Symptoms of tuberculous pleurisy
Tuberculous pleurisy can be self-clinical form and as a complication of other forms of tuberculosis of any localization.
Currently, the share of tuberculous pleurisyamong effusions of different etiologies of approximately 15-30%. Tuberculous pleural effusion occurs in 6-8% of newly diagnosed patients and in 0,8-3,1% of patients with recurrent tuberculosis. Are ill usually young men.
The occurrence of exudative pleurisy oftenassociated with cooling, operations, and women more - with pregnancy, childbirth and abortion. From the moment the primary fixation of the pathogen in the pleural sheets to the clinical picture of exudative pleurisy takes from several weeks to several months. The reservoir of infection may serve as intrathoracic lymph nodes or residual tubercular changes, in which the process is reactivated. Very rarely, with active pulmonary tuberculosis possible breakthrough in the pleural cavity of caseous focus located in the cortical regions of the lungs, and the development of tuberculous empyema.
Mycobacterium tuberculosis present in the exudate is not constant, due to the migration of macrophages as part of the inflammatory.
Localization of pleural effusion often one-sided, in inferolateral departments chest.
Symptoms parapneumonic pleurisy
Parapneumonic effusion is a complicationnonspecific pulmonary inflammation (acute pneumonia, lung abscess, bronchiectasis, and others.). When bacterial pneumonia pleural effusion is diagnosed in approximately 40% of patients. Most often, this happens with pleurisy pneumonia streptococcus and staphylococcus etiology. For parapneumonic pleurisy is characterized by a high incidence of purulent exudates.
Symptoms of tumor pleurisy
Neoplastic pleurisy in the general structureexudative pleurisy occupy 15-20%. The most frequent cause of their occurrence are lung cancer (70% of patients), lung carcinomatosis without a specific source of metastasis, pleural mesothelioma, breast cancer, cancer of the gastrointestinal tract.
The occurrence of pleural effusion depends onthe nature of the tumor lesion. When metastatic pleural fluid accumulation due to increased vascular permeability and a decrease in pleural fluid resorption. Metastases to the lymph nodes violate lymph drainage, and sprouting of blood vessels leads to a violation of blood circulation. Education effusion also contribute to cancer and giporoteinemiya parakankroznaya pneumonia.
In metastatic lesions of the pleura of the primary tumor located outside the lung (eg, breast cancer), bilateral pleural effusion.
Symptoms pancreatogenic (fermentogennogo) pleurisy
Pankreotogenny pleurisy is observed in 20-30%patients with acute pancreatitis. Pancreatic enzymes come into the pleural cavity through the lymphatic vessels through the diaphragm and cause damage to the pleural sheets. Typically localized pleural effusion on the left pleural cavity, due to the anatomical location of the tail of the pancreas, in contact with the left diaphragm dome. In addition, the formation of internal pancreatic fistula or pancreatic pseudocyst breakthrough in the pleural cavity. The pleural exudate there is a high concentration of amylase. Pericardial effusion in rheumatoid arthritis occurs in 4-5% of patients with rheumatoid arthritis with subcutaneous rheumatoid nodules. Usually such men suffer from pleurisy. Localization of pleural effusion is often bilateral. When biopsy of the parietal pleura in most cases are signs of chronic inflammation and fibrosis. Possible detection of rheumatoid nodules and productive vasculitis. Current rheumatoid pleurisy may be recurrent with the formation of massive pleural overlays.
Symptoms of purulent pleurisy (empyema)
Empyema - all cases of pleurisy, whentest liquid detect bacteria or pus. The most common causes of pleural empyema is a complication of infectious pleurisy for bacterial pneumonia, pulmonary abscesses and subdiaphragmatic, perforation of the esophagus. About 20% of the cases of pleural empyema associated with pleural biopsies performed and the subclavian vein (with damage to the pleura). The causative agent of empyema may be Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella, E. coli, Streptococcus pneumoniae, anaerobic microorganisms.
There are 5 groups of pleural empyema:
- purulent pleurisy in the presence of inflammatory processes in the body
- purulent pleural effusion complicating spontaneous pneumothorax
- pyothorax complicating therapeutic pneumothorax in patients with pulmonary tuberculosis
- pyothorax in penetrating wounds of the chest
- pyothorax after operations on organs of the chest cavity
Pleural effusion in combination with ascites,due to non-metastatic tumors of the pelvic organs in women. The peculiarity of tumors of the pelvic organs - profuse secretion of peritoneal fluid, which is when a significant amount of ascites tumors or leaks through defects in the diaphragm stretched in the pleural cavity. Pleural effusion is located in the right pleural cavity. With the elimination of ascites in these patients disappear and pleural effusion.