Dry pleurisy and pleural effusion
There are two main forms. With dry, or fibrinous, pleurisy, fibrin is deposited on the leaves of the pleura, they lose their smoothness and rub against each other. The main symptom is acute stabbing pain on the affected side, which sharply intensifies with a deep breath, coughing and bending to the healthy side, so the person breathes shallowly. With exudative pleurisy, fluid accumulates between the leaves. She separates them, and the pain decreases, but the growing volume of effusion compresses the lung, and shortness of breath and a feeling of heaviness in the chest come to the fore.
- Dry pleurisy - pain when inhaling, pleural friction noise
- Exudative pleurisy - shortness of breath, heaviness, decreased breathing
- Purulent pleurisy (empyema) - a serious condition with fever
- Hemothorax - blood in the pleural cavity after injury
- Transudate in heart and renal failure - often bilateral
Reasons
Pleurisy is not an independent diagnosis, but a syndrome. Most often, it complicates pneumonia when inflammation from the lung tissue spreads to the pleura. In our region, tuberculosis remains an important cause, especially in young people with effusion without obvious pneumonia. Unilateral effusion in older people makes it necessary to exclude a tumor process. Bilateral fluid is more often associated with heart failure, kidney and liver disease. Some causes include pulmonary embolism, systemic rheumatic diseases, pancreatitis, and chest trauma.
- Pneumonia and other lung infections
- Tuberculosis
- Malignant tumors and metastases
- Pulmonary embolism
- Heart, kidney and liver failure
- Rheumatic diseases
- Chest injuries and surgeries
Symptoms
The clinical picture consists of the manifestations of pleurisy itself and the underlying disease. Unilateral chest pain associated with breathing is typical; it may radiate to the shoulder or abdomen if the diaphragmatic part of the pleura is involved. Breathing becomes frequent and shallow, the person spares the sore side and often lies on it. With significant effusion, shortness of breath appears with slight exertion, and then at rest. Fever, weakness, sweating, cough and weight loss indicate an infectious or tumor nature.
- Stitching pain in the side, worsening with inspiration
- Dry cough
- Shortness of breath and a feeling of heaviness in the chest
- Fever and sweating
- Weakness, loss of appetite, weight loss
- Forced position on the sore side
Diagnostics
The first step is an examination and x-ray of the chest in two projections: it reveals effusion, changes in the lungs and displacement of the mediastinal organs. Ultrasound examination of the pleural cavity is more sensitive to a small amount of fluid and helps to select a point for puncture. Computed tomography shows the condition of the lung tissue, pleura and lymph nodes. Pleural puncture is of decisive importance: the resulting fluid is examined for protein, cellular composition, mycobacteria and tumor cells. Additionally, blood tests are evaluated, if thromboembolism is suspected - D-dimer and CT angiography.
- Chest X-ray in two projections
- Ultrasound of the pleural cavity
- Computed tomography of the chest
- Pleural puncture with fluid analysis
- Complete blood count, C-reactive protein
- Testing for tuberculosis
- D-dimer and CT angiography for suspected thromboembolism
Treatment
Treatment is aimed primarily at the cause: for pneumonia, antibacterial therapy is prescribed, for tuberculosis, anti-tuberculosis drugs according to the standard regimen, and for heart failure, cardiac therapy is adjusted. To relieve pain, use painkillers and anti-inflammatory drugs selected by your doctor. If the effusion is large and causes shortness of breath, the fluid is removed by puncture; in case of purulent pleurisy, drainage is installed and the cavity is washed. After inflammation subsides, breathing exercises and a gradual expansion of activity are important so that adhesions do not form.
- Treatment of the underlying disease is the main condition
- Painkillers and anti-inflammatory drugs as prescribed by a doctor
- Pleural puncture for large effusions
- Drainage for pleural empyema
- Breathing exercises after pain subsides
- Observation with control x-ray or ultrasound