Pleurisy - inflammation of the pleura to formfibrinous deposits on its surface or in its cavity effusion. Always secondary, or syndrome is a complication of many diseases, but in a certain period can be extended in the clinical picture to the fore, masking the underlying disease.
Mechanisms of disease
The emergence of the infectious nature of pleurisydue to the impact of specific pathogens (Mycobacterium tuberculosis, pale treponema) and nonspecific (pneumococci, staphylococci, E. coli, viruses, fungi, etc.) infections; pathogens penetrate the pleura by contact, lymphogenous, hematogenically, in violation of the pleural cavity. A common cause of pleurisy are systemic connective tissue disease (rheumatic fever, systemic lupus erythematosus, and others.); neoplasms; thromboembolism and thrombosis of the pulmonary arteries. The pathogenesis of most allergic pleurisy. The development blastomatous pleurisy is very important block tumor metastasis of lymph nodes, lymphatic and venous vessels, during germination tumor from adjacent organs - the destruction of serous covers.
Symptoms for defined localization,prevalence, nature of pleural inflammation, changes in the function of adjacent organs. The main forms of pleurisy: dry or fibrinous, exudative, or exudative. Exudative pleurisy, in turn, are separated by the character in the serous effusion, seroplastic, purulent, haemorrhagic, mixed. Having defined the character of effusion, you can specify the cause of pleurisy and choose pathogenetic therapy. So, the cause of dry and serous, seroplastic pleurisy more often tuberculosis, pneumonia, rheumatism, and other systemic diseases of connective tissue (rheumatoid, lupus and other pleurisy). Hemorrhagic pleurisy often develop in tumors, thromboembolism and pulmonary vascular thrombosis, hemorrhagic diathesis, flu, at least in tuberculosis, rheumatism. By localizing effusions are distinguished:
Dry or fibrinous, pleurisy. The main symptom - pain in the side, growing at a breath, cough. Pain decrease in position on the affected side. Noticeably respiratory restriction of mobility corresponding to half of the chest. Body temperature is usually low-grade, may be chills, night sweats, weakness. Difficult diagnosis of diaphragmatic pleurisy dry. They are characterized by pain in the chest, in the upper quadrant, in the lower ribs, hiccups, abdominal pain, flatulence, abdominal muscle tension, pain on swallowing. Type of breathing chest with only the upper part of the chest, and increased pain in the lower part with a deep breath. Are identified pain points:
- in the first intercostal spaces at the sternal
- in the place of attachment of the diaphragm to the ribs
- on the spinous process of the first cervical vertebrae
In recognition of diaphragmatic pleurisy helpsX-ray examination in which identifies the indirect symptoms of functional disorders of the diaphragm: its high state, restricting her mobility on the affected side. Current favorable, disease duration of 10-14 days, but relapses pleurisy dry for several weeks, followed by recovery.
Effusion, or effusion, pleural effusion. At the beginning of the pleural exudation observed pain in his side, the limitation of respiratory mobility of the affected side of the chest, pleural friction. Often there is a dry painful cough reflex nature. With the accumulation of effusion flank pain disappears, there is a sensation of gravity, increasing shortness of breath, mild cyanosis, a bulging of the affected side, smoothing the intercostal spaces. For percussion and X-ray examination can be determined by the characteristic contour of the upper boundary of the effusion. Large effusion causes a shift of the mediastinum to the healthy side, and significant violations of respiratory function due to respiratory failure mechanics decreases the depth of breathing, it becomes more frequent; functional diagnostic methods revealed decline in external respiration (vital capacity, ventilation and other reserves.). There are violations of the cardiovascular system, which are shown reduction of shock and cardiac output due to reduced blood sucking in the central veins because of ventilation disorders, heart and displacement of large vessels with large pleural effusions; development of compensatory tachycardia. Blood pressure tends to decrease.
For exudative pleurisy, especiallyinfectious nature, characterized by febrile body temperature from the start of pleural exudation, expressed symptoms of intoxication, leukocytosis, increased erythrocyte sedimentation rate. Pleural exudate has a relative density higher than 1016-1018, is rich in cellular elements, gives a positive reaction Rivalta. Tumor etiology of pleurisy exclude cytology exudate. The flow depends on the etiology of pleurisy. When an infectious-allergic pleurisy, including tuberculosis, exudate may disappear within 2-4 weeks. Possible outcome of the development of pleural adhesions, pleural cavities and imperforate interlobar slits form a massive overlay, Mooring, pleural thickening, formation of respiratory failure.