Dry pleurisy

Dry pleurisy (adhesive, fibrinous) is the pathology of the respiratory system that characterized by bands and commissures formation between pleural layers and increase of their thickness due to the inflammation.

Etiology

- infection (tuberculosis, bacterial infection, fungus, viral infection);

- dissemination of the tumor cells to pleura;

- reactive pleuritis (uremia);

- dehydrotation (profuse bleeding, vomiting, diarrhea).

Pathogenesis

- dilation of lymphatic capillaries;

- increased vessels penetration;

- pleural inflammation;

- pleural infiltration;

- fibrin accumulation on visceral and parietal pleura;

- fibrosis development;

- anatomic and functional block of resorbtion apparatus;

Clinical features

Intensity of clinical features depends on the pathologic process spreading. The main complaints in patients with dry pleurisy are: cough, pain in the chest and dyspnea.

Cough - most commonly dry and has reflectivity character.

Pain in the chest - connecting with pleura injury, occurs suddenly on the affected side, intensive and increases during deep inspiration or coughing.

Dyspnea - intensity depends on process spreading.

Objective examination. General patient's condition may be from middle grave to grave.

The posture of the patients is forced (lie on the affected side in order to relieve the pain).

The color of the skin and visible mucosa is without changes.

In inspection occur superficial, rapid breathing (via intensive pain); participation of the accessory respiratory muscles in the breathing act or even mixed type of respiration. In static inspection as usual the chest is symmetrical, on dynamic - detect poor movement of the chest expansion on one side.

In palpation the chest is painful on the damage side, elasticity is saved, vocal fremitus is equal transmitted.

In comparative percussion of the lungs may be observed dull sound over pathological region.

In topographic percussion of the lungs the normal lower borders are revealed, respiratory mobility of the lower border on the affected side is decreased.

In auscultation of the lungs over the region with decreased vesicular breathing detect pleural friction sound.

Additional methods of examination

Clinical blood analysis: leukocytosis, neutrophilia, shift of leukocyte formula to the left, accelerated ESR.

X-ray examination: - the signs of pleura injury and fibrin deposition.

Pleurisy with effusion

Pleurisy with effusion is characterized by the presence of exudate in the pleural cavity, mostly in the outer costal-diaphragmatic sinus. Parietal, supradiaphragmatic and interlobar pleurisy also occur. After abatement of inflammation, effusion (serous, serofibrinous, haemorrhagic, purulent) usually resolves but the pleura remains thickened, its membranes adhere to one another, and the pleural cavity is completely obliterated in some cases. Effusion sometimes remains between adhesions to stimulate encapsulated pleurisy.

Etiology

- infection (tuberculosis, bacterial infection, fungus, viral infection);

- dissemination of the tumor cells to pleura;

- allergic and autoimmune pleurisy;

- pleurisy in diffuse connective tissue pathology;

- posttraumatic pleurisy.