Dry pleurisy is a reactive inflammation of the parietal and visceral pleura with the loss of fibrin on its surface. Symptoms of disease are characterized by chest pains that increase with breathing, dry cough, subfebrility, malaise. Diagnostic criteria are clinical and auscultative data (pleural friction noise), radiological signs, pleural ultrasound. The main treatment is aimed at eliminating the primary pathology (tuberculosis, acute pneumonia, etc.); symptomatic therapy includes the use of analgesic, anti-inflammatory, antitussive drugs.
The general term “pleurisy” in clinical pulmonology refers to a group of inflammatory lesions of the pleura of various genesis, occurring with or without the formation of pathological effusion. Pleurisy can be independent (primary) in nature, but more often develop secondarily, against the background of acute or chronic processes in the lungs. Taking into account the presence or absence of effusion and its nature, dry (fibrinous) pleurisy and exudative (serous, serous-fibrinous, hemorrhagic, purulent) pleurisy are distinguished. Pleurisy can have bacterial (nonspecific and specific), viral, tumor, traumatic etiology.
Dry pleurisy causes
Dry pleurisy has no independent significance. Most cases of fibrinous pleurisy are etiologically associated with pulmonary tuberculosis or tuberculosis of the intra-thoracic lymph nodes. Dry pleurisy of tuberculous etiology occurs with a subpleural location of foci, their breakthrough into the pleural cavity with the contamination of the latter or as a result of hematogenic introduction of pathogens. The causes of the development of pathology are also often nonspecific lung lesions: pneumonia, bronchiectasis, lung infarction, lung abscess, lung cancer.
Among the extrapulmonary processes, disease can be complicated by digestive diseases (cholecystitis, pancreatitis, subdiaphragmatic abscess), collagenoses (SLE, rheumatism, systemic vasculitis), infections (brucellosis, typhus, whooping cough, measles, flu). In some cases, dry pleurisy accompanies eating disorders (cachexia, scurvy), uremia.
The pathogenetic basis of pathology is an inflammatory reaction of the parietal and visceral pleura, occurring with hyperemia, edema, thickening of pleural leaflets. The amount of exudate is so insignificant that it is reabsorbed by the pleura with the deposition of fibrin filaments on the surface of the pleura in the form of pleural overlays that make it difficult for the leaves to slide. In the future, this can lead to the formation of massive mooring lines and restriction of lung mobility. In most cases, dry pleurisy turns into exudative, but it can resolve without the formation of pleural effusion.
Dry pleurisy symptoms
If the costal pleura is interested, dry pleurisy begins with severe pain in the corresponding half of the chest to the lesion. The pain increases at the height of inspiration, when coughing or straining, forcing the patient to lie on the sick side and thereby limit the mobility of the chest. As the activity of the inflammatory process subsides and the pleural leaves are covered with fibrinous overlays, the sensitivity of the nerve endings of the pleura decreases, which is accompanied by a decrease in pain response.
In the case of inflammation of the diaphragmatic pleura, the pain is localized in the abdominal cavity, simulating the clinic of acute cholecystitis, pancreatitis or appendicitis. With dry apical pleurisy, pain is determined in the projection of the trapezius muscle; when involved in pericardial inflammation, pleuropericarditis develops.
With fibrinous pleurisy, there is a dry cough, common symptoms of inflammation – malaise, decreased appetite, night sweats. Body temperature is usually subfebrile, but it can be normal or reach febrile values (38-39 ° C). Fever is accompanied by chills, tachycardia.
The duration of the clinical course of dry pleurisy is 1-3 weeks. Its outcome may be a complete recovery, a transition to an exudative form or a chronic course. In the latter case, disease lasts for months with periodic exacerbations.
Formal diagnosis of dry pleurisy is insufficient, it is always necessary to find out the cause of the disease. Therefore, if disease is suspected, the patient should be consulted by a pulmonologist, a phthisiologist, a rheumatologist, a gastroenterologist, an infectious disease specialist.
Auscultative signs are the weakening of breathing on the affected side, listening to localized or extensive pleural friction noise. The noise of pleural friction occurs when rough pleural leaves come into contact with each other; it can be subtle, gentle or rough, pronounced. Palpation reveals rigidity and soreness of the muscles.
During X-ray and lung x-ray, there is a restriction of the excursion of the diaphragm on the affected side, obliteration of the sinuses, high standing of the diaphragm, a change in its contour (irregularities, flattening, bulging). To exclude the presence of exudate, ultrasound of the pleural cavity is performed.
Dry pleurisy must be differentiated from intercostal neuralgia, myositis, rib fracture, angina attack, myocardial infarction (according to ECG data).
Dry pleurisy treatment
Since dry pleurisy in most cases is a secondary process, the main treatment should be aimed at eliminating the primary disease. In fibrinous pleurisy of tuberculous etiology, specific anti-tuberculosis therapy with streptomycin, tubazid, rifampicin, etc. is indicated. In the presence of nonspecific inflammation of the pulmonary and extrapulmonary localization, antibacterial, anti-inflammatory therapy is performed.
In order to alleviate the pain syndrome in the acute period of dry pleurisy, it is recommended to observe bed rest, applying a tight pressure bandage to the chest, setting warming compresses, mustard plasters, cans. Antitussive agents (codeine, ethylmorphine, etc.) are prescribed to relieve cough. Respiratory gymnastics is performed to prevent massive adhesions in the pleural cavity. In case of recurrent dry pleurisy, a pleurectomy with lung decortication may be undertaken.
Prognosis and prevention
Since dry pleurisy of unclear etiology can be caused by tuberculosis, patients are subject to dispensary observation by a phthisiologist and preventive specific treatment in an antitubercular dispensary. The prognosis for dry pleurisy depends on the root cause of the disease. In the case of the transition of dry pleurisy to an exudative or recurrent form, the ability to work may be limited for a long time.
Prevention of fibrinous pleurisy consists in the treatment of pulmonary and extrapulmonary inflammatory processes, prevention of hypothermia and colds, adequate nutrition.