Pleurisy - is an inflammatory process in the pleural sheets (visceral and parietal), wherein on the surface of the pleura (membrane covering the lungs) fibrin deposits are formed and then forming adhesions, either within the pleural cavity accumulates different types effusion (inflammatory fluid) - purulent, serous, hemorrhagic.
Pleurisy are not independent disease, it is a secondary process. He accompanies many diseases in the lungs, mediastinum and diaphragm.
Pleurisy is often a symptom of systemic diseases (cancer, rheumatism, tuberculosis). However bright the clinical manifestations of the disease often force doctors to exhibit symptoms of pleurisy at the forefront, and already in his presence to find out the true diagnosis.
Pleurisy can occur at any age, many of them are not recognized.
Causes
The causes of pleurisy can be divided into infectious and inflammatory or aseptic (non-infectious).
By infectious include:
- microbial pleurisy (infection of the pleural cavity staphylococci, Escherichia coli and Pseudomonas aeruginosa, and pneumococcal etc.)
- viral pleurisy (arising from the virus infection of influenza, herpes)
- fungal pleurisy (pleural defeat candidiasis, Coccidiosis, blastomycosis)
- pleurisy with particularly dangerous infections (tularemia, brucellosis, typhoid fever caused by a microbe or arising at typhus),
- syphilitic or tubercular pleurisy,
- parasitic (hydatid or amoebic)
- pleurisy occurring in wounds or chest operations due to enter the pleural cavity microbes.
Noncommunicable pleurisy typically occur
- matestazirovanii with lung cancer in the pleural cavity,
- with primary malignant tumor of the pleura - Mesothelioma
- lymphoma,
- with ovarian malignancy, breast cancer as a result of cancer cachexia (terminal stage of cancer),
- at rheumatoid arthritis,
- vasculitis (vascular damage)
- at rheumatism,
- at systemic lupus erythematosus,
- at scleroderma,
- as a result of pulmonary embolism and pulmonary edema,
- with pulmonary infarction,
- at myocardial infarction due to stagnation in the pulmonary circulation.
- during a hemorrhagic diathesis (coagulation disorders)
- while leukemia,
- in acute pancreatitis.
Kinds
By the nature of exudate (fluid produced in half a pleura) and the number of pleurisy is divided into:
dry or fibrinous (little exudate, fibrin forms on the surface)
exudative (to form a sufficiently large amount of inflammatory fluid in the pleural cavity)
For pleurisy can be:
- keen to 2-4 weeks
- subacute from 4 weeks to 4-6 months,
- chronic, more than 4-6 months.
symptoms of pleurisy
When dry pleurisy main symptoms are:
- stabbing pain in the chest, especially when coughing, deep breathing, and sudden movements,
- forced position on the patient side,
- superficial and gentle breath, the affected side behind visually in breathing,
- auscultation - pleural friction, easing breathing zone of fibrin deposits,
- fever, chills and severe sweating.
If pleural effusion is somewhat different clinic. appear:
- dull pain in the affected area,
- dry painful cough,
- strong lag lesion chest in breathing,
- a feeling of heaviness, shortness of breath, bulging of the spaces between the ribs,
- weakness, fever, shivering, and profuse perspiration.
With a significant accumulation of fluid can move the heart and other organs of the mediastinum to the pressure reduction, change in frequency and depth of breathing, severe disturbance of health.
Diagnostics
Can be suspect pleurisy during inspection and percussion (prstukivanii fingers) the thorax - fluid boundary is defined.
When listening to audible noise friction lung pleura inflamed, particularly upon application of fibrin. In liquid breathing congestion auscultated weak.
Complements the study of ultrasound and chest X-ray, and further held puncture (puncture needle sampling exudate) and research content. In general and biochemical blood tests, there are signs of inflammation.
For the purpose of visual inspection carried thoracoscopy pleural cavity (cavity special inspection device with a camera), and pleural taking biopsies.
pleurisy treatment
Pleurisy treated with physicians and surgeons. When infectious pleurisy appoint:
- antibiotics or antifungal medicines,
- at a particular infection (syphilis, Tularemia, parasites) specific therapy in conjunction with specialists (phthisiatrician, infectious disease).
- Also shown:
- painkillers,
- antipyretics,
- when a large amount of effusion - diuretics to remove fluid,
- after exudates absorbed - prescribed physical therapy and exercise therapy.
If effusion much more 500-1000 ml, in a surgical hospital performed puncture and pleural exudate removal. If necessary, give special tube-drains and the pleural cavity was washed with antibiotics and special solutions (hormones, enzymes).
In treatment it is necessary to ensure that between the sheets of pleura did not appear adhesions - they will interfere with the light, and they can not move normally during breathing.
In the presence of non-infectious pleurisy initially treat the underlying disease.
Patients with pleurisy under surveillance for a long time, about 2-3 years after recovery. They show a special regime, prevention of colds and hypothermia.
