PLEURISY

PLEVRIT - inflammatory lesions of the pleura with the formation of fibrinous plaque on its surface (dry pleurisy) or accumulation of fluid (effusion) in the pleural cavity (exudative pleurisy). In most cases, pleurisy is a symptom or complication of various diseases and can occur in croupous pneumonia, pulmonary tuberculosis, rheumatism, systemic lupus erythematosus, rheumatoid arthritis, postinfarction syndrome, pleural lesions, pulmonary artery thromboembolism.

Clinical picture . The onset of the disease is usually sudden. With dry pleurisy patients complain of pain in the chest , worse with breathing, dry cough . The pain is usually localized over the hearth of pleurisy, but can irradiate to the lower part of the chest or stomach, simulating the disease of the abdominal organs. The pain decreases in the position on the affected side. Reduction of respiratory excursions of the affected half of the thorax is revealed, respiration is superficial, accelerated. At auscultation, the noise of friction of the pleura is heard during both inhalation and exhalation. Sometimes the noise of rubbing the pleura can be felt by palpation of the chest. Dry pleurisy usually precedes the accumulation of exudate in the pleural cavity. When a pleural effusion occurs, the pain usually subsides. When there is a lot of fluid, dyspnea occurs. There are lagging or absence of chest excursions on the side of defeat, smoothness or bulging of intercostal spaces, weakening of voice trembling and bronchophonia, pronounced dullness of percussion sound, sharp weakening of breathing until complete absence of its holding. There are various manifestations of intoxication (fever, tachycardia , weakness, headache , lack of appetite). In the blood - an increase in ESR, leukocytosis with a shift of the formula to the left. X-ray is characterized by a homogeneous darkening of the pulmonary field with the presence of an oblique level of fluid, a shift of the mediastinum to a healthy side.

Depending on the nature of the exudate, there are serous (serous-fibrinous), purulent, hemorrhagic and chilious pleurisy. With parapneumonic pleurisy and pulmonary tuberculosis, exudate, as a rule, serous-fibrinous; Hemorrhagic exudate is more typical for tumor lesions of the pleura, thromboembolism of the pulmonary arteries. Pleurisy can be complicated by the development of respiratory and heart failure.

The diagnosis is based on the data of objective research, radiographic picture, the presence of inflammatory fluid in the pleural cavity. It is necessary to distinguish exudate from non-inflammatory fluid (transudate), which is formed in heart failure, nephrotic syndrome, liver cirrhosis. For exudate, in contrast to the transudate, the protein content is more than 3 g / l, the relative density is more than 1020, the positive Rivalta test (turbidity of the liquid when acetic acid is added to it).

Treatment is directed primarily to the underlying disease. In bacterial pleurisy, antibacterial therapy is performed (with parapneumonic pleurisy - antibiotics depending on the presumed or established etiological variant of pneumonia, in tuberculosis - antituberculous drugs). Patients with rheumatic diseases are prescribed non-steroidal anti-inflammatory drugs, glucocorticoids. With purulent pleurisy, pleural cavities are washed with antibiotics and antiseptic solutions (dioxidin, furacilin) ​​through constant drainage, hemodiosis infusion, and plasma. Physiotherapy with exudative pleurisy includes electrophoresis of calcium chloride, UHF-therapy. To prevent pleural adhesions, respiratory gymnastics and massage are recommended. With the development of respiratory and heart failure, pleural punctures are indicated.