The pleura is a thin membrane that lines the inside of the chest, the petals of the lungs, and the diaphragm. Its main function is not only the protection of the respiratory organ, but also the production of lubricant to ensure the normal movement of the lungs during breathing. Inflammation of this membrane can be either an independent disease, or a symptom of any other disease. What are the etiology, pathogenesis, clinic and diagnosis of pleurisy, as well as modern methods of treating the disease?
Definition
Pleurisy is an inflammatory disease of the membrane of the lungs, which is characterized by the deposition of fibrin on the surface of the pleura or the formation of fluid in the pleural cavities. This condition is quite dangerous for human life, especially if measures are not taken to diagnose pleurisy and its subsequent treatment. In addition, if the condition arose as a symptom of another disease, it is also important to properly prescribe treatment for it.
Etiology
The causes of pleurisy are many. They are conditionally divided into three categories: infectious origin, inflammatory or non-infectious, as well as aseptic. Diagnosis and treatment of pleurisy depends on the possible origin of the disease. Among the causes of inflammation of the pleural membrane of the lungs may include the following:
- Bacterial infections such as staphylococcus, pneumococcus.
- Lesions of fungi of the genus Candida or blastomycosis.
- Syphilis.
- Pulmonary tuberculosis.
- Mechanical chest injuries, which may cause damage to the pleura.
- Some surgical interventions.
Among the non-infectious causes of the origin of the inflammatory process, the following are distinguished:
- Malignant neoplasms in the lungs.
- Lung metastasis in cancer. Especially often occurs with breast cancer or lung damage.
- Autoimmune diseases, such as systemic lupus erythematosus, systemic vasculitis.
- Pulmonary infarction, in which thromboembolism occurs in the vascular tissue of an organ.
Aseptic pleurisy can occur for a number of the following reasons:
- Penetration of invasive pancreatic enzymes into the pleural cavity.
- Lymphogranulomatosis.
- Some diseases of the kidneys and liver.
Diagnosis of pleurisy is aimed not only at identifying the fact of the disease, but also at determining its root cause.
Pathogenesis
Pathogens can enter the pleural region in several ways:
- through lymph;
- through the blood;
- with surgical intervention;
- with injuries;
- from infectious foci in the lungs - with an abscess, suppuration of cysts or tuberculous lesions.
Pathogens that get inside cause an inflammatory process, which is characterized by the expansion of the lymphatic ducts and, as a result, swelling, increased permeability of blood vessels. There is also fibrous plaque on the pleural lobes. With the rapid development and high intensity of the inflammatory process, exudate is secreted.
Symptoms
Differential diagnosis of pleurisy begins with an examination of the patient, as well as with the collection of symptoms of the disease that he is experiencing. At the initial stage of the development of the inflammatory process, a person can feel such manifestations of the disease:
- Pain in the chest, which increases when trying to take a deep breath.
- Dry or wet cough, which may be accompanied by the release of a certain amount of sputum or even blood.
- Low-grade fever, which is accompanied by severe chills, poor appetite.
- Sudden and unreasonable weight loss.
Dry pleurisy is an inflammatory process in which no fluid is released between the pleural membranes. Diagnosis of dry pleurisy can begin with the detection of such specific symptoms:
- pain in the chest during palpation;
- pleural noise when listening to the lungs, which occurs when there is insufficient lubrication;
- in some cases, there is a constant dull pain in the chest area.
Exudative or effusion pleurisy is an inflammatory process in which there is a release of a large amount of fluid, which accumulates in the lung bag. Its specific symptoms are the following manifestations:
- a feeling of constant heaviness in the chest;
- reflex dry cough;
- cyanosis - blueness and blanching of the skin in the region of the lungs and neck;
- swelling of the cervical veins;
- inflammation of the lymph nodes that are located on the neck and chin;
- gurgling sounds may occur while listening to breathing.
Purulent pleurisy is an inflammation of the pulmonary membrane, which is accompanied by the release of a certain amount of pus. It is considered one of the most severe varieties of pleural inflammation. Diagnosis of a pleurisy clinic with purulent discharge describes the same symptoms that a person experiences with an exudative variety of the disease. However, severe intoxication of the whole organism is also noted, hectic fever is a condition in which significant changes in body temperature during the day are noted.
The clinical picture of tuberculous pleurisy is characterized by acute onset, shortness of breath, fever up to 39-40 degrees, cough. Differential diagnosis of tuberculous pleurisy is accompanied by a pulmonologist or TB specialist.
How to identify the disease?
In order to correctly identify the disease, it is important to undergo a series of clinical studies, the results of which can confirm or refute the alleged conclusion. Dif diagnosis of pleurisy consists in the following methods:
- Anamnesis by a pulmonologist who finds out the symptoms experienced by the patient and their prescription.
- Examination of the patient, in which the doctor can find out symptoms that have external manifestations - cyanosis of the skin, swollen lymph nodes, asymmetry of the chest, which is often noted with exudative pleurisy.
- Auscultation - listening to breath with a stethoscope. In this case, the doctor may hear wheezing in the chest, rustling of the pleura with dry inflammation or insufficient weak breathing.
- Ultrasound diagnosis of pleurisy helps determine the upper boundaries of the effusion.
- Radiography makes it possible to take a picture of the lungs in order to track the dynamics of the disease, as well as to enable related specialists to advise the patient.
- Pleural puncture - a puncture of the chest tissue and a collection of pleural exudate for subsequent histological and cytological examination. Also, using this procedure, you can completely remove the allocation, if this is a necessary measure.
- Pleural biopsy is a method for the diagnosis of pleurisy, which consists in obtaining a sample of the affected lung tissue or pleura for subsequent laboratory study.
- Pleural thoracoscopy is a chest examination using a thoracoscope, which is inserted directly through incisions on the skin. This method of differential diagnosis of pleurisy allows you to assess the condition of the affected lung. The operation can be performed both under local anesthesia and under general anesthesia.
- A blood test in which there will be such abnormalities in pleurisy - increased ESR as evidence of an inflammatory process, an excess of fibrin and sialic acids, an increase in seromucoids.
Of particular effectiveness is the radiation diagnosis of pleurisy (radiography). With it, you can find out which of the lungs was affected, the upper boundaries of the effusion, which provide information about the estimated amount of fluid accumulated in the pleural cavity, and also monitor the patient's condition as treatment progresses.
General principles of therapy
Diagnosis and treatment of pleurisy of the lungs, regardless of the type of disease, have general principles that all pulmonologists and related specialists adhere to:
- At the beginning of therapy for the inflammatory process in the pleural cavity, broad-spectrum antibiotics are prescribed. They are necessary in order to suppress the possible causative agent of this condition. Local pain medications are also prescribed, which are aimed at reducing pain during breathing.
- After diagnosing exudative pleurisy, purulent or dry and identifying the pathogen, broad-spectrum antibacterial agents are replaced with narrow-focus antibiotics that act on specific varieties of pathogenic bacteria. This will help to quickly deal with the unpleasant symptoms of the disease.
- When diagnosing pleurisy of the lungs, neoplasms or metastases can be detected that have caused a pathological condition. In this case, specific therapy is prescribed, which consists of chemicals, radiation treatment, which is necessary to destroy cancer cells. It is also necessary to take medications that relieve swelling and slow down tumor growth if aggressive therapy at this stage is not possible.
- No less important is the appointment of drugs that are used to strengthen blood vessels in the body, to avoid hemorrhage, expectorants to remove sputum from the lungs and bronchi, diuretic tablets to remove excess fluid from the body.
- Physiotherapeutic procedures are necessary at the final stage of treatment to strengthen the result.
In the presence of a large accumulation of exudate, lymphatic drainage is necessary - removal of fluid from the pleural cavity. At one time, no more than 1 liter of liquid can be pumped out, since with a larger volume, internal organs can shift. Normally, the exudate should have a straw yellow color, be transparent and odorless. If the pumped liquid has an unpleasant aroma or cloudy, then we are talking about suppuration. In this case, therapy should also be aimed at removing the causes of pus production.
Drug therapy
After the diagnosis of exudative pleurisy, a dry or purulent inflammatory process in the pleural cavity, therapy with the help of drugs is always prescribed. Among the commonly prescribed drugs are the following:
- Acetylsalicylic acid ("Aspirin"). This drug has an anti-inflammatory effect, and also anesthetizes. It is prescribed for fever or fever. The drug has such contraindications as the age of 15 years and the presence in the history of peptic ulcers of the stomach and intestines.
- Analgin or other painkillers are used to reduce soreness when breathing. It is not recommended to use the drug for bronchial asthma, as well as during pregnancy.
- "Benzylpenicillin" is an intramuscular injection that works against bacteria. Contraindicated in case of individual intolerance to penicillin.
- "Indomethacin" is a drug that is used to reduce inflammation and fever. It is contraindicated in children under 14 years of age, as well as in people with peptic ulcers of the stomach and intestines. If there are contraindications, the drug is replaced by another with a similar effect.
- Diclofenac Sodium is used to reduce inflammation and fever. It is forbidden to use during pregnancy and lactation, as well as in the presence of a history of kidney and liver pathologies.
- Calcium chloride is necessary to prevent allergic reactions, as well as the destruction of certain pathogenic bacteria and microorganisms. A contraindication is the tendency to form blood clots in the vessels.
- "Lefosocacin" is a broad-spectrum antibiotic that is prescribed immediately after diagnosis. Contraindicated in case of individual lactose intolerance, under the age of 18 years, epilepsy and pregnancy.
- "Erythromycin" is an antibacterial drug that is widely used in many diseases of the respiratory tract. You can not use when carrying a child, breastfeeding, as well as at the same time with drugs such as "Terfenadine" or "Astemizole".
Differential diagnosis of exudative pleurisy or its other varieties is necessary for the proper treatment. Self-medication with drugs is undesirable, since improper dosage or incorrect prescription of a drug can only exacerbate the problem.
Surgery
At the initial stage of the disease or with its mild degree, therapy at home is possible. If the condition worsens or if drug treatment did not bring the desired result, it is necessary to supplement it with surgical intervention. With pleurisy, several types of operations are used:
- Thoracocentesis is a surgical procedure, the purpose of which is to remove fluid accumulated in the pleural cavity. The operation is used for any kind of exudative pleurisy, if there are no contraindications to its conduct. The procedure is performed under local anesthesia. To do this, under the control of the ultrasound apparatus, a needle is inserted into the pleural cavity in the scapular region and exudate is taken. Cuts at the end of the operation are sutured. After the procedure, the patient almost immediately feels relief, as the amount of accumulated fluid decreases.
- If it is necessary to repeat the exudate suction, the intrapleural port system is used, which provide access to the cavities without performing additional incisions. They are a system that consists of a catheter and a titanium membrane that are inserted into the cavity. The system is convenient in that it takes much less time to carry out the fluid intake procedure, and even if the patient is in urgent need it can be performed by the patient’s relatives.
- Pleurodesis is an operation whose purpose is to create artificial adhesions between the pleura sheets in order to prevent fluid accumulation. It is necessary for patients with cancer who do not experience improvement from chemotherapy. At the same time, a drug substance with an antitumor effect is introduced into the cavity.
Also in rare cases, the installation of a shunt and removal of the pleura. In this case, fluid from the pleural cavity passes into the abdominal cavity, which does not exclude the need for pumping it out. These methods are quite radical, so doctors resort to them only in the most extreme cases, when other methods of treating all types of pleural inflammation do not bring the desired result.
Folk methods
It is impossible to consider recipes of traditional medicine as the only remedy for treating pleurisy. This can be dangerously worsening in general condition and even fatal outcome in the absence of timely qualified medical care. However, various natural herbs, oils and berries that are used in traditional medicine, judging by the reviews, can have a positive effect on the body as a whole. They strengthen the immune system, which gives strength to fight infections, and also contain a large number of healthy vitamins. Most often, essential lavender and camphor oil is used, which must be rubbed into the chest - this tool not only warms the skin, but is also used as aromatherapy. Infusions of elderberry, peppermint, elecampane, natural honey and fresh aloe leaves have a positive effect on the body of a sick person.
Conclusion
Symptoms, diagnosis and treatment of dry pleurisy or its other varieties indicate that it is a rather serious disease that can have unpleasant consequences if there is no competent therapy. Unfortunately, it is impossible to completely prevent its occurrence, however, if you adhere to a healthy lifestyle, you can significantly reduce the number of prerequisites for its occurrence.