How adhesions form
Between the layers of the pleura there is normally a little fluid that provides sliding. During inflammation, the vessels of the pleura become permeable, the protein fibrin comes to the surface, and the leaves stick together. If the inflammation subsides quickly, fibrin disappears without a trace. If the process is delayed or is accompanied by an accumulation of pus and blood, connective tissue grows in places of adhesion and strong cords form. Essentially, it is a scar, and scars do not disappear: they remain for life, but also do not progress if the cause is eliminated.
- Past pleurisy and pneumonia
- Pleural tuberculosis
- Chest trauma and hemothorax
- Operations on the chest organs
- Previous pneumothorax
- Empyema of the pleura
Are there symptoms?
Limited adhesions usually do not give any sensation, and a person learns about them by chance during fluorography or x-rays. Some people note nagging pain or discomfort on the side of the adhesions when taking a deep breath, coughing, changing weather and physical activity. Extensive adhesions covering a significant surface of the lung can limit its expansion: then shortness of breath on exertion, decreased tolerance to physical activity, and sometimes lag of half of the chest when breathing appear. It is important that the adhesions themselves do not cause fever or hemoptysis.
- Most often are asymptomatic
- Drawing pain when taking a deep breath
- Discomfort during exercise and coughing
- Shortness of breath with extensive adhesions
- Restricted mobility of half of the chest
- No fever or hemoptysis
Diagnostics
Most often, adhesions are described by radiologists as pleurodiaphragmatic or pleuroapical adhesions, sinus obliteration, and pleural overlays. Such a conclusion in itself does not require treatment, but it does require an understanding of what caused it. The doctor compares the finding with the medical history: whether there was pneumonia, pleurisy, trauma, surgery, contact with tuberculosis. A CT scan of the chest gives a more accurate picture and helps to distinguish adhesions from pleural thickening of another nature and from a space-occupying formation. Spirometry shows whether there is a real breathing restriction.
- Chest x-ray
- CT scan of the chest with an unclear picture
- Comparison with previous images
- Spirometry
- Testing for tuberculosis according to indications
- Consultation with a thoracic surgeon for extensive adhesions
Is treatment necessary?
In the vast majority of cases, no. Adhesions are scar tissue and cannot be resolved with pills, injections, physiotherapy or herbs; remedies that promise such an effect have no evidence. It is not the find itself that requires attention, but the reason: if adhesions formed after suffering from tuberculosis, you need to make sure that the process is inactive. If a person is worried about shortness of breath, it is important to understand whether it is actually due to adhesions or another disease, such as bronchial asthma, COPD, heart failure or excess weight.
- Limited adhesions do not require treatment
- Scar tissue is not resolved by medications
- It is important to establish and exclude an active cause
- Assessment of respiratory function for shortness of breath
- Looking for other causes of shortness of breath
- Avoiding unproven methods
What helps and when is surgery needed?
For discomfort and moderate limitation of chest mobility, regular breathing exercises, chest stretching exercises, aerobic exercise as tolerated, and smoking cessation are beneficial. They do not destroy adhesions, but improve lung ventilation and exercise tolerance. Surgical separation of adhesions is rarely performed and only when there is a significant limitation in lung expansion, recurrent pneumothorax, or as part of surgery for another reason. The decision is made by the thoracic surgeon after assessing CT and respiratory function.
- Breathing exercises and chest exercises
- Aerobic exercise according to tolerance
- Quitting smoking
- Timely treatment of pneumonia and pleurisy
- Surgical separation of adhesions according to strict indications
- Observation with control images for extensive changes