional medical advice and does not replace a doctor's appointment. For diagnosis and treatment, contact only qualified doctors.

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I am a general practitioner and general practitioner. My competence includes issues of early diagnosis of patients and treatment of many diseases of the gastrointestinal tract, lungs and respiratory tract, liver, kidney, cardiovascular and urogenital systems, skin diseases, metabolic disorders, etc. 15 years of experience as a therapist in Moscow clinics, 5 of which worked in one hospital in St. Petersburg .. I will be happy to answer questions from readers of my blog.

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The lungs are the main organ of the human respiratory system. They have an anatomical structure that allows them to perform the function of providing oxygen assigned to them.

The serous membrane of the lungs is called the pleura, which can be visceral (pulmonary) or parietal (parietal):

1. Visceral pleura - covers the lungs from all sides and is tightly connected with them. It enters the space between the pulmonary lobes, passing into the parietal at the surface of the lung root.
2. Parietal pleura - lines the nearby walls of the chest region, protecting the lungs from the mediastinum. Fusion with the inner surface of the sternum. Forms a bag, in each of the halves of the chest cavity, which contain the lungs covered with a visceral pleura.

The lungs are a paired organ divided into a right lung and a left lung. Located in the chest cavity, they occupy up to 80% of its total volume. Lung tissue looks like a sponge with pink pores. Gradually, it darkens due to smoking, pathologies in the respiratory system, aging.

What is pleurisy of the lungs?

Pleurisy of the lungs is a complex inflammatory pathology, especially dangerous for children and the elderly. The disease begins as a result of inflammation (infectious or not) of the pleura. Rarely independent, more often a consequence disease processes in the lungs.

Inflammation of the pleural membranes of the lungs is accompanied by the release of exudate:

1. With dry pleurisy, fibrin falls on the surface of the pleura.
2. With exudative pleurisy, the secret accumulates in the pleural cavity.

Exudative pleurisy of the lungs are also called processes accompanied by pathological effusion without inflammation - tumors, injuries, infections.

Species and general taxonomy

Depending on the reasons that served as the beginning of pleurisy of the lungs, its development and forms of manifestation, it happens:

1. Purulent.
   • Occurs due to the filling of the pleural cavity with purulent effusion. Pulmonary and parietal membranes become inflamed.
2. Exudative.
   • The pleura is affected by infections, tumors, injuries.
3. Dry.
   • Complications of diseases of the lungs and other organs located near the pleural cavity. It can manifest itself as a symptom of systemic diseases.
4. tuberculosis.
   • The serous membranes that create the pleural cavity and envelop the human lungs are affected. The disease is diagnosed by a large volume of secreted fluid.

The symptoms of each type are typical and depend on the nature of the course of the disease.

Stages of the disease

By the nature of the course, pleurisy of the lungs has three stages.

1. The first stage is the stage of exudation.
   • There is an increased production of pleural fluid - a consequence of the expansion of blood vessels and an increase in their permeability. This happens when immune cells activate biological processes against the background of infection. Excess fluid has time to be excreted by the lymphatic system, since its volume in the pleura does not exceed normal.
2. The second stage is the stage of formation of purulent exudate.
   • Sticky, saturated with fibrin, exudate begins to be deposited on the pleural sheets. The friction between them increases, gradually the sheets are soldered (fused together). "Pockets" are formed, which significantly complicate the release of exudate from the pleural cavity. In places of accumulation of the secret accumulate bacteria that died from contact with immune cells. Which, combined with protein activity, leads to putrefaction and decay. Inflammatory processes begin to develop in adjacent tissues, the outflow of fluids through the vessels of the lymphatic system is disturbed. In the pleural cavity, even more liquid purulent mass is collected.
3. The third stage is the stage of chronicity or recovery.
   • The stage of resorption of pathological formations or their transition to a chronic form. Chronology appears:
     • a significant decrease in lung mobility;
     • an increase in the thickness of the pleura;
     • decreased outflow of pleural fluid;
     • the formation of pleural adhesions;
     • sometimes, the pleura is completely overgrown with fibrous tissue.

Causes

Meet the disease in pure form rarely succeeds. You can get pleurisy with a chest injury or hypothermia, but more often this is a consequence of a complication of another disease. It depends on the nature of the symptoms.

Infectious pleurisy is the most common form. For its development, the general sensitivity of the patient is important. The reactivity of the disease changes significantly when, due to microbes or toxins, allergization of the pleural cavity begins. The immune system sends antibodies to the affected area, which, when combined with antigens, affect the production of histamines.

Approximately three-quarters of infectious problems are caused by exposure to bacterial agents:

• tubercle bacillus;
• fungal infection;
• streptococci;
• staphylococci;
• anaerobic bacteria;
• legionella.

The non-infectious form may occur for the following reasons:

• the formation of malignant tumors on the pleural sheets;
• spread of metastases in the pleural cavity;
• lung infarction;
• connective tissue injuries against the background of:
  • scleroderma;
  • systemic vasculitis;
  • lupus erythematosus.

Pleurisy of the lungs contribute to the following diseases:

• angina;

Symptoms of pleurisy of the lungs

The symptomatology of pleurisy depends on the specific form of the disease and the nature of its course. Often the onset of the development of the disease is missed by patients, because it is confused with the common cold. However, the main symptoms of the disease still differ from other respiratory pathologies.

Exudative, encysted pleurisy: symptoms

There are significant differences in the clinical picture of this form of the disease, depending on the place of localization and the statute of limitations of the pathology. The nature of the secretions and their volume also matter.

Pleurisy of this type includes:

1. Interlobar:
   • do not have severe symptoms.
2. Bagged wall:
   • intensifying (when sneezing and coughing) pain in the chest;
   • encapsulation of exudate in the sinus of the diaphragm leads to the spread of pain impulses in upper area stomach, it becomes difficult to swallow;
   • pain can spread to the area of ​​the scapula, neck. By nature, it resembles pain in Pancoast cancer or plexitis.
3. Encapsulated purulent:
   • gives a typical picture of pleural empyema:
     • the temperature rises;
     • the patient feels severe chills,
     • there is clear toxicity.
   • Of the not pronounced symptoms:
     • the patient feels general weakness;
     • malaise;
     • purulent encysted effusion can break into the bronchi and tissues of the chest cavity, forming pleuro-cutaneous or pleural-bronchial fistulas.

Signs of dry (fibrinous), adhesive pleurisy

Adhesive pleurisy - a form of fibrinous pleurisy - is the most common chronic disease affecting the lining of the lungs. From fibrinous plaque on the pleura, adhesions are formed, which lead to the immobilization of tissues, reducing the volume of the lungs.

The disease corresponds to the symptoms characteristic of all types of dry pleurisy:

• a dry cough appears, manifested by seizures;
• body temperature rises, chills begin;
• rapid and difficult breathing;
• pleural sheets, when rubbing against each other, cause wheezing;
• shortness of breath occurs;
• the patient feels a general malaise;
• in the evening the fever increases with a sharp increase in perspiration.

Against the background of these symptoms, severe pains begin in the affected lung, aggravated by deep breaths or sharp bends / turns of the body. Sometimes there are pains in the region of the heart, in the upper abdomen and neck.

A characteristic feature is the suddenness of the onset of symptoms. The patient can accurately name the time of onset of the development of pathology.

Manifestations of effusion (purulent, serous) pleurisy of the lungs

Purulent, effusion pleurisy of the lungs is the most severe form of pathology. Diagnosed in all categories of citizens, does not depend on gender and age. Causes damage to the lining of the lung, the formation of arrays of liquid pus inside the organ.

The disease is characterized by the following symptoms:

• heaviness or pain in the chest;
• general weakness, loss of strength is felt;
• an annoying strong cough begins;
• shortness of breath appears;
• body temperature rises sharply;
• in the side there is a constant feeling of fullness
• breathing is disturbed, it becomes difficult for a person to breathe in and out.

With purulent pleurisy, pain - main feature. Gradually, as pus accumulates in the pleural cavity, this symptom disappears. Cough is rarely accompanied by sputum production, manifesting itself mainly at night. If this is a complication after an infection, exudate may be released.

Differences of tuberculous, viral pleurisy

Tuberculous pleurisy is a pulmonary pathology with active release of exudate (into the pleural cavity and onto the surface of the lung). The disease is characteristic childhood although it also occurs in adults. It can be either a separate form of tuberculosis, or an independent disease.

1. allergic form.
   • Occurs in tuberculosis patients, with sensitivity to tuberculin, prone to hyperergic reaction. Symptoms appear sharply: a rapid increase in temperature that persists for 10-14 days. Due to serous effusion, there are problems with breathing, pain in the side, increased heart rate.
2. perifocal form.
   • It starts gradually. Often the symptoms are associated with hypothermia or a viral infection. There is a dry cough, borderline temperature (37-38 0 C), tingling, burning in the chest. When pressing on the intercostal zones, painful sensations. Pain is similar to myositis or intercostal neuralgia, with irradiation into the abdominal cavity - to an attack of cholecystitis.

Cough with pleurisy

With pleurisy, the pleura becomes inflamed, it can be dry and exudative. When dry, a dry, often reflex, cough is manifested. Patients try to restrain him, because the shudder of the chest causes severe pain.

As fluid accumulates in the pleural plane, the intensity of cough gradually decreases. There is heaviness and shortness of breath in the side. Weak vesicular breathing can be expressed, sometimes you can feel the noise from the friction of the pleura.

Exudative pleurisy passes without obvious activation of the cough center. Accompanied by a sharp weakening of breathing, the voice trembles and the percussion sound is shortened.

Possible Complications

Treatment of pleurisy must be carried out on time, the only way to avoid possible complications. And the disease has a lot of them:

• adhesions form in the pleural cavity;
• general respiratory failure of organs and systems;
• adhesive form of pleurisy;
• obliteration of interlobar fissures;
• the pleural cavity is scarred;
• decreased diaphragm mobility;
• pleurosclerosis.

The appearance of complications depends on the causes of the pathology, the course of its development. To avoid complications, you should not hesitate to visit a doctor.

Diagnostics

Diagnosing pleurisy itself is easy, defining it as clinical condition presents no problem. It is difficult to determine the causes of the painful condition. Diagnostics will require the following methods:

• examination and questioning;
• examination of the patient in a clinical setting;
• blood analysis;
• collection and analysis of pleural effusion;
• microbiological examination.

Based on the results of the diagnostic examination, the necessary treatment is prescribed.

Treatment

In the treatment of pleurisy, two main tasks are pursued: to stabilize the patient's condition and normalize his respiratory function. But first, it is required to eliminate the cause that caused the disease. For this, both methods of traditional and alternative medicine are suitable.

traditional medicine

The basis of medical methods for the treatment of pleurisy are antibacterial drugs, since the nature of the disease is infectious. The pleura itself is treated with desensitizing and anti-inflammatory drugs.

The selection of drugs depends on the data obtained after the diagnosis. The choice of antibiotics is based on the sensitivity of pathogenic microflora, which is detected during laboratory examination. Dosage rates - according to the current condition of the patient.

1. Antibiotics:
   • Clindamycin;
   • Ceftriaxone;
   • Ampicillin.
2. Non-steroidal anti-inflammatory drugs:
   • Meloxicam;
   • ibuprofen;
   • Diclofenac.
3. Glucocorticosteroid:
   • Prednisolone.

Folk remedies

You can treat pleurisy based on recipes traditional medicine. The most common home remedies include:

.

Prevention of pleurisy, coupled with measures to strengthen the immune system, reduces the risk of inflammatory lung diseases.

Turning to human anatomy, the mechanism of the disease becomes clear.

Pleura- consists of outer and inner sheets with an intermediate gap or pleural cavity. Under the influence of any causes (autoimmune, infection), the level of permeability in the pleural vessels increases, liquid plasma components of the blood, as well as proteins, enter the cavity. With a small volume, the liquid is absorbed back, with the exception of fibrin (blood protein), which becomes a sediment on the pleura sheets - at the same time they thicken. In this way, it is formed fibrinous or dry pleurisy. At more fluid in the pleural cavity develops exudative pleurisy.

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Classmates

What is this disease?

Pleurisy makes the pathological processes occurring in the human body more complex. Symptoms of this inflammation are often observed in patients with tuberculosis, after suffering, as well as against the background of oncology. Men under 40 are more susceptible to the disease. contribute to its emergence:

• excessive cooling or vice versa, overheating;
• untreated acute respiratory infections;
• trauma;
• poor nutrition with poor intake of vitamin C;
• heavy physical exertion without recovery.

Reasons for the appearance

In general, allocate three main reasons or ways of formation of inflammation:

Aseptic etiology:

• malignant oncology of the pleura (mesothelioma), one or multiple metastases in the pleural cavity in oncological diseases of other organs, for example, mammary glands, ovaries, lungs, and so on;
• autoimmune cause: local damage to connective tissues (lupus erythematosus, arthritis, systemic vasculitis, rheumatism, etc.);
• heart attacks (myocardium, lung);
• other (pancreatitis, leukemia, renal failure).

Mixed ancestry:

• Infectious-allergic;
• toxic-allergic;
• autoimmune-toxic.

• Allergy to chemical substances or the plant is accompanied by a runny nose - this is not as harmless as it seems. Learn more about and fight allergies.
• Suffering from a cough? Pay attention to the health of children, as a predisposition to bronchospasm may be hereditary. you can read about the causes of bronchitis.

Symptoms

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

Symptoms of dry pleurisy:

• chest pain;
• General unhealthy condition;
• dry cough;
• 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.

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 is usually tuberculous in origin.

characterized by three stages:

• exudation;
• stabilization;
• effusion resorption.

In the initial period (exudative) smoothing or even bulging 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.

Stabilization period characterized by a decrease in acute symptoms: the temperature drops, chest pain 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.

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.

Clinical manifestations of inflammation of the pleura are divided into:

• acute (the disease is pronounced, it develops rapidly);
• subacute (moderate course of inflammation);
• chronic (weak symptoms, periods of exacerbation).

TO 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 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.

Prevention

Very simple: it is necessary to adequately treat the primary infectious disease, monitor nutrition, alternate physical activity with quality rest, do not overheat and do not succumb to excessive cooling.

Pleurisy perifocal- in patients with pulmonary forms of tuberculosis, it has a chronic stagnant character. Relapses are possible. The exudate is serous, also without mycobacteria.

If you find in yourself or people close to you the described signs of pleural inflammation, you should urgently contact a local therapist.

After the initial examination of the clinical picture, which can tell the specialist a lot, take a series of tests, act on the further prescription of the doctor. Most likely, a referral to a pulmonologist will follow.

It is important to remember that with an early diagnosis of the disease, the doctor will prescribe adequate therapy, following which, you can count on the final full recovery.

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