Pleurisy – symptoms, causes, treatment

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Pleuritis is an inflammation of the membrane in which the lungs sit. This causes fluid to build up in the pleural cavity, making it difficult to breathe. Pleurisy most often occurs as a symptom accompanying other diseases. The cause of inflammation can be bacteria and viruses as well as tuberculosis.

What is pleurisy?

Pleurisy is a condition that occurs as a complication of tuberculosis, pneumonia, or chest surgery. During the disease, fluid accumulates in the pleural cavity, which causes breathing problems due to the expansion of the lungs and impaired mobility of the chest. The increase in volume also causes pressure and movement of adjacent tissues and organs. Under normal conditions, the pleural cavity does not contain any microbes inside it, and an increase in the amount of pleural fluid can cause bacteria to accumulate. This is because the fluid contains glucose and is an excellent breeding ground for bacteria, and the activity of the immune cells in the fluid is greatly impaired. If left untreated, the disease can cause right ventricular hypertrophy, respiratory failure and even death. The cause of pleurisy viruses, bacteria or mycobacteria tuberculosis.

What is a pleural cavity?

The pleural cavity is located between the lining of the lungs and the lining of the inner wall of the chest. It resembles a narrow groove where there is pleural fluid, which moisturizes the pleural plaques in contact with each other during breathing. The pleural cavity is closed at the top by the chest walls and by the diaphragm at the bottom.

Pleurisy – types and symptoms

Pleural inflammation may be of the following nature:

1. primary – they only affect the pleura in an isolated way (the pulmonary parenchyma remains intact),
2. secondary – the inflammatory process also attacks the pleura (e.g., very often in the case of lobar pneumonia) or, due to close contact, it begins to irritate it, triggering a reactive inflammatory process (e.g. in the case of neoplastic foci in the vicinity of the pleura, pulmonary infarction).

The inflammatory process causes thickening and congestion of the pleura and the deposition of fibrin on its surface, i.e. the protein that determines the formation of blood clots. Thus, irregularities are formed on the pleura, which rub against breathing and cause a stabbing pain in the chest. It happens that fluid accumulates in the pleural cavity, which may be associated with purulent discharge. Hence, pleurisy is divided into:

1. dry – the expression of tuberculous inflammation; the onset of the disease is sudden and is associated with severe chest pain when inhaling and shaking (coughing, sneezing, jumping);
2. exudative – fluid accumulated in the pleura may compress the lung, reduce gas exchange surfaces and cause a feeling of shortness of breath.
3. exudative purulent,
4. exudative hemorrhagic.

Other symptoms of pleurisy are:

1. chills,
2. poty,
3. high temperature,
4. a general feeling of tiredness and breakdown.

Pleural pain is relieved when the patient lies down on the affected side. If there is a large amount of fluid in the pleural cavity or adhesions develop, the patient may feel short of breath and breathing becomes faster and shallow. On the other hand, if the ailment is secondary to another inflammatory process, the symptoms of the underlying disease may also be present.

The causes of pleurisy

Pleurisy usually occurs as a complication of conditions in adjacent tissues, including:

1. pneumonia,
2. kidney failure
3. tuberculosis,
4. lung cancer
5. pulmonary embolism,
6. heart failure
7. liver failure
8. endocrine disorders,
9. digestive tract ailments,
10. pancreatic diseases.

In addition, pleurisy may result from heart, liver or kidney failure, as well as endocrinology, pancreatitis, and other gastrointestinal ailments. Broken ribs and trauma to the chest can also contribute to the onset of the disease.

Pleurisy – diagnosis

The diagnosis of pleurisy should always be made by a physician who can sometimes listen to a pleural rub. A chest X-ray is also necessary to assess the possible presence and amount of fluid and other changes in the chest. In addition, the doctor orders:

1. Ultrasound – revealing less fluid than X-ray. This test is safe and can be performed even at the patient’s bedside.
2. CT (computed tomography) – thanks to this method it is possible to accurately assess inflammatory changes, fluid system and lung parenchyma. The indication for tomography is the suspicion of a pleural empyema.

Sometimes it may be necessary to puncture the pleural cavity in order to decompress it, determine the type of fluid and collect samples for further diagnostic tests: biochemical, bacteriological or cytological. Pleural puncture involves local anesthesia of the skin and collection of pleural fluid. During this test, the following elements are assessed: color, pH, leukocytes, smell, glucose content, number of cells and LDH activity. Sometimes, additionally, Gram staining for aerobic and anaerobic bacteria is performed, as well as cytological diagnostics for fungi and tuberculosis.

Pleurisy – treatment

Treatment of pleurisy should be tailored to the type of lesions diagnosed, the degree of their severity, and comorbidities. In home proceedings, rest in a lying position, taking diaphoretic and antipyretic preparations are used. Therapy is mainly based on taking antibiotics. Most preparations have a positive effect on the pleural fluid. Do not take aminoglycosides as they lose their activity in an acidic environment. If bacteria are found in the pleural fluid, the doctor will start treatment based on the sensitivity of the bacteria to the antibiotic.

It is also a good idea to lie on your healthy side with a roller under your chest. Some patients do breathing exercises. In addition, in the event of fluid accumulated in the pleural cavity, the doctor may use puncture or drainage. If drainage and antibiotic therapy do not bring the expected benefits, surgery should be considered.