Pathogenesis

- direct pleura injury (trauma, operation, tumor, infection through lymph or blood);

- contact way of process spreading;

- infection and allergic mechanism;

- inflammatory exudation to the pleural cavity;

- impaired lymph and blood circulation;

- oncotic pressure disturbance;

- impaired resorbtion;

- fluid accumulation in pleural cavity.

Clinical features

Intensity of clinical features depends on the pathologic process spreading, etiology, amount and character of exudates. The main complaints in patients with exudative pleurisy are: cough, dyspnea, pain and feeling of heaviness in the chest, supplementary - general weakness, hyperthemia, loss of appetite and perspiration.

Cough - most commonly in initial stage dry and has reflectivity character, along disease progression becomes moist.

Pain in the chest - one of the fist symptoms and connecting with pleura injury, may be different in its intensity (from moderate to acute) and increases during deep inspiration or coughing. In cause of diaphragmatic pleurisy localization the pain can irradiate to the upper abdominal region or via the n. diaphragmatic to the neck. For the period of exudates volume intensity the pain becomes duller but dyspnoea increase.

Dyspnea - has mixed character and its intensity depends on the exudates volume and speed of its accumulation, degree of affected lung ventilation via compression by fluid and mediastenum organs displacement.

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 revile the pain).

The color of the skin and visible mucosa are characterized by diffuse cyanosis. In case of mediastenum fluid localization observed edema of the face and neck, dysphagia and voice changes.

In inspection observe superficial, rapid breathing (via intensive pain); mixed type of dyspnea. In static inspection as usual the chest is asymmetrical, on dynamic - detect poor movement of the chest expansion on the affected side.

In palpation the chest is painful, rigid with badly vocal fremitus transmission on the damaged side.

In comparative percussion of the lungs detect dull sound over the pathological region.

In topographic percussion of the lungs the lower edge on the affected side is elevated, respiratory mobility is increased. In large exudates amount over the lung there are 5 clinical-diagnostic zones (for more detail information seen syndrome of fluid accumulation in pleural cavity).

In auscultation of the lungs in the initial stage on the affected side over the region with decreased vesicular breathing detect pleural friction sound. In large exudates amount according to the five clinical-diagnostic zones there are distinguished: over exudates - the zone with significant decreased vesicular breathing or full absent of breathing sounds; over consolidate pulmonary tissue - the zone with pathological bronchial breathing; over the free from fluid and healthy side - the zone with increased vesicular breathing.