Update: December 2018
Each lung is enclosed in a double-layer bag (pleura), between
листками которой в результате различных заболеваний может
скапливаться кровь, отечная или воспалительная жидкость. it
condition in medicine is called pleurisy, which is in the form of
self-inflicted disease is extremely rare, usually this
The process is a complication of such diseases and conditions as:
- pulmonary tuberculosis
- connective tissue diseases – autoimmune (rheumatism,
systemic lupus erythematosus)
- allergic reactions (eosinophilic pleurisy)
- hemorrhage in injuries and operations on the chest
- acute bacterial pneumonia (usually pneumococcal)
- cardiovascular, renal, hepatic failure
- oncological processes, leukemias
- infectious diseases (brucellosis, syphilis)
- fungal diseases of the lungs
- dystrophy from prolonged fasting
- in acute pancreatitis, the development of enzymatic
Each of these states reduces the protective forces
organism, disrupts the normal course of metabolic processes, changes
composition of blood and lymph. In the pleura is quite developed
capillary network of lymphatic and blood vessels, which are
are the source of fibrin or fluid in its cavity.
However, the most common causes of fluid accumulation in
плевральной полости и развития pleurisy сегодня являются туберкулез
and oncology. An independent and very dangerous disease is
empyema of the pleura – purulent pleurisy. About pleurisy, symptoms and treatment
This insidious disease is our article.
Types of pleurisy
- With dry pleurisy, on the surface of the pleura and in its cavity
Fibroin strands are deposited. Такой вид pleurisy часто встречается
with tuberculosis, as its primary manifestation or accompany
pulmonary form. Can be observed with brucellosis, systemic red.
Click to enlarge
- Exudative pleurisy, characterized by accumulation in the pleural
cavity exudate – inflammatory fluid. Accompanying
non-specific inflammatory diseases of the lungs, myocardial infarction
or lung, liver amebiasis.
- Hydrothorax – effusion in the pleural cavity is not inflammatory
fluid, which is called – transudate. it осложнение
accompanies abdominal surgery on the chest, and diseases,
accompanied by severe edema.
- Hemorrhagic pleurisy is characteristic of blood diseases and
traumatic injuries of the chest (rib fractures,
penetrating wounds). The contents of the pleural cavity is
Симптомы сухого pleurisy
Pleurisy have a number of specific symptoms. In this clinic
сухого pleurisy значительно отличается от pleurisy с выпотом.
The clinical picture is complemented by symptoms of the underlying disease.
The onset of the disease is sudden, patients can accurately indicate the time
the onset of the disease. The infection process may be accompanied by
high fever. Fibrinous pleurisy is characterized by a sharp
pain syndrome on the affected side of the lung. Breath
shallow cough, all this
accompanied by severe pain that comes from touching
inflamed pleural leaves. Pain increases with
body tilts in the opposite direction, with a deep breath or
The patient tries to lie on a healthy side, which is slightly
eases his suffering. With the localization of the inflammatory process
near the diaphragm, pain may occur in the upper part
belly, in the heart, in the neck, which sets the stage for the erroneous
On examination, the diseased half of the chest lags behind in the act
breathing, it can be seen from the movement of the blades. When listening
the lung is determined by the very characteristic sound of pleural friction.
Radiography in acute dry pleurisy does not provide sufficient
information. Laboratory tests will characterize the main
Treatment сухого pleurisy
- To relieve pain syndrome prescribed painkillers
drugs analgin, ketanov (see the list of NSAIDs in the article shots from
pain), tramadol with the ineffectiveness of these funds, in conditions
the hospital may introduce narcotic painkillers
- Effective warming alcohol or camphor compresses,
mustard plasters, iodine net.
- Prescribe drugs that suppress the cough – synode, codelac,
libexin (see antitussives with dry cough).
- Since the root cause most often is tuberculosis, after
подтверждения диагноза туберкулезного pleurisy в
tuberculosis dispensary spend specific
Mode is recommended to comply with bed or half-bed.
- According to the WHO, the death rate from tuberculosis and the number of patients
tuberculosis (including tuberculous pleurisy) in Russia is higher
8 times than in European countries.
- Prisoners with tuberculosis, when leaving prison, as
usually do not go to doctors and do not get registered, infecting in a year
- Every year, 25,000 people die from tuberculosis in Russia,
120,000 people fall ill.
- The most terrible that every 10 patients are detected
multidrug resistance that is practically
an incurable form of pulmonary tuberculosis and its extrapulmonary forms (kidney,
joints, spine, genital organs, eyes).
Exudative pleurisy and hydrothorax
Симптомы экссудативного pleurisy
В отличие от фиброзного pleurisy, боль при плеврите с различными
kinds of effusion is not the leading symptom, except
chest damage, therefore signs of fluid accumulation
appear only a few days after the onset
Exudative pleurisy begins gradually, symptoms increase
slowly, a person complains of headache, fever, weakness,
feeling of heaviness in the affected side of the chest, with gradually
increasing dyspnea, which worries the patient even at rest (see
Dyspnea due to a decrease in lung volume, due to compression
their enlarged pleural cavity. The pulse is increasing, face
turns pale, nasolabial triangle takes on a bluish tint,
neck veins swell. At the site of accumulation of effusion may emit
intercostal spaces. There is a lag in the affected half.
In severe conditions caused by heart failure,
liver, kidney process can develop symmetrically, pleurisy
marked on both sides. Then bright symptoms characteristic of
pleurisy не будет, хотя общее состояние пациента ухудшится.
Самой частой причиной экссудативного pleurisy у взрослых
tuberculosis remains, and in 70% of cases it begins according to the type
lobar pneumonia, with fever 39C, pain, general weakness,
The leading criterion will be radiography, radiographic
признаки pleurisy или гидроторакса достаточно красноречивы. With
аускультации легких в отличие от сухого pleurisy пораженная сторона
chest “dumb.” Laboratory indicators will be
match the underlying disease. Only with hemorrhagic
signs of anemia (anemia) may occur in pleurisy.
Exudative pleurisy is treated in the hospital. With отечной форме
the main disease is prescribed a discharge diet that limits
liquid and salt. With гнойных pleurisyх обязательна
antibiotic therapy (broad-spectrum antibiotics),
НПВС, обезболивающие и антигистаминные препараты, которые
reduce edema and have anti-allergic effects (see
If the volume of effusion is large enough, as a result
marked violations of the respiratory and cardiovascular
functions, the pleural cavity is urgently punctured and evacuated
content. The resulting material must be investigated to clarify
his nature and main diagnosis. Perhaps the introduction of antibiotics,
prednisolone or hydrocortisone in the pleural cavity, to reduce
phenomena of exudation. For several days, install drainage
When in the postoperative period the accumulation of fluid in the chest
cell should not be considered a complication?
If an operation was performed to remove a lung or part of it,
an empty space is formed in the chest cavity, which is filled
fluid. «Withрода не терпит пустоты», это своего рода
protective compensatory response to maintain a stable pressure
in the chest cavity, which provides a normal location
Neither the heart nor the remaining lungs are shifted, it allows them
function normally. In the process of recovery of the liquid
absorbs, the part is replaced by fibrin, forming adhesions. In that
case of pleurisy is not a complication. With других операциях,
появление pleurisy считается осложнением, образовавшуюся жидкость
удаляют и проводят соответствующее treatment.
Forecast плевритов благоприятный, хотя напрямую зависит от
ведущего diseases. Inflammatory, infectious,
post-traumatic pleurisy is cured successfully and does not affect
quality of later life. Is that for later life on
radiographs will be marked pleural adhesions.
The exception is dry tuberculous pleurisy, as a result
whose fibrous deposits can over time
calcified, so-called shell pleurisy is formed.
The lung turns out to be enclosed in a “stone shell”, which interferes with its
proper functioning and leads to chronic respiratory
For the prevention of the formation of adhesions, which are formed after
removal of fluid from the pleural cavity, after treatment, when
acute period the patient should be rehabilitated
procedures are physiotherapy, manual and vibratory massage,
It is necessary to conduct daily breathing exercises (according to
Strelnikova, with the help of the Frolov breathing simulator).