Pleurisy (pleurisy) is a symptom or complication of an underlying condition. Characterized by shortness of breath and pain when breathing and coughing. Sighing is virtually impossible. There may also be radiating pain in the shoulder and sometimes even in the abdomen, which can have a masking effect. Pleurisy has two forms: dry and wet or exudative (purulent) pleurisy. In addition, pleurisy is almost always a complication or symptom of pneumonia, tuberculosis or cancer.
- Negative chest pressure
- Wet and dry pleurisy
- Symptoms of pleurisy
- Dry pleurisy
- Wet pleurisy
- Causes of pleurisy
- Underlying condition
- Treatment of pleurisy
Negative chest pressure
The pulmonary membranes, or pleurae , line the chest cavity internally and the lungs externally. The pleural space between the two pleural leaves is a slit-shaped, airtight space. This makes the pressure slightly lower than the outside air (negative chest pressure). There is a little fluid between the membranes, which allows the pleural sheets to slide past each other, but cannot be separated, like two glass plates with some water between them.
Two pleural leaves
Heart and lungs / Source: Patrick J. Lynch, Wikimedia Commons (CC BY-2.5)
In order to breathe without problems, it is crucial that the pleural membranes function flawlessly. These membranes are:
- Visceral leaf ( pleura visceralis ). This pleural membrane is attached to the lung tissue.
- Parietal leaf ( pleura parietalis ). This membrane is fused with the chest wall, the diaphragm and the space between the two lungs (mediastinum).
Wet and dry pleurisy
Pleurisy is an inflammatory process in the pleura with fibrin deposits, or insoluble proteins that arise during blood clotting. It makes the membranes rough and dry. This is called dry pleurisy or pleurisy sicca . Too much fluid can also develop in the pleural space, or wet pleurisy ( exudative pleurisy ). Dry pleurisy usually progresses to wet pleurisy.
The fluid accumulation that forms between the pleural leaves is called a pleural empyema. (Lobar) pneumonia and bronchopneumonia are known to cause two serious complications: lung abscess and pleurisy. Nowadays, however, antibiotics are used quickly, so these complications usually do not occur.
Symptoms of pleurisy
Pleural inflammation is always a consequence or complication of an underlying disease, such as severe pneumonia, tuberculosis or cancer. Various symptoms may therefore occur that accompany the symptoms of pleurisy.
- In dry pleurisy, the surface of the pleural leaves is not smooth, but rough and dry. The membranes then rub against each other, which is very painful.
- Stabbing pain in the chest. It worsens with breathing and coughing, and is sometimes continuous, often accompanied by fever, chills and a dry hacking cough.
- Rapid, shallow (careful) breathing.
- Pain in the back and side. Radiating pain in the neck, shoulders and abdomen, depending on the location of the inflammation.
- Decreased mobility of the affected half of the chest (no thoracic symmetry).
- The symptoms vary greatly. The acute, stabbing pain of dry pleurisy usually disappears and is then replaced by sometimes severe breathing problems. This is because pus (pus) forms between the pleural leaves. The space between the leaves then becomes larger, which often makes the pain disappear. As soon as the amount of pus increases, there is more and more pressure on the lungs (compression). This is accompanied by shortness of breath.
- Vague pain, sometimes just an unpleasant feeling.
- Shortness of breath.
Source: Mwooten, Pixabay
When diagnosing pleurisy, rubbing of the pleural leaves can be heard with the stethoscope (pleural rubbing noise). In a later stage, breathing sounds are reduced or virtually absent. The noise also coincides with the breathing movements. However, chest pain can also be the result of a heart attack. Exudative pleurisy often results in reduced breath sounds. An X-ray is usually taken (chest X-ray); the fluid in the pleural space can then be traced. The amount of exudate can amount to up to 4 liters. The ultrasound method is also suitable as a diagnostic instrument.
Sometimes the CT scan is used to detect and determine anomalies underlying the pleurisy. During a pleural puncture, the fluid is examined (including culture and cytological and bacterial examination) for clues that lead to the diagnosis. Sometimes the doctor removes a piece of the pleura (biopsy) for further microscopic examination to reveal the deeper cause of the pleurisy.
Causes of pleurisy
Pleurisy can be a complication of many diseases, including:
- Bacterial and viral infections of the respiratory tract.
- Pancreatitis (pancreatitis).
- Pulmonary infarction (embolism).
- Metastases in the pleural cavities ( pleuritic carcinoma ).
- Systemic diseases, such as lupus erythematosus , rheumatoid arthritis .
- Cardiovascular diseases, such as congestive heart failure.
- Kidney disorders.
- Mediastinal gland disorders (obstruction of lymphatic circulation).
Source: Frolicsomepl, Pixabay
As such, pleurisy is a symptom, a complication of an underlying condition that manifests itself in pleural problems. The treatment is therefore not only symptomatic, such as pain relief, but mainly aimed at detecting and treating the disease that causes pleurisy.
Treatment of pleurisy
The treatment is of course aimed at curing the disease underlying pleurisy, such as cardiovascular disease, lung problems, kidney disease or respiratory infections. In exudative pleurisy, excess pleural fluid is removed using a puncture, which can relieve shortness of breath. Furthermore, painkillers are often given symptomatically.
In case of pleuritic carcinoma, the doctor usually also administers local cytostatics. Bacterial pleurisy can easily be treated with antibiotics. Anti-inflammatories are often prescribed for viral pleurisy. After treatment, a pleural effusion usually forms, a pleural thickening consisting of a connective tissue layer.
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