Treatment of pleural effusion and other diseases of the pleural cavity. Pleural effusion and pleural fluid analysis Small amount of fluid in the pleural space

Differential diagnosis of effusion in the pleural cavity

Pleural effusion is diagnosed annually in approximately 1 million patients. But the true frequency of pleural effusions is difficult to establish, since the pathological processes in the pleura are secondary.

Despite the secondary nature of the accumulation of fluid in the pleural cavity, the severity of the course of the underlying disease is often determined, and in some cases it requires special therapeutic measures. Differential diagnosis is based on the principle: from establishing the fact of the presence of a pleural effusion through its characteristics (transudate or exudate) to identifying the etiology of this effusion. This approach will enable early recognition of the disease and its early treatment.

Normal and pathological physiology.

Normally, there is 1-2 ml of fluid between the sheets of the parietal and visceral pleura, which allows the visceral pleura to slide along the parietal during respiratory movements. In addition, such a small amount of liquid exerts the force of adhesion of the two surfaces. Normally, there are more lymphatic vessels in the parietal pleura, and more blood vessels in the visceral pleura. The diameter of the blood capillaries in the visceral pleura is greater than the diameter of the capillaries of the parietal pleura. The movement of fluid in the parietal pleura is carried out in accordance with Starling's law of transcapillary exchange. The essence of this law lies in the fact that the movement of a fluid is carried out due to the difference in the absolute gradient of hydrostatic and oncotic pressure. In accordance with this law, the normal pleural fluid from the parietal pleura is sent to the pleural cavity, from where it is adsorbed by the visceral pleura. It is believed that 100 ml of fluid per hour is formed in the parietal pleura, while 300 ml is absorbed, so there is practically no fluid in the pleural cavity. Other ways of moving fluid: the removal of fluid from the pleural cavity can occur through the lymphatic vessels of the parietal pleura. In healthy individuals, fluid drainage through the lymphatic vessels is 20 ml / hour, that is, 500 ml per day.

Mechanisms of accumulation of fluid in the pleural cavity in pleurisy.

1. The permeability of the vessels of the parietal pleura increases, which leads to an increase in capillary hydrostatic pressure in the visceral and parietal pleura.

2. Increase in the amount of protein in the pleural cavity,

3. Decreased oncotic pressure of blood plasma.

4. Decreased intrapleural pressure (with atelectasis due to bronchogenic lung cancer, sarcoidosis).

5. Violation of the outflow of pleural fluid through the lymphatic vessels.

With carcinomatous pleurisy, a combination of several mechanisms is possible.

Diagnostic search in differential diagnosis includes the following 3 stages:

1. The first stage is the establishment of the fact of the presence of fluid in the pleural cavity.

2. Establishing the nature of the pleural effusion - transudate or exudate. If it is a transudate, then it is necessary to treat the underlying disease and then the transudate resolves. If you have established that this is exudate (pleural lesion), then you need to establish the cause of the exudate.

3. Establishing the cause of the exudate.

Examination plan for a patient with effusion in the pleural cavity:

1. Clinical examination: complaints, anamnesis, physical data.

2. X-ray examination: chest x-ray, chest tomography, bronchography, CT.

3. Thoracocentesis - pleural puncture.

4. Examination of the pleural fluid: appearance, the presence of protein, the level of lactate dehydrogenase, the level of glucose, amylase.

5. Cytological examination of pleural effusion.

6. Invasive research methods - open biopsy of the pleura, scanning of the lungs, angiography of the vessels of the lungs.

7. With encysted pleurisy, ultrasound is of great importance.

on pain in the chest (pain always indicates damage to the parietal pleura, and most often with exudative pleurisy)

dry unproductive cough. It is believed that the accumulation of fluid leads to the convergence of the bronchi, their compression and, naturally, to irritation, that is, to coughing. Dry cough may be a manifestation of the underlying disease.

Shortness of breath is the main symptom of pleural effusion. The accumulation of fluid in the pleural cavity leads to a decrease in VC and the development of respiratory failure, the main manifestation of which is shortness of breath.

Signs of damage to other organs and systems: are there any: peripheral edema, liver signs, enlarged thyroid gland, joint damage, enlarged lymph nodes, enlarged heart, enlarged spleen, ascites, etc.

Examination according to the system: reverse examination of the chest - smoothness of the costal spaces, lagging of the affected half of the cell, weakening of voice trembling, percussion sound, lack of breathing in places of shortening of percussion sound. If the amount of fluid in the pleural cavity is small, then you may not get a shortening of the percussion sound. It is necessary to change the position of the patient and once again percuss.

If there is little liquid (up to 1000 ml), then you can not see anything. You can see the accumulation of fluid in the sinuses.

If the fluid is more than 1000 ml, then a homogeneous darkening appears in the pleural cavity, with an oblique upper level. This is not always the case.

Diffuse spread of liquid

Contralateral displacement of mediastinal organs

The most difficult to diagnose is the left-sided effusion. Here you need to pay attention (especially with basal pleurisy) to the distance between the lower border of the lung and the air bladder (normally no more than 2 cm, with the accumulation of fluid, this distance increases markedly). With interlobar pleurisy or effusions, this is a biconvex shadow; in these conditions, a lateral image is required.

If air appears in the pleural cavity, then a horizontal level of fluid is formed. Diagnosis is more difficult when fluid fills the entire pleural cavity. Darkening of the entire cavity occurs: with total pneumonia, obliteration of half of the chest cavity, with atelectasis due to neoplasms. With fluid in one half of the chest, the organs are displaced contralaterally, and if it is atelectasis, then the organs are displaced towards the lesion.

With total pneumonia - there is no complete blackout, it is imperative to take pictures in dynamics.

If these examinations did not help, then it is necessary to resort to CT; with encysted pleurisy, ultrasound helps.

If the fact of the presence of fluid is established, then they proceed to the next stage - the stage of establishing the nature of the pleural fluid, for which a pleural puncture is performed.

Algorithm for the differential diagnosis of transudate and exudate:

More than 175 mmol/l

Less than 1.3 mmol/l

Odds (in doubtful cases)

The ratio of effusion protein to serum protein

The ratio of effusion LDH to serum LDH

If a transudate is established, then it is not difficult to imagine the reasons:

1. Congestive heart failure

2. Nephrotic syndrome: glomerulonephritis,

3. Cirrhosis of the liver

5. Pulmonary embolism, with the formation of infarct-pneumonia and effusion

It is necessary to treat the underlying disease.

If exudate is established, then the etiology of exudate is more diverse.

1. First place - neoplasms: metastatic lesion of the pleura, primary tumors of the pleura - mesothelioma.

2. Infectious diseases:

· Pneumococcus. In parallel with pneumonia, parapneumonic (develop along with pneumonia) and metapneumonic (after pneumonia) pleurisy can develop.

staphylococcus. It is mainly the cause of pleural empyema.

Pseudomonas aeruginosa, Escherichia coli

3. Pulmonary embolism

4. Gastrointestinal diseases: acute and chronic pancreatitis, pancreatic tumors, subdiaphragmatic abscesses, esophageal perforation

5. Systemic connective tissue diseases: SLE, rheumatoid arthritis.

6. Systemic vasculitis: periarteritis nodosa

7. Allergic diseases: postinfarction allergic syndrome, drug allergy

8. Other diseases and conditions: asbestosis, sarcoidosis, uremia, radiation therapy, chylothorax, hemothorax, electrical burns, etc.

The third stage is the establishment of the etiology of pleurisy.

Composition of normal pleural fluid:

Normal composition of pleural fluid.

Specific gravity 1015

Has no smell

total number of erythrocytes in mm 3

total leukocyte count mm 3

neutrophils up to 10%

eosinophils up to 1%

lymphocytes up to 23%

plasma cells up to 5%

protein 1.5 - 2 g per 100 ml (15-25 g / l).

LDH 1.4 - 1.7 mmol/l

glucosamg per 100 ml (2.1 - 2.2 mmol/l)

Algorithm for assessing the appearance of the pleural fluid:

If the liquid is bloody, then it is necessary to determine the hematocrit -

If the hematocrit is more than 1%, then you need to think about a tumor, trauma, pulmonary embolism.

More than 50% is an obvious hemothorax requiring immediate drainage.

Full transparency - then you need to start a biochemical study - the level of glucose and amylase:

· If the glucose level is low, the most likely cause is malignancy or tuberculosis.

If the level of amylase rises, it is more likely a pathology of the pancreas or a disease of the esophagus (cancer).

If the level of amylase and glucose is normal, then proceed to the cytological examination of the pleural fluid.

Muddy - chylothorax or pseudochylothorax - need to investigate lipids

If cholesterol crystals are detected - pseudochylothorax

If triglyceride crystals are detected - chylothorax, which is always the result of damage to the main lymphatic tract by a tumor

In squamous cell carcinoma - a positive result is rare

· A positive response is more common in lymphomas - 75%, especially in histiocytic lymphomas, in 20% - lymphogranulomatosis.

Determination of cellular composition:

The predominance of leukocytes - acute pleurisy, with pneumonia - parapneumonic pleurisy. If there is no pneumonia, then CT scan, thoracoscopy, lung scan, pleural biopsy should be performed.

The predominance of mononuclear cells is a long-term accumulation of fluid. Further search is necessarily a biopsy of the pleura (double) - in order to determine malignancy or tuberculosis. If the diagnosis is not established after a bilateral double biopsy of the pleura, then they resort to CT scan, lung scanning, with doubtful answers angiography. A lung scan may reveal an embolism.

Characterization of transudate in congestive heart failure.

Transudate is more common in congestive heart failure: patient complaints, signs of circulatory failure. X-ray: bilateral accumulation of the same volume of fluid in both cavities. With unilateral accumulation, or unequal levels, it is imperative to do a pleural puncture, because pleurisy may be the cause. A diagnosis of congestive heart failure does not rule out a diagnosis of lung cancer.

If the transudate is in the pleural cavities for a long time, then the amount of protein in it can increase to the same as with exudative effusions!

Characteristics of transudate in cirrhosis of the liver. In cirrhosis, fluid in the pleural cavity is more common with ascites. Unlike effusions in congestive heart failure, effusions can be unilateral or bilateral.

The mechanism of formation of pleural effusion in cirrhosis of the liver:

1. Decreased oncotic pressure of blood plasma.

2. The most likely is the ingress of ascitic fluid from the abdominal cavity into the chest through the lymphatic vessels or through defects in the diaphragm. With intense ascites, intra-abdominal pressure rises, the diaphragm stretches, and stretching of the diaphragm leads to the formation of microdefects through which fluid enters the chest cavity.

Diagnosis is difficult: it is necessary to perform thoracocentesis and laparocentesis at the same time. At the same time, in both liquids there will be a low protein content, a low level of LDH. The fluid in the pleural cavity with ascites may be bloody, which is associated with a violation of the production of the main coagulation factors due to liver damage.

Characteristics of the most common exudates:

Exudate in neoplasms:

Most often metastasizes peripheral lung cancer, breast cancer, lymphomas. The primary tumor is not established in 14%.

The mechanism of formation of pleural effusion in malignant neoplasms.

The direct effect of the tumor:

1. Tumor metastases to the pleura (the permeability of the pleural vessels increases and obstruction of the lymphatic vessels occurs).

2. damage to the lymph nodes of the mediastinum (decrease in lymphatic outflow from the pleura).

3. Blockage of the thoracic duct (with frequent development of chylothorax).

4. Bronchial obstruction (intrapleural pressure decreases).

5. Damage to the pericardium.

6. hypoproteinemia due to liver metastases

7. vascular embolism

The composition of the pleural fluid in malignant neoplasms:

An increase in erythrocytes by 50%, the total number exceeds 100 thousand.

eosinophilia is not characteristic

sharply reduced glucose level - below 60 mg per 100 ml of liquid

May increase amylase levels in primary pancreatic tumors.

In the diagnosis, a cytological examination of the exudate helps. In metastatic tumors, metastases are localized in the visceral pleura, and the parietal pleura is taken for biopsy.

CT scan, bronchoscopy, bronchography after a double open pleural biopsy are mandatory.

The primary lesion of the pleura is observed with mesothelimus. Mesothelioma develops more often in people who have had contact with asbestos. The period between contact and the appearance of a tumor is years. These tumors can develop in children whose parents have been exposed to asbestos.

There are benign and malignant mesothelioma. Malignant mesothelioma simultaneously affects the pleura, pericardium, liver, often there are changes in the lungs. Mostly men are ill from 40 to 70 years. The first complaint is shortness of breath, coughing fits, rarely - chest pain. The radiography is of the greatest importance: extensive (often total) effusions into the pleural cavity, 50% of the fluid is bloody, with a sharp decrease in glucose levels. The liquid is viscous, viscous, due to the high content of hyaluronic acid. The best diagnostic method is open pleural biopsy and CT. Of great importance is the cytological examination of the fluid - malignant mesothelial cells, the number of which exceeds 5-15%. The prognosis is unfavorable, patients die 7-10 months after the onset of pleural effusion. If the disease is diagnosed in the first 2 stages, then a chemotherapeutic study prolongs life and its quality.

Benign mesothelioma - the tumor consists of connective tissue, but produces effusions, often hemorrhagic. Treatment is surgical, the prognosis is favorable.

Exudate in parapneumonic pleurisy. The most common cause of parapneumonic pleurisy is anaerobic flora, less often pneumococci and gram-negative flora. With parapneumonic exudates, the course of pleurisy has 3 stages:

Stage 1 - stage of sterile liquid

Stage 2 - fibrinous-purulent

Stage 3 - the stage of organization of the effusion with the formation of pleural layers (mooring), which can completely obliterate the pleural cavity and the lung ceases to function.

Parapneumonic pleurisy requires the rational prescription of antibiotics. Otherwise, empyema develops.

Signs of transition to pleural empyema:

1. The liquid becomes cloudy with a putrid odor.

2. The specific gravity of the pleural fluid increases.

3. Under microscopy, the amount of protein and leukocytes increases.

4. When sowing the pleural fluid - the growth of bacteria.

5. The level of glucose begins to decrease, and if it is below 60 mg per 100 ml, then the process clearly turns into empyema.

6. The pH of the liquid decreases.

7. Sharply increases the level of LDH (over 1000 units).

If the cause is not established, then it is not necessary to carry out ex juvantibus therapy, but it is better to immediately perform a thoracoscopy and a biopsy of the pleura and establish a diagnosis.

Pleurisy in pancreatitis. They occur in 17-20% of cases. The accumulation of fluid is due to 3 mechanisms:

1. Transudation through the diaphragm, when inflammatory exudate from the affected pancreas penetrates the diaphragm.

2. Through the lymphatic pathways.

3. The formation of fistulas between the pancreas and the pleural cavity - the most common.

Most often pleurisy occurs in chronic pancreatitis.

The clinical picture depends on the nature of the process: in acute pancreatitis, pain in the chest, shortness of breath join, on x-rays - a small amount of fluid in the left half of the chest, which is revealed as a bulge (elevation) and inertia of the dome of the diaphragm during its movement. In chronic pancreatitis, symptoms from the chest prevail more often (pancreatopleural fistulas are more often formed), a large amount of exudate accumulates - extensive or total pleurisy. When examining the pleural fluid, an increased level of amylase is noted - over 100 thousand units, a high content of protein, LDH, an increase in the number of leukocytes up to 50 thousand per 1 mm3.

Accumulation of fluid in the pleural cavity

The appearance of effusion in the pleural region is a dependent symptomatic phenomenon. It has a variety of etiologies. Many factors can lead to the development of pathology: from functional disorders in the body to medical errors. Nevertheless, the prognosis for the course of the disorder is generally favorable, but requires surgical intervention.

Pleural fluid

The left and right lungs are simultaneously placed in two "bags", which are, as it were, threaded into each other; there is a narrow space between them. It is called the pleural cavity or pleura.

"Sacks" are scientifically called pleural sheets and are serous membranes:

• external parietal (adjacent to the inner surface of the chest);
• internal visceral (thin membrane enveloping the lung itself).

The parietal membrane has pain receptors, which explains the unpleasant symptoms that accompany pleural effusion.

Thus, between the lungs and other tissues there is a reliable barrier in the form of cavities that do not communicate with each other. They maintain a pressure below atmospheric pressure. This contributes to the flow of the respiratory act. The pleural cavity is a sealed compartment, normally filled with a small amount of fluid.

Fluid in the pleural cavity is normal. In composition, it is similar to blood and is a serous substance. Under normal conditions, its amount does not exceed 1-2 teaspoons (15-20 ml). This substance is produced by parietal cells and capillaries of nearby arteries. Periodically, it is absorbed through the lymphatic system for filtration (reabsorption occurs). Pleural fluid is actively pumped out of the pleura - this is a natural process. Due to this, it does not accumulate.

Do not confuse it with fluid in the lungs - this is a separate pathological phenomenon.

The fluid in the pleural region acts as a lubricant - a lubricant. This makes it easier for the petals of the pleura to slide freely against each other during inhalation and exhalation. Its other function is to keep the lungs in a straightened state during the movement of the chest during breathing.

An effusion is a pathologically large amount of accumulated biological fluid in a particular cavity of the body without the possibility of its natural excretion. Accordingly, pleural effusion is an increase in the volume of fluid inside the pleura.

The process of its accumulation may differ etiologically and symptomatically depending on the nature of the released substance. The following types of effusions can fill the pleural fissure:

Pleural effusion can be formed as a result of disruption of the circulatory and lymphatic systems, as well as inflammation.

The fluid between the pleural sheets can increase in volume, regardless of inflammatory processes. In this case, its accumulation is due to a failure of the natural process of its production or reabsorption.

For such cases, the term "transudate" (non-inflammatory effusion) is used and hydrothorax (edema in the pleural cavity) is diagnosed. The accumulated volume of fluid is not able to leave the pleura on its own.

Transudate has the appearance of a yellowish transparent liquid without odor.

The reasons

The presence of fluid in the pleural cavity is caused by two main physiological disorders associated with its production and evacuation:

• increased secretion;
• inhibition of the absorption process.

A pleural effusion of a transudative nature can also be formed due to the following factors:

1. Heart failure. In the small and large circles of blood circulation, hemodynamics worsens, blood stagnation occurs, and blood pressure rises. A local edematous effusion begins to form.
2. Renal failure. Oncotic pressure, which is responsible for the flow of body fluids from tissues into the blood, decreases. As a result, the walls of the capillaries pass it in the opposite direction, and edema occurs.
3. peritoneal dialysis. Increased intra-abdominal pressure. Due to this, the local tissue fluid rises and is pushed through the pores in the diaphragm into the pleural cavity, thereby increasing the volume of the pleural substance.
4. Tumors. In the case of the occurrence of neoplasms, the outflow of lymph or blood from the pleura may be impaired. An accumulating transudate is formed.

Symptoms

The syndrome of fluid accumulation in the pleural cavity combines local symptoms and clinical manifestations of the disease that caused it. The larger the effusion, the more severe the disease. Usually we are talking about bilateral pathology.

The volume of effusion can reach several liters.

Large accumulations of fluid put pressure on the organs of the chest.

This causes the lung to collapse. This can lead to the following:

• dyspnea;
• rare chest pains;
• dry recurring cough;
• additional swelling around the congestion.

Diagnostics

Fluid syndrome in the pleural cavity involves certain diagnostic procedures, the most popular of which is ultrasound. Specialists carry out a number of activities to identify effusion:

1. Percussion tapping. In the place of accumulation of fluid, a dull sound is detected, changing location with a change in the position of the patient's body.
2. X-ray examination. The picture allows you to see the area of ​​​​accumulating transudate.
3. ultrasound. Ultrasound examination reveals an increased amount of fluid.
4. Pleural puncture. The cavity is punctured, which allows you to take the effusion for differential analysis.
5. CT. Computed tomography helps eliminate the risk of tumors.

Important! In the treatment, pumping of the transudate from the pleura with the help of a puncture is indicated.

Syndrome of accumulation of pleural fluid during inflammation

The accumulation of fluid in the pleural cavity can be triggered by an inflammatory process. In this case, doctors talk about exudation (exudation in the form of exudate). The mechanism of the course of this pathology is due to an infectious lesion and includes the following changes in the body:

• the permeability of the walls of blood vessels is increased;
• overflow with blood of tissues in the area of ​​​​inflammation;
• increased oncotic pressure;
• symptoms of a primary inflammatory disease are felt.

The pleural cavity may fill with the following types of inflammatory effusion:

1. Serous. Transparent liquid. It is released during inflammation of the serous pleura. The prognosis is favorable. Sources of inflammation - burns, allergies, viruses. For example, pleurisy is accompanied by effusion of serous exudate.

Fibrous. More dense, villous exudate, with a high content of fibrin. The pleural membrane under the influence of this fluid is destroyed: scars, adhesions, ulcers appear.

May be due to tuberculosis.

Purulent. Opaque, viscous fluid in the pleural cavity of a green hue. It consists of a large number of spent protective cells of leukocytes. Caused by the ingestion of pathogens such as fungi, streptococci, staphylococci.

Hemorrhagic. Occurs as a result of the destruction of the blood tract. It is a reddish liquid due to saturation with red blood cells. Occurs in tuberculous pleurisy.

Treatment focuses on antibacterial drug therapy and is aimed at destroying the infectious agent. To remove the exudate resort to surgery.

Fluid in the pleural cavity after surgery

In case of injury or unsuccessful surgery, an effusion in the form of accumulation of blood (hemothorax) can form between the pleural membranes of the lungs.

Most often, heavy internal bleeding can lead to this - a seal is formed, which has a squeezing effect on both the lung itself and the chest.

As a result, gas exchange and hemodynamics are disturbed, which leads to pulmonary insufficiency. Symptoms are determined by the amount of fluid in the pleural cavity.

In this case, the patient experiences signs of blood loss:

During the examination, doctors detect a dull sound in the chest area when tapped. Auscultation diagnoses a malfunction of the organ and the absence of respiratory noises. For a more accurate diagnosis, ultrasound and x-rays are used.

Important! Therapy of hemothorax involves the introduction of drainage into the pleura and pumping out the effusion, followed by suturing.

A chylothorax can also be a consequence of a complication after surgery. The effusion in this case is formed due to the accumulation of lymph. Unsuccessful surgical intervention often leads to damage to the parietal pleura and the lymphatic duct passing through it. Thus, the pathology with the presence of fluid in the pleural cavity is due to reasons associated with surgical intervention:

• neck surgery;
• tumor removal;
• operations on the aorta;
• surgery for aneurysm;
• surgical treatment of the lung;
• diagnostic puncture.

If the lymphatic channel is damaged, the fluid will initially accumulate in the tissue of the mediastinum. After gaining a critical mass, it breaks through the pleural lobe and pours into the cavity. Compaction of chylothorax before moving it to the pleura can take a long period of time - up to several years.

Symptoms of the disease are similar to the signs of the above pathologies and represent compression of the respiratory system, vein clamping, lung failure. To this are added signs of exhaustion, since the loss of lymph is the loss of substances useful for the body: proteins, fats, carbohydrates and trace elements.

Diagnostic measures are the same as for hemothorax (percussion, auscultation, ultrasound, X-ray), with the use of lymphography and the addition of a contrast agent. This procedure allows you to clarify the level of damage to the lymphatic duct.

Treatment of chylothorax is carried out by puncture, drainage, or through the occlusion of the lymphatic channel surgically.

• nervousness, sleep disturbance and appetite.
• frequent colds, problems with the bronchi and lungs.
• headache.
• bad breath, plaque on the teeth and tongue.
• change in body weight.
• diarrhea, constipation and stomach pain.
• exacerbation of chronic diseases.

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Diseases, consultations, diagnostics and treatment

Causes, symptoms and treatment of pleural effusion and pleurisy

The lungs are surrounded on all sides by dense connective tissue - the pleura, which protects the respiratory organs, ensures their movement and expansion during inhalation and exhalation. This peculiar bag consists of two sheets - the outer (parietal) and the inner (visceral). Between them there is a small amount of constantly renewing sterile fluid, thanks to which the pleura sheets slide relative to each other.

In some diseases of the lungs and other organs, the volume of fluid in the pleural cavity increases. A pleural effusion develops. If the cause of its appearance is inflammation of the pleura, such an effusion is called pleurisy. The accumulation of fluid in the pleural cavity is quite common. This is not an independent disease, but only a complication of some pathological process. Therefore, pleural effusion and its special case - pleurisy require careful diagnosis.

Forms of pleurisy

In a condition such as pleurisy, the symptoms are determined by the amount of fluid in the pleural cavity. If it is more than normal, they talk about the exudative (effusion) form of the disease. It usually occurs at the onset of the disease. Gradually, the liquid resolves, on the surface of the pleura sheets, overlays are formed from a protein involved in blood clotting - fibrin. There is fibrinous, or dry pleurisy. With inflammation, the effusion may initially be small.

The composition of the liquid may be different. It is determined by pleural puncture. On this basis, the effusion can be:

• serous (clear liquid);
• serous-fibrinous (with an admixture of fibrinogen and fibrin);
• purulent (contains inflammatory cells - leukocytes);
• putrefactive (caused by anaerobic microflora, decayed tissues are determined in it);
• hemorrhagic (with an admixture of blood);
• chylous (contains fat, is associated with the pathology of the lymphatic vessels).

The fluid can move freely in the pleural cavity or be limited by adhesions (adhesions) between the sheets. In the latter case, they speak of encysted pleurisy.

Depending on the location of the pathological focus, there are:

• apical (apical) pleurisy,
• located on the costal surface of the lungs (costal);
• diaphragmatic;
• in the region of the mediastinum - the area between the two lungs (paramediastinal);
• mixed forms.

The effusion may be unilateral or involve both lungs.

The reasons

In a condition such as pleurisy, the symptoms are nonspecific, that is, they depend little on the cause of the disease. However, the etiology largely determines the tactics of treatment, so it is important to determine it in time.

What can cause pleurisy or pleural effusion:

• The main cause of fluid accumulation is pulmonary tuberculosis or lymph nodes located in the chest cavity.
• In second place is pneumonia (pneumonia) and its complications (lung abscess, pleural empyema).
• Other chest infections caused by bacteria, fungi, viruses, mycoplasma, rickettsia, legionella, or chlamydia.
• Malignant tumors affecting the pleura itself or other organs: metastases of neoplasms of different localization, pleural mesothelioma, lung cancer, leukemia, Kaposi's sarcoma, lymphoma.
• Diseases of the digestive organs, accompanied by severe inflammation: pancreatitis, pancreatic abscess, subphrenic or intrahepatic abscess.
• Many connective tissue diseases: systemic lupus erythematosus, rheumatoid arthritis, Sjögren's syndrome, Wegener's granulomatosis.
• Damage to the pleura caused by the use of drugs: amiodarone (cordarone), metronidazole (trichopolum), bromocriptine, methotrexate, minoxidil, nitrofurantoin and others.
• Dressler's syndrome is an allergic inflammation of the pericardium, which can be accompanied by pleurisy and occurs during a heart attack, after heart surgery, or as a result of a chest injury.
• Severe renal failure.

Clinical manifestations

If the patient has a pleural effusion or pleurisy, the symptoms of the disease are due to compression of the lung tissue and irritation of the sensitive nerve endings (receptors) located in the pleura.

The main complaint is chest pain. It has the following characteristics:

• occurs suddenly;
• aggravated by coughing and deep inspiration;
• often limits movement (the patient cannot lie on his back due to pain);
• sharp, stabbing;
• may weaken in the supine position on the sore side;
• often accompanied by a strong dry cough.

With the accumulation of fluid between the layers of the pleura, they diverge, and the pain subsides. However, compression of the lung tissue increases, which leads to the appearance and intensification of shortness of breath.

With exudative pleurisy, fever is usually noted, with dry body temperature rises to 37.5 - 38 degrees. If the effusion is non-inflammatory, body temperature does not rise.

For dry pleurisy, an acute onset is more characteristic. Effusion is accompanied by a gradual accumulation of fluid and a slower development of symptoms.

Other complaints are associated with the underlying disease that caused the accumulation of fluid in the pleural cavity.

When examining a patient, a doctor can detect such physical data:

• forced posture lying on a sore side or leaning in this direction;
• backlog of half of the chest during breathing;
• frequent shallow breathing;
• soreness of the muscles of the shoulder girdle can be determined;
• pleural friction noise with dry pleurisy;
• dullness of percussion sound with effusion pleurisy
• weakening of breathing during auscultation (listening) on ​​the side of the lesion.

Possible complications of pleurisy:

• adhesions and limitation of lung mobility;
• respiratory failure;
• empyema of the pleura (purulent inflammation of the pleural cavity, requiring intensive treatment in a surgical hospital).

Diagnostics

In addition to a clinical examination, the doctor prescribes additional research methods - laboratory and instrumental.

Changes in the general blood test are associated with the underlying disease. The inflammatory nature of pleurisy can cause an increase in ESR and the number of neutrophils.

The basis for the diagnosis of pleurisy is pleural puncture and examination of the resulting effusion. Some features of the fluid that allow you to determine one or another type of pathology:

• protein more than 30 g / l - inflammatory effusion (exudate);
• the ratio of pleural fluid protein / plasma protein more than 0.5 - exudate;
• the ratio of LDH (lactate dehydrogenase) of pleural fluid / LDH of plasma more than 0.6 - exudate;
• positive Rivalta test (qualitative reaction to protein) - exudate;
• erythrocytes - a tumor, a lung infarction or injury is possible;
• amylase - thyroid diseases, esophageal injury are possible, sometimes this is a sign of a tumor;
• pH below 7.3 - tuberculosis or tumor; less than 7.2 with pneumonia - pleural empyema is likely.

In doubtful cases, if it is impossible to make a diagnosis by other methods, an operation is used - opening the chest (thoracotomy) and taking material directly from the affected area of ​​the pleura (open biopsy).

X-ray for pleurisy

• radiography of the lungs in direct and lateral projections;
• the best option is computed tomography, which allows you to see a detailed image of the lungs and pleura, diagnose the disease at an early stage, suggest a malignant nature of the lesion, and control pleural puncture;
• ultrasound helps to accurately determine the volume of accumulated fluid and determine the best point for puncture;
• thoracoscopy - examination of the pleural cavity using a video endoscope through a small puncture in the chest wall, which allows you to examine the pleura and take a biopsy from the affected area.

The patient is assigned an ECG to rule out myocardial infarction. The study of the function of external respiration is carried out to clarify the severity of respiratory disorders. With a large effusion, VC and FVC decrease, FEV1 remains normal (restrictive type of disorders).

Treatment

Treatment of pleurisy primarily depends on its cause. So, with tuberculous etiology, it is necessary to prescribe antimicrobial agents; with a tumor, appropriate chemotherapy or radiation, and so on.

If the patient has dry pleurisy, symptoms can be relieved by bandaging the chest with an elastic bandage. A small pillow can be applied to the affected side to press the irritated pleura and immobilize them. To avoid tissue compression, it is necessary to bandage the chest twice a day.

Fluid in the pleural cavity, especially with a large amount of it, is removed using a pleural puncture. After taking a sample for analysis, the remaining liquid is gradually removed using a vacuum plastic bag with a valve and a syringe. The evacuation of the effusion must be carried out slowly so as not to cause a sharp decrease in pressure.

With the inflammatory nature of pleurisy, antibiotics are prescribed. Since the result of a pleural puncture, which allows determining the sensitivity of the pathogen to antimicrobial agents, is ready only after a few days, therapy is started empirically, that is, based on statistical data and medical research on the most likely sensitivity.

The main groups of antibiotics:

• protected penicillins (amoxiclav);
• cephalosporins II - III generations (ceftriaxone);
• respiratory fluoroquinolones (levofloxacin, moxifloxacin).

In renal, heart failure, or cirrhosis, diuretics (uregit or furosemide) are used to reduce effusion, often in combination with potassium-sparing diuretics (spironolactone).

Anti-inflammatory drugs (NSAIDs or short courses of glucocorticoids) and centrally acting cough medicines (Libeksin) are prescribed.

With dry pleurisy at the onset of the disease, alcohol compresses can be used on the affected area, as well as electrophoresis with calcium chloride. Physiotherapy for exudative pleurisy can be prescribed for liquid resorption - paraffin baths, electrophoresis with calcium chloride, magnetic field treatment. Then a chest massage is given.

A fragment of a popular program dedicated to pleurisy.

Syndrome of accumulation of fluid in the pleural cavity develops as a result of damage to the pleural sheets or in connection with general disorders of water and electrolyte metabolism in the body.

Up to 5-6 liters of fluid can accumulate in the pleural cavity. A volume of less than 100 ml is not clinically detected, but can be detected in some cases during an ultrasound examination. A volume of more than 100 ml is detected on a chest x-ray, preferably in a lateral view. The volume of liquid more than 500 ml is determined during the physical examination of the patient.

First, the fluid accumulates above the diaphragm, and then fills the costophrenic sinus, and up to 1500 ml of fluid can be held above the diaphragm.

A large accumulation of fluid in the pleural cavity disrupts the functions of respiration and circulation. Respiratory failure develops due to limited lung mobility and the formation of compression atelectasis in the area of ​​​​the greatest accumulation of fluid. Cardiac disorders are caused by compression of the mediastinum, its displacement to the healthy side, as well as disorders of the pulmonary circulation.

The fluid in the pleural cavity can be exudate, transudate, blood, and lymph. Exudate is an inflammatory fluid. It is formed during inflammatory processes in the pleura (pleurisy). In the vast majority of cases, pleurisy is not an independent disease. They can be a complication of diseases of the lungs, mediastinum, diaphragm, subphrenic space, systemic and oncological diseases.

Exudates are serous and serous-purulent (with pneumonia and pulmonary tuberculosis), putrefactive (with lung gangrene), hemorrhagic (with malignant neoplasms, pulmonary infarction), chylous (with difficulty in lymphatic drainage through the thoracic lymphatic duct due to its compression by a tumor or enlarged lymph nodes).

The exudate is always opalescent, and on standing it forms a clot. Its relative density is above 1015, the protein content exceeds 30 g/l, often reaching 50 g/l, the Rivalta test is positive, i.e. a special protein contained in the exudate is determined - seromucin. The exudate is rich in cellular elements, primarily leukocytes.

transudate- this is an effusion of non-inflammatory origin, which accumulates in the pleural cavity due to general disorders of water and electrolyte metabolism in the body, for example, with circulatory failure. The transudate is based on pathological processes leading to an excess of hydrostatic pressure in the capillaries over the colloid osmotic pressure of the plasma. As a result, a relatively protein-poor fluid leaks through the unchanged capillary wall and accumulates in the pleural cavity.

The color of the transudate is from light yellow to light greenish. Sometimes it is hemorrhagic. The transudate is transparent, does not coagulate when standing, has an alkaline reaction. The protein content in it is less than 30 g/l, the relative density is below 1015, the Rivalta test is negative, the sediment is poor in cells, among which desquamated mesothelium predominates. The accumulation of transudate in the pleural cavities is called hydrothorax.

Hydrothorax can be caused by heart failure of various origins (decompensated heart defects, pericarditis, damage to the heart muscle), diseases with severe hypoproteinemia (nephrotic syndrome, cirrhosis of the liver, alimentary dystrophy), mediastinal tumors that compress the superior vena cava.

The accumulation of blood in the pleural cavity is called hemothorax, and lymph is called chylothorax. Hemothorax can occur when the lungs are damaged (penetrating wounds, closed chest trauma, transpleural operations), tuberculosis, neoplasms of the lungs, pleura, mediastinum. Already in the first hours, a patient with hemothorax develops hempleuritis (aseptic inflammation of the pleura). The clinical picture depends on the severity of bleeding, compression and damage to the lung and mediastinal displacement.

Chylothorax is caused by mechanical damage to the thoracic duct, lymphosarcoma, tuberculosis, metastases of a cancerous tumor with a massive blockade of the lymphatic system and mediastinal veins. The main signs of chylous effusion include milky color, the formation of a creamy layer on standing, high fat content. The addition of ether and caustic alkali to the chylous effusion causes the liquid to become clear, and microscopy of the sediment reveals drops of neutral fat, well stained with sudan or osmic acid.

Main patients' complaints with the presence of free fluid in the pleural cavity - this is shortness of breath, heaviness and a feeling of "liquid transfusion" in the chest on the side of the lesion. Some patients may have chest pain and cough.

The severity of shortness of breath depends on the volume of fluid in the pleural cavity, the speed of its accumulation, the degree of reduction in the area of ​​the respiratory surface of the lungs and the displacement of the mediastinal organs under the influence of fluid.

If the visceral and parietal layers of the pleura affected by the pathological process are in contact, then patients experience pains of varying intensity (from moderate to acute) in the chest, which are aggravated by breathing and coughing. With diaphragmatic localization of the lesion of the pleura, pain spreads to the upper half of the abdomen or along the phrenic nerve to the neck.

Limitation of chest excursion on the side of the lesion reduces the intensity of pleural pain. Patients themselves often find the right position (they lie on that half of the chest where there is a pleural lesion), press and fix the painful area of ​​the chest with their hands, a tight bandage, etc. As the fluid accumulates, pushing the pleural sheets, the pain decreases, but shortness of breath increases.

When examining a patient attention is drawn to his forced position with a raised upper body. Often the patient lies on the side of the accumulation of fluid

With a massive accumulation of fluid in the pleural cavity as a result of developed respiratory failure, cyanosis of the skin and visible mucous membranes appears. In the case of the mediastinal location of the fluid and its entrapment, dysphagia (violation of the act of swallowing and passing food through the esophagus), swelling of the face, neck, and hoarseness of voice can be observed. Possible swelling of the neck veins.

Respiratory excursions on the affected side are limited. In lean patients with poorly developed muscles, smoothness and even bulging of the intercostal spaces are noticeable. The intercostal spaces are widened. With significant effusions, the affected half of the chest increases in volume. The skin in the lower part of the chest becomes edematous, and the skin fold, lifted with two fingers, appears to be more massive than on the opposite side (Wintrich's symptom).

Depending on the composition of the fluid (exudate or transudate), physical and some clinical signs have their own characteristics. So, with a significant accumulation of exudate in the pleural cavity with the help of palpation (the phenomenon of voice trembling), percussion, auscultation and X-ray examination, three zones can be identified.

The first zone is the area where the bulk of the exudate is located, bounded from below by the diaphragm, and from above by the arched Damuazo-Sokolov line rising to the axillary region. Exudate with exudative pleurisy accumulates more freely in the lateral sections of the pleural cavity, in the region of the costophrenic sinus.

The second zone is bounded from the outside by the Damuazo-Sokolov line, from above by a horizontal line connecting the highest point of the Damuazo-Sokolov line (the highest point of the fluid location) with the spine, and from the inside by the spine. The area formed by these lines has a triangular shape and is called the Garland triangle. In this zone there is a section of a compressed lung.

The third zone is located above the Garland triangle and the Damuazo-Sokolov line and includes the part of the lung that is not covered and not compressed by the liquid.

As the fluid accumulates, the lung collapses and the mediastinum shifts to the healthy side. With a massive effusion on the healthy side along the spine, a dullness of percussion sound of a triangular shape (Grokko-Rauhfus triangle) appears, caused by a displacement of the mediastinum and part of the pleural sinus, overflowing with fluid. The triangle is limited to the spine, the continuation of the Damuazo-Sokolov line to the healthy side and the lower border of the lung.

In the first zone voice trembling is significantly weakened up to complete disappearance, which is associated with the absorption of sound vibrations by a thick layer of fluid in the pleural cavity. When percussion over this zone, an absolutely dull sound is noted. The lower border of the lungs is shifted upward. The mobility of the lower pulmonary edge is reduced.

During auscultation above the diaphragm, where the liquid layer is especially massive, breathing is either not heard, or weakened, as if coming from afar, bronchial breathing is noted. Bronchophony over the first zone is weakened or not carried out.

In the second zone(Garland's triangle) with percussion, dull tympanitis is heard, which is due to the air contained in the bronchi. Voice trembling, as well as bronchophony, is increased in this zone due to compaction of the lung compressed by fluid. Auscultation also reveals breathing with a bronchial tone, and often pathological bronchial breathing.

In the third zone(above the lungs, not covered by a layer of liquid), an unchanged voice trembling and percussion-clear lung sound is determined. If vicarious emphysema develops in this part of the lung, then a boxed shade of percussion sound is noted.

In this zone, increased vesicular breathing can be heard, and with the development of hypoventilation and pleural damage, moist small and medium bubbling rales, as well as pleural friction noise. The noise of pleural friction is heard on exhalation and on inspiration, is intermittent and resembles the creaking of snow underfoot.

If the fluid in the pleural cavity is a transudate, then percussion of the lungs usually reveals its almost horizontal location and the absence of the Garland triangle zone. In this regard, with hydrothorax above the lungs on the side of the lesion, only two zones are determined - the transudate zone and the lung zone above the liquid level.

Hydrothorax is more often bilateral, with a large accumulation of fluid on the side of habitual lying. Percussion of the chest reveals a change in sound depending on the position of the patient's body and the free movement of fluid in the pleural cavity.

In the case of a left-sided location of the fluid, a dull sound appears in the region of the Traube space, which is limited to the right by the left lobe of the liver, from above by the apex of the heart and the lower edge of the left lung, to the left by the spleen, and from below by the edge of the costal arch. Normally, in healthy people, a tympanic sound is heard in this area, due to the gas bubble of the stomach.

On the healthy half of the chest, the percussion sound may have a boxy tone due to vicarious emphysema, and during auscultation, increased vesicular breathing is heard there.

The boundaries of dullness of the heart and mediastinum are shifted to the healthy side. On the affected side, cardiac dullness merges with dullness due to pleural effusion. When the fluid is absorbed, the heart returns to its normal position. Auscultation is determined by tachycardia, muffled heart sounds.

On x-ray examination an intense uniform darkening is detected, which is adjacent to the outer edge of the chest and diaphragm and has a clear upper border corresponding to the Damuazo-Sokolov line.

Along with the main symptoms of hydrothorax, patients have signs of the main pathological process that led to it - circulatory failure (shortness of breath, cyanosis, swelling in the legs, enlarged liver, ascites), kidney disease, mediastinal tumors that compress the superior vena cava In doubtful cases, the issue is decided by the study of pleural liquids.

If the accumulation of fluid in the pleural cavity is not encysted, then when the position of the patient's body changes, the darkening changes its shape due to the movement of the fluid. The border of the shadow of the encysted effusion becomes sharper, convex upward, sometimes uneven. The fluid can be encysted in different parts of the pleural cavity, including in the interlobar fissure. In this case, the shadow is usually homogeneous, has even and convex contours.

The presence of fluid in the pleural cavity is an indication for diagnostic pleural puncture, which allows you to confirm the presence of fluid and determine its nature. Immediately after the pleural puncture, it is necessary to perform a second X-ray examination of the lungs, which can be decisive in determining the diagnosis. The pleura is punctured in 8-9 intercostal spaces in the middle of the distance between the scapular and posterior axillary lines. The skin in the puncture zone is treated with alcohol and iodine. The needle is passed to the pleura along the upper edge of the underlying rib to avoid damage to the neurovascular bundle, which is located in the groove running along the lower edge of the rib. The puncture of the parietal pleura is felt as a failure into the void.

Pleurisy - inflammation of the pleura (that this is an inflammatory process, says the ending in -itis). The pleura is a thin membrane covering the organs in the chest. Its first leaf (inner) covers the lungs, the second leaf (outer) covers the inner surface of the chest and the diaphragm from above. In addition, the pleura passes between the lobes of the lungs: the right lung has three lobes, the left has two (The left lung has fewer lobes, because the heart occupies part of the space on the left side.) cavity. This cavity is divided into two - left and right. They are isolated, that is, they do not communicate with each other.

The pleura itself is smooth and slippery, its cells produce fluid to lubricate the chest from the inside. Lubrication is needed so that the lungs, expanding or contracting during breathing, freely slide along the inner surface of the chest, and one sheet of pleura does not rub strongly against the other. There should be little such lubricating fluid, so excess fluid is sucked back. But this happens only in a healthy body.

In the case of any lesion of the pleura, two types of situations can arise. In the first case, due to the inflammatory process or irritation, some parts of the pleura swell and thicken. Due to uneven edema, and also due to the deposition of fibrin threads (a special protein) in these places, which is deposited from the “lubrication”, the pleura becomes rough (loses smoothness). Such pleurisy is called dry.

In the second case, the pleura begins to secrete more fluid than usual, which does not have time to be absorbed and accumulates in the left or right pleural cavity, and sometimes in both at once. And there can be a lot of liquid. (In my practice, for example, there were examples when up to 4 liters of fluid accumulated in one of the pleural cavities.) Such pleurisy is called exudative (inflammatory fluid that accumulates in any body cavity is called exudate). Sometimes the disease can begin with dry pleurisy, and then go into exudative.

Causes of the disease

♦ The most common cause of pleurisy, especially exudative, is tuberculosis - or primary tuberculosis of the pleura, or tuberculosis of another localization.

♦ Pleurisy can occur as a complication of pneumonia if it is severe or if the focus of pneumonia is located close to the pleura (then the infection simply goes to the pleura).

♦ The cause of the accumulation of fluid in the pleural cavity, more often in old age, may be tumors. This is no longer microbial inflammation, but the reaction of the pleura to the ingestion of tumor cells.

Less common causes of pleurisy are related to the disease of other organs located nearby.

♦ Possible pleurisy in severe heart disease: fluid accumulates in the pleura due to heart failure.

♦ There are pleurisy in collagenoses - connective tissue diseases (connective tissue is also part of the pleura). Collagenosis includes rheumatism, rheumatoid arthritis and some other diseases.

♦ Dry pleurisy (rarely exudative) may result from chest trauma such as broken ribs. Sometimes, with injuries, blood accumulates in the pleural cavity.

There are even rarer causes - for example, inflammation of the pancreas. But there the mechanisms of this phenomenon are completely different.

Symptoms of the disease

Dry pleurisy is characterized by pain and dry cough.

Unlike the lungs, the pleura has a huge number of nerve endings. Therefore, when the rough sheets of the pleura begin to rub against each other during breathing, this causes severe pain at the site of pleurisy and coughing. The pain clearly increases with deep breathing and coughing and decreases if you lie on your sore side (in this position, the lower lung is less displaced). The cough in this case is dry, since there is nothing to cough up, the pleural cavity is closed (it does not open outward, as, for example, the alveoli of the lungs through the bronchi, so the fibrin threads cannot be coughed up - evacuated from the pleural cavity). By itself, a small dry pleurisy of the general condition does not particularly disturb and does not cause a rise in temperature: the focus is too small.

If pleurisy accompanies pneumonia, then symptoms of pneumonia are also observed, including fever, weakness, chills, sweating, etc. With pleurisy with pneumonia, the cough will be wet (sputum will come from inflamed lungs).

With exudative pleurisy, the pleura sheets are separated by a layer of fluid, so there is no friction between them and irritation of the nerve endings. So, there will be no pain, no severe cough. But the person feels bad about it. The fluid in the pleural cavity from the outside squeezes the right or left lung (depending on the side where it is located), preventing it from expanding when breathing. There is a lack of oxygen - shortness of breath, weakness appear. Moreover, the severity of shortness of breath depends on the amount of fluid.

Diagnostics

Dry pleurisy is not visible on the radiograph. But an attentive doctor, listening to the patient, can hear the characteristic sound of breathing - the noise of friction of the pleura.

Exudative pleurisy is visible on x-ray examination. And when the doctor listens to the lungs during breathing, in the area where the fluid has accumulated, breathing is not heard at all or it is weakened, because the lung is depressed.

True, there is one "but". If pleurisy began a long time ago, then fibrin is deposited from the exudate on the walls of the pleural cavity and dense adhesions are formed. Through this dense tissue, breathing is perfectly conducted from other areas, so it is audible when listening. So with long-standing pleurisy, the doctor sometimes cannot determine by ear that there is fluid in the pleural cavity. Therefore, an X-ray examination is necessary. And it is desirable to tap, which is now done only by pulmonologists.

Treatment

Dry pleurisy, as a rule, does not need special treatment. The main disease is treated outpatiently. The doctor only has to establish that the pain is associated with pleurisy. To relieve pain, it is recommended to take painkillers and antihistamines. They also take antitussives - not expectorants, since coughing with pleurisy is unproductive, it only increases pain.

With exudative pleurisy, the patient is sent to a hospital - as a rule, to a specialized pulmonology department. They conduct an additional examination to determine the cause of pleurisy. If it is pneumonia complicated by pleurisy, or microbial exudative pleurisy without pneumonia, they are treated on the spot. If tuberculosis is transferred to a tuberculosis department. If the oncological process - in the oncological. If the accumulation of fluid in the pleural cavity is caused by cardiac pathology (this is often immediately clear), the patient is treated in the cardiology department. With collagenization - in rheumatological.

To clarify the diagnosis and straighten the compressed lung, a pleural puncture is done: fluid is pumped out and taken for analysis, which helps determine the cause of pleurisy. The liquid itself will not sufficiently resolve (an exception is cardiac pathology). Sometimes, with a large amount of liquid, it is pumped out but in one. and for 2-3 doses. The removal of fluid is also necessary so that massive adhesions do not form in the pleural cavity. The puncture procedure for the patient is unpleasant, like any prick with a thick needle, but tolerable. Moreover, it is done with anesthesia.

If the inflammatory process has not yet been completed, after pumping out the fluid, it can accumulate again. This can be established already 3-4 days after the last puncture when listening, percussion and X-ray examination.

Pleurisy does not heal on its own. I can only give general recommendations on nutrition: with this disease, you can not eat anything salty and drink a lot of fluids. Everything that has diuretic properties is useful - parsley, dill, celery.

Pleural effusion in heart failure

Left ventricular failure is the most common cause of pleural effusion. Fluid enters the pleural cavity from the interstitial tissue of the lungs. and its quantity is so great that the lymphatic vessels do not have time to absorb it.

Tumor pleurisy

Pathological processes in the pleura and pleural cavity, including pleurisy, are usually secondary, most often they are complications of lung diseases, chest injuries, diseases of the mediastinum and abdominal cavity. At the same time, the symptoms of pleural effusion are often leading in the clinical picture of the disease.

The history of the doctrine of pleurisy is centuries old. In the XVIII century. some clinicians tried to isolate pleurisy into an independent nosological form. For decades, the etiology, pathogenesis of pleurisy and the most appropriate methods of their treatment have been studied.

An effusion in the pleural cavity should not be considered an independent disease, since it is only a peculiar manifestation of various common diseases: tumors, pneumonia, allergic conditions, tuberculosis, syphilis, heart failure, etc. (Table 1).

The accumulation of fluid in the pleural cavity, due to heart failure and pneumonia, occurs 2 times more often than in malignant tumors.

The mechanism of formation of pleural effusion in malignant neoplasms:

direct influence of the tumor

1. Metastases in the pleura (increased permeability of pleural capillaries)

2. Metastases in the pleura (obstruction of the lymph nodes)

3. Damage to the lymph nodes of the mediastinum (reduction of lymphatic outflow from the pleura).

4. Obstruction of the thoracic duct (chylothorax).

5. Bronchial obturation (decrease in intrapleural pressure).

6. Tumor pericarditis.

Indirect effect of the tumor

1. Hypoproteinemia.

2. Tumor pneumonia.

3. Embolism of the vessels of the lungs.

4. Condition after radiation therapy.

Pleural effusion may be transudate or exudate. The cause of transudate formation is usually congestive heart failure, mainly in patients with left ventricular failure and pericarditis. With the accumulation of transudate (hydrothorax), the pleura are not involved in the primary pathological process.

hydrothorax observed in cases where systemic or pulmonary capillary or oncotic plasma pressure changes (left ventricular failure, cirrhosis of the liver).

Pleurisy(accumulation of exudate in the pleural cavity) is most often formed in patients with malignant neoplasms. The most common cause of exudative pleurisy is metastasis to the pleura and lymph nodes of the media. Pleural effusion in tumors has a complex origin: fluid accumulation is due to an increase in capillary permeability due to inflammation or rupture of the endothelium, as well as deterioration of lymphatic drainage due to obstruction of the lymphatic tract by the tumor and tumor invasion into the pleura. The accumulation of effusion in cancer patients can contribute to malnutrition and a decrease in serum protein.

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Tumor (metastatic) pleurisy is a common complication of lung cancer . breast, ovaries . and also when lymphomas and leukemias . So, with lung cancer, it occurs in 24-50% of patients, breast - up to 48%, with lymphomas - up to 26%, and ovarian cancer - up to 10%. In other malignant tumors, tumor pleurisy is detected in 1-6% of patients (cancer of the stomach, colon, pancreas, sarcomas, melanomas, etc.). The most common cause of exudative pleurisy is metastasis to the pleura and mediastinal lymph nodes. Pleurisy, as a rule, indicates a far advanced tumor process and is a consequence of tumor eruptions along the pleura.

Diagnostics

Cytological examination of the pleural fluid on tumor cells (the content of erythrocytes is more than 1 million/mm3) is an important diagnostic method. Obtaining hemorrhagic exudate during pleural puncture with a high degree of probability indicates a tumor etiology of the effusion. The frequency of detection of tumor cells in this case reaches 80-90%. Based on a cytological examination of the pleural fluid, it is often possible to determine the morphological type of the primary tumor.

Table 1. The frequency of effusions of various etiologies (R. Light, 1986)

The space between the lung and the chest contains the pleural cavity. pleural fluid for lubrication of the pleura sheets - parietal (parietal) and visceral (pulmonary). The parietal pleura covers the chest, mediastinum, diaphragm and ribs, the visceral pleura covers the lungs and enters deep gaps between its lobes. The right and left pleural cavities are separated from each other by the mediastinum.

Pleura It is built from a single layer of cells - mesothelium, which produce pleural fluid and constantly filter lymph.

Norm

The volume of pleural fluid is normally 0.13 ml/kg of body weight, which is 10 ml for a person weighing 70 kg. It is clear (with a slight yellowish tint), sterile (no bacteria or viruses), and contains very few cells. The level of glucose is the same as in the blood, a minimum of protein and almost zero concentrations of enzymes, fats, lactic acid.

Pleural effusion

Pleural effusion- this is a pathological accumulation of fluid in the pleural cavity, a symptom of diseases of the lungs, pleura, heart and other organs. Pleural effusion appears when there is an imbalance between the formation of pleural fluid and its reabsorption into the blood.

The appearance of pleural effusion is a symptom of the disease and requires urgent diagnosis and treatment.(not always).

1.5 million cases of pleural effusion are diagnosed annually in the United States, or 320 cases per 100,000 population per year in developed countries, mostly in older people.

The main causes of pleural effusion

• congestive heart failure
• tuberculosis and pneumonia
• tumors
• pulmonary embolism

Pathogenesis

The mechanism of occurrence of pleural effusion in each individual disease is different.

• increased permeability of the pleura - inflammation, neoplasms, embolism
• decrease in oncotic pressure of proteins in the blood - nephrotic syndrome and cirrhosis of the liver
• increased capillary permeability or massive vascular rupture - trauma, tumors, inflammation, infections, pulmonary infarction, drug allergy, uremia, pancreatitis
• increased hydrostatic pressure - heart failure, superior vena cava syndrome
• reduced pressure in the pleural cavity and the inability of the lung to fully expand on inspiration - atelectasis and lung fibrosis
• insufficient drainage of lymph or complete blockade of the lymph nodes - trauma, tumors
• increase in the volume of peritoneal fluid in the abdominal cavity and its penetration through the diaphragm - cirrhosis of the liver, peritoneal dialysis
• movement of fluid into the pleural cavity with pulmonary edema

With pleural effusion, the dome of the diaphragm becomes flat, the distance between the sheets of the pleura increases, the lung is compressed and the heart, esophagus, trachea, and vessels are displaced, which is manifested by respiratory failure and shortness of breath.

And here there is a need for a pleural puncture - removal of part of the pleural effusion.

Indications for pleural puncture

Indication for pleural puncture- unexplained accumulation of fluid in the pleural cavity, which is accompanied by shortness of breath, chest pain, cough, sometimes with fever and.

During a pleural puncture, several tubes are filled with pleural fluid and sent to the laboratory for analysis.

What are they researching?

• physical properties - quantity, color, smell, acidity
• biochemical parameters -, and others
• smear microscopy
• testing for infections

Pleural fluid analysis carried out to diagnose the causes of accumulation of fluid in the pleural cavity. The procedure for taking fluid for research - pleural puncture or thoracentesis.

Pleural fluid is normal

• Appearance - clear transparent
• pH 7.60-7.64
• total protein up to 2% (1-2 g/dl)
• up to 1000 in mm 3
• glucose - equal to the level in the blood
• LDH - below 50% blood levels

There are two main types of pathological pleural fluid - transudate and exudate.

transudate

Transudate in the pleural cavity- the result of an imbalance between the pressure inside the vessel and outside it.

The reasons

• congestive heart failure - the left ventricle is not pumping enough blood out of the lungs
• cirrhosis of the liver with a decrease in total protein and albumin, which normally retain fluid inside the vessel
• atelectasis - collapse of the lung when air is blocked by the bronchus in case of tumors or blockage of the pulmonary artery
• nephrotic syndrome - blood proteins are lost in the urine
• peritoneal dialysis - a method of purifying the blood when the kidneys are not working
• myxedema - severe deficiency
• adhesive pericarditis - adhesion of the sheets of the lining of the heart (pericardium)
• leakage of cerebrospinal fluid into the pleura - with ventriculopleural shunting, trauma, or after operations on the spinal cord
• duropleural fistula is a rare complication of spinal cord surgery
• displacement of the central venous catheter

Transudate properties

The transudate is transparent, the levels of total protein, albumin and LDH are reduced, the concentration of glucose is the same as in the blood, the total number of cells is normal or slightly increased.

Pleural fluid with transudate properties involves only 6 tests - assessment of external properties, total protein, albumin, glucose, LDH and microscopy.

Exudate

damage and inflammation pleura leads to the appearance of exudate.

The reasons

• pneumonia - inflammation of the lung
• malignant neoplasms - lung cancer, pleural cancer (mesothelioma), metastases of other tumors (breast cancer, lymphoma, leukemia, less often - ovarian cancer, stomach cancer), sarcomas, melanoma
• pulmonary embolism - blockage of the pulmonary artery by a blood clot
• connective tissue diseases - rheumatoid arthritis, systemic lupus erythematosus
• pancreatitis - inflammation of the pancreas
• chest trauma
• esophageal perforation - direct communication between the esophagus and the pleural cavity, for example, with injuries of the esophagus, tumors, burns
• fungal infection
• rupture of a lung abscess into the pleural cavity
• after heart bypass surgery
• pericardial disease
• Meigs syndrome - a combination of ascites and pleural effusion in a benign ovarian tumor
• ovarian hyperstimulation syndrome during in vitro fertilization
• asbestosis - lung damage due to repeated contact with asbestos
• severe chronic renal failure
• fistula - connection of the pleural cavity with the ventricles of the brain, with the biliary tract, with the stomach
• sarcoidosis
• autoimmune diseases - rheumatoid arthritis and systemic lupus erythematosus
• tumors - lymphomas, leukemias, lung cancer, lung metastases, pleural cancer
• after heart surgery, lung and heart transplantation
• abscess in the abdomen (liver abscess)

Exudate properties

The exudate is yellow and even yellow-greenish, turbid. Total protein, albumin, LDH are significantly increased, the total number of cells also exceeds the norm, and glucose is reduced.

Additional exudate tests

• , and ( , )
• Gram stain - to detect bacteria and fungi
• tank. culture for Mycobacterium tuberculosis
• bakposev and antibiogram - will determine the type of bacteria in the pleural fluid and their sensitivity to various antibiotics to select the most targeted drug
• fungal culture – fungal culture media and antifungal susceptibility testing
• adenosine deaminase - for the diagnosis of tuberculosis
• less often - tests for viruses

Analysis of pleural fluid in diseases

• red pleural fluid tumor, pulmonary infarction, trauma, asbestosis, pleural endometriosis
• white or milky color suggests chylothorax, usually due to trauma (eg, car accident, after surgery) or impaired lymph drainage (lymphoma, metastases)
• black pleural fluid - infection with the fungus aspergilus ( Aspergillus niger)
• green - fistula between the pleural cavity and the biliary tract or gallbladder
• dark red-brown color - amoebiasis or rupture of an amoebic liver cyst
• very viscous effusion characteristic of pleural mesothelioma or empyema
• putrefactive smell pleural fluid occurs with empyema caused by anaerobic microbes, a breakthrough of a lung abscess into the pleural cavity
• low pH(less than 7.3) pleural fluid - always means exudate, especially empyema, tumor, rheumatoid pleurisy, systemic lupus erythematosus, tuberculosis, esophageal injury
• pH below 7.1-7.2 indicates the need for immediate drainage of pleurisy, and pH above 7.3 indicates pleurisy can be treated with antibiotics
• pH less than 6.0 - damage to the esophagus
• very high levels of LDH in the pleural fluid(more than 1000 IU / l) occurs with empyema, rheumatoid pleurisy, paragonimiasis, malignant tumor, pneumocystic pneumonia (with AIDS)
• glucose 1.6 - 2.7 mmol / l- tumor, tuberculous pleurisy, rupture of the esophagus, pleurisy with systemic lupus erythematosus
• glucose in the pleural fluid below 1.6 mmol / l - rheumatoid pleurisy or empyema
• lactic acid formed when bacteria consume glucose in the pleural effusion and increased in infections
• amylase pancreatitis, pancreatic pseudocyst, esophageal injury, peptic ulcer, small bowel necrosis (eg, mesenteric vascular thrombosis)

The pleura is the main component of the human lungs.. In fact, it is a smooth and thin shell that is completely covered with elastic fibers.

In the absence of health problems, the pleural tissues naturally produce a minimum amount of fluid, which is approximately 2 ml. This volume is quite enough for free breathing, for full compression and unclenching of the chest.

If a person becomes ill, if he develops pleurisy, the amount of fluid released increases significantly, and it begins to accumulate in the pleural cavities. A serious illness develops.

Causes and symptoms of pleurisy

Doctors consider pleurisy as a secondary inflammatory process, which is formed as a complication after more severe pathologies.

Often these are viral or bacterial infections that develop in the respiratory system. These include tuberculosis and pneumonia.

Diseases such as pancreatitis and rheumatism are often accompanied by the development of pleurisy. Less commonly, pathology develops after a chest injury and after a surgical operation.

It is worth being attentive to your health, carefully treating diseases of the respiratory system, in order to wonder how pleurisy of the lungs proceeds, what it is, how to treat pathology.

The development of pleurisy is evidenced by such unpleasant symptoms as:

• dry exhausting cough;
• pain when breathing, for example, when taking a deep breath and if the person lies on their side;
• shallow breathing, which is gentle and rapid;
• the sick side takes less part in breathing;
• long-term subfebrile temperature;
• malaise, weakness, sweating, fatigue;
• painful hiccups and sharp pain during swallowing.

If you have these symptoms, you should immediately contact a specialist who, after the examination, will establish an accurate diagnosis and decide how to treat pleurisy at home.

In all forms of pleurisy, drugs are prescribed, as well as traditional medicine methods and certain physiological measures.

Pleurisy. What to do if it hurts to breathe

Basic rules of treatment

Patients with pleurisy in the acute period are prescribed bed rest and nursing care so that rehabilitation is faster.

To reduce pain, the doctor prescribes procedures such as mustard plasters, banks and various compresses, accompanied by tight bandaging.

As for drugs, tablets and injections of the following categories are mandatory:

1. Cough and pain relievers.
2. Anti-inflammatory drugs.
3. Desensitizers.

Along with modern medicines, therapy with folk remedies is mandatory.

After the acute pain goes away and the temperature decreases, the patient is prescribed various physiotherapeutic procedures - massage, rubbing and breathing exercises.

Regardless of the chosen form of therapeutic therapy, hygiene is of particular importance, since it is not completely known whether pleurisy of the lungs is contagious to others, and a complete fortified diet.

Another important point is the fact that all forms of treatment should be developed and administered by experienced doctors. The patient is required to strictly follow the instructions.

As for folk methods and treatment at home, here you can rely on what is at hand and on the absence of individual intolerance.

Means of internal use

A fairly quick positive result can be achieved with the simultaneous treatment of pleurisy with modern medicine and home remedies.

Here are the simplest and most effective of them:

• fresh onion juice must be mixed with regular honey in a one to one ratio. The mixture is taken in a tablespoon a couple of times a day after lunch and after dinner. This is a unique anti-infective agent;
• honey in a ratio of one to one can be mixed with freshly squeezed radish juice. The composition is taken on a spoon three times a day;
• cherry pulp and juice it is necessary to take a quarter cup three times a day and preferably after meals;
• after the removal of acute symptoms of the disease, you can independently prepare medicinal pills. To prepare it, you need to take butter and honey in equal volumes, you can add a little nettle and almond seeds to them. All this is mixed and small balls are made from the resulting composition. After cooling the dragees, they need to be absorbed one at a time three times a day.

Traditional medicine is not conceivable without herbal treatment. For the treatment of pleurisy, you can use special fees and herbal infusions. Among the most popular and effective are:

1. Two parts of anise, licorice root, marshmallow, sage and pine buds are taken. A spoonful of the resulting mixture is brewed in a glass of boiling water, tightly closed and infused for 5 hours. After straining, the infusion is drunk on a spoon about 4-5 times a day.
2. You can take part of the roots of elecampane, peppermint, licorice and cudweed, as well as 2 parts of the leaves of coltsfoot. Based on these herbs, it is necessary to prepare a solution - a spoonful of the mixture in a glass of boiling water. An infusion of half a glass of herbal decoction is taken three times a day.
3. For effective treatment of exudative pleurisy, you will need to take a glass of fresh aloe juice, a glass of homemade linden honey, a glass of vegetable oil, 150 grams of birch buds, 50 grams of linden flowers. Preparing a medicinal mixture is quite simple - birch buds and linden are poured with a couple of glasses of boiling water, boiled in a water bath for 15 minutes and then everything is infused for half an hour. After straining, aloe juice and honey are added to the composition. After a short heating, quite a bit of vegetable oil can be added to the resulting mixture. this is a very effective composition that should be taken 1-2 tablespoons three times a day, depending on how long the temperature lasts. Eating here doesn't really matter.
4. A tablespoon of horsetail is poured with half a liter of boiling water and infused for three hours. You need to take the remedy in half a glass 4 times a day.

If you use these traditional medicine systematically, if you follow the doctor's recommendations, you can quickly restore the body in the elderly and children, completely get rid of a disease such as pleurisy.

As soon as the acute form of the pathology goes away, it is worth introducing procedures associated with external manipulations along with internal treatments.

Compresses and rubbing

High-quality treatment of pleurisy in adults consists in taking medications, herbal infusions, and also in the use of compresses and various rubbing. At home, you can easily prepare products for compresses and rubbing.

Here are some of the most famous recipes:

1. 300 grams badger fat, the same amount of crushed aloe leaves is mixed with a glass of honey. The resulting mixture should be then in a slightly heated oven for 15 minutes. Only then is the product ready for use. This tool can rub the chest and back. The advantage of this remedy is that it can be taken orally - three times a day before meals.
2. For effective grinding, you can use 30 grams of camphor oil, three grams of lavender and eucalyptus oils. It turns out a fairly liquid composition that can be rubbed into the chest a couple of times a day.
3. For therapeutic rubbing, you can use plain olive oil. The product must be preheated to the desired temperature using a water bath. The oil is rubbed into the chest area, and on top of the diseased area is covered with a mustard compress.
4. For lung diseases clean coniferous air helps well. If it is not possible to go to the forest every day, you can use high-quality fir essential oils and oils. this product can not only be inhaled, but also rubbed into the lung area.
5. An effective composition of carefully mixed 30 grams of camphor oil, lavender in the amount of 2.5 grams and lavender oil in the same volume. This mixture is rubbed into the sore side two to four times a day, and at night you can make a compress from the oils.
6. At the very beginning of the development of the disease, if there is no temperature, you can make a compress from plain hot water, preferably sea.
7. Worth it for pain relief apply a bandage with dry mustard to the sore spot.
8. It is very efficient compress cake with calendula oil. To prepare it, you need to take 6 tablespoons of flour, 2 tablespoons of mustard, calendula flowers, linden honey and 4 tablespoons of vodka. To prepare a compress, you will need to take 2 tablespoons of calendula oil, add powder from the mixed substances listed above. All this is thoroughly mixed and heated in a water bath for 5 minutes. The mixture should be in the form of a more or less steep dough, which is placed on gauze and applied to the chest, and covered with a warm scarf or scarf on top. Such a compress should be kept for about half an hour, and the process itself should be repeated every day for a month.
9. For rubbing, table salt in the amount of 50 grams, the same amount of mustard seeds and about 30 ml of purified kerosene are well suited. Everything is thoroughly mixed and rubbed into painful areas.
10. Mustard powder in an amount of 30 grams is mixed with 2.5 glasses of water and a teaspoon of honey. Everything is mixed and a terry towel is wetted in the resulting solution. The fabric is then wrung out and applied to the chest. To enhance the effect, you need to lay a woolen scarf on top. Such a compress lasts 20 minutes, and after the procedure it is recommended to lie down under a warm blanket for half an hour.

These are quite effective and effective methods of treating pleurisy. Rather, their effectiveness far exceeds drug treatment and is a unique and effective addition to the main treatment.

The most important thing in this form of treatment is the correct preparation of mixtures and formulations, regularity and lack of temperature at the time of the procedure.

Massage and breathing exercises

In the period of complete recovery, it is worth applying certain physiotherapy procedures. This includes a set of exercise therapy exercises for pleurisy, massage. Breathing exercises for pleurisy are no less effective.

The benefits of such events include:

1. Rapid resorption of infiltrates and removal of accumulated fluid in the pleura.
2. Activation of blood and lymphatic supply of the lungs.
3. Stimulation of chest mobility.
4. Prevention of the formation of adhesions.
5. Strengthening and activation of the body's defenses.

The massage procedure should be entrusted only to an experienced specialist who is perfectly familiar with the characteristics of the disease and the sequence of the treatment process.

Independently at home, you can only carry out a light massage, using a regular cream. The procedure will not improve blood flow and lymph flow in the lungs, but it is guaranteed to prevent stagnant processes that often cause pneumonia.

The sequence of massage actions in this case is as follows:

• kneading paravertebral areas;
• rubbing the latissimus dorsi;
• stroking and kneading supra- and subclavian areas;
• massage of the diaphragm and chest area.

At the end of the massage procedure, it is worth doing simple breathing exercises. The general course of treatment with massage lasts 12-15 times for 20 minutes. You can do it every day or every other day.

Balloon inflation can be used as an effective breathing exercise.. At first, the process is difficult, the patient may experience pain, but little by little the event will be easier and easier, recovery will accelerate significantly.

Disease prevention

If therapy is carried out in a timely manner, the answer to the question of how much pleurisy is treated and whether it can be cured will disappear by itself, everything will pass in a few days. If the disease is advanced, it will take more than one month.

At the same time, tablets cannot be taken for a long time, therefore, treatment with folk remedies at home will be the best result.

To prevent the disease, to protect against an unpleasant, time-consuming treatment, it is worth carefully observing certain precautionary and preventive measures.

It is very important to carry out the measures presented to your attention in order to prevent the development of the pathology itself or in a timely manner to cure diseases that can cause their formation.

The best prevention of pleurisy is the most timely diagnosis of the disease and the prevention of diseases that can cause its development.

To achieve these goals, it is very important to follow simple recommendations. First of all, it is required to strengthen the immune system by all possible methods, then you don’t have to worry about questions about what is dangerous for pleurisy and how to treat it.

This therapy includes exercise, taking multivitamin complexes and proper nutrition. It is very important to carefully train the respiratory system by performing simple breathing exercises.

If you combine them simultaneously with morning exercises, you can be sure to avoid problems with the respiratory system.

It is equally important to avoid the complications of seasonal, seemingly simple colds and various forms of SARS.. Even with the slightest hint of pneumonia, it is necessary to conduct an X-ray examination, to begin a full-fledged therapy from a whole range of recreational activities.

It is very important to completely give up nicotine, since smoking often provokes such a dangerous disease as tuberculosis.

Strengthening the immune system and close attention to your health will help you to protect yourself from inflammatory diseases and pleurisy, including.

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Inflammation of the pleura, the smooth serous membrane surrounding the lungs, is called pleurisy. The cause of pleurisy can be a chest injury, infection, tumor process, allergic reactions. Most often, pleurisy is a complication of pneumonia, infectious diseases, such as pneumonia. Unfortunately, pleurisy pesters people not only in the cold season, but also in summer, due to drafts, hypothermia during bathing, etc.

What are pleurisy

Pleurisy is divided into dry, exudative (exudative) and purulent. With dry pleurisy, the pleura thickens, it becomes uneven. With effusion - fluid accumulates in the pleural cavity, which compresses the lungs. With purulent - the fluid in the pleura contains pus. With pleurisy during breathing, pain occurs due to the friction of the rough sheets of the pleura against each other. There may also be shortness of breath, fever, cough, weakness, breathing is frequent and shallow.
With dry pleurisy, pain may disappear with the accumulation of fluid in the pleural cavity, which separates the sheets of the lungs from each other. The patient usually lies on the affected side, as this reduces the friction of the pleural sheets against each other, and the pain subsides. Only after X-ray examination, analysis of pleural fluid, etc. disease can be established. Pleurisy causes the formation of adhesions, which compresses the lungs and leads to respiratory failure and, consequently, to a deterioration in the quality of human life. Pleurisy and effusion in the pleural cavity are usually a complication of some other disease, most often very serious, therefore, when the first symptoms appear, it is necessary to diagnose its cause and further treatment.

General wellness techniques: compresses, juices, herbs

The specific cause of pleurisy determines the nature of the treatment, which may include antimicrobial and anti-inflammatory agents. Getting rid of pleurisy I recommend starting with the simplest: a compress on a sore spot from a sponge dipped in hot water. In this case, salt or sea water is especially effective. Traditional in the treatment of all types of pleurisy, including dry, at the initial stage is the use of various juices and special compresses with rubbing and bandaging.
The very first remedy is onion juice. It is mixed with honey equally. And take 1 tbsp. l. the resulting mixture 3 times a day. This agent exhibits antimicrobial activity. Instead of onion juice, you can take the juice of black radish .. Take in the same way a quarter cup of pulp and cherry juice.
The following treatment method helps with pleurisy. Take 200 g of chopped horseradish root and juice squeezed from four lemons. Use 0.5 tsp. in the morning on an empty stomach and at night when you go to bed. Such a medicine will not corrode the gallbladder, kidneys, mucous membrane of the digestive tract. But after taking the medicine, the mucus will begin to dissolve.
Take herbs at the same time. Infusion of cudweed grass, mint leaves, coltsfoot, licorice roots and elecampane take 0.3 cups 3 times a day. For the treatment of pleurisy, infusions are also prepared from sage leaves, anise fruits, marshmallow roots, pine buds, horsetail grass, highlander. Dragees are also made from butter, honey, almonds and nettles (4:4:1:1), cooling the resulting mixture in the refrigerator.

At the first symptoms of the disease, compresses are effective not only with warm salt or sea water, but also with various oils. So, they help in the treatment of rubbing camphor oil with added lavender oil (10: 1) into the sore side. After this procedure, a warm compress is placed and a tight bandage is applied. You can rub warm olive oil. A bandage with mustard also has a warming and distracting effect, in addition, it will relieve pain.

Exudative pleurisy

Patients diagnosed with "exudative pleurisy", as a rule, are subject to hospitalization to establish the diagnosis of the underlying disease and appropriate treatment. Just as with dry pleurisy, the main attention should be paid to the pathogenetic therapy of the process complicated by pleurisy (pneumonia, tuberculosis, collagenosis, etc.). Depending on the general condition of patients, bed or semi-bed rest is prescribed, as well as a diet rich enough in vitamins and proteins with restriction of fluid, salts and carbohydrates.
Treatment also begins with home remedies. It is necessary to take 100 g of May honey, melt the internal pork fat, aloe leaves (not younger than five years old), chop and remove the thorns. Add sugar and cocoa to these ingredients. Transfer the composition to a bowl of clay and heat in a water bath, over low heat, stirring constantly with a wooden spoon. You should get a homogeneous mass. After the mass has cooled, take it 1 tbsp. l. three times a day for 2 months. Then you need to take a break and repeat the course of treatment again. You need to be treated in this way three times during the year. The composition is stored in the refrigerator.
In my practice, in the treatment of exudative pleurisy, a recipe based on aloe juice has proven itself well. Take 0.5 cups of aloe juice, linden honey, vegetable oil, 75 g of birch buds, 1 cup of heart-shaped linden flowers. Birch buds and lime blossom pour 2 cups of boiled water, heat in a water bath for 20 minutes, leave for 2 hours. Add honey and aloe juice to the resulting infusion. Heat in a water bath for 10 minutes, cool and add vegetable oil. Take 2 tbsp. l. 3 times a day before meals.
Then they move on to a combination of juices and herbs. Mix 1 glass of linden honey, aloe leaf juice, infusion on birch buds and linden flowers, heat for 5 minutes in a water bath, after cooling add 1 glass of oil, preferably olive oil. The tool is taken in 2 tbsp. l. before meals 3 times a day.

The reception is alternated (every other day) with such a combination of juices and herbs: aloe (juice), warty birch (buds), small-leaved linden (flowers), linden honey, olive oil, boiled water.
Preparation: birch buds (150 g) and lime blossom (50 g) are poured with 2 cups of boiled water, heated in a water bath for 15 minutes, insisted for 30 minutes, filtered. Honey (1 glass) and aloe juice (1 glass) are added to the resulting infusion, everything is heated in a water bath for 5 minutes, cooled, poured into two bottles, equally adding Provencal oil (1 glass) to each. Stored in the refrigerator. Take 2 tbsp. l. 3 times a day before meals. The mixture is shaken before use.
If the disease is accompanied by darkening in the lungs, bronchitis, take 1 tbsp. l. honey, internal pork fat and chicken egg yolk. Mix all ingredients and combine with a glass of milk. It must be boiled. Drink everything at once. This treatment is performed at bedtime and in the morning before leaving the house.
I also advise you to alternate the intake with a more concentrated badger fat. To do this, take 250 g of badger fat and aloe leaf juice (they need to be crushed and cleaned of thorns). Mix the two ingredients and add 1 cup of honey. Put the composition in the oven for 20 minutes, then strain and discard the raw materials. The composition is used for 1.5 tbsp. l. three times a day half an hour before meals.
It helps a lot with such complications of pleurisy tincture of onion in wine. Take 0.5 kg of onion, peel and chop it, pour 0.75 l of dry white grape wine, mix the composition with 150 g of light honey. Insist for 8 days, shaking occasionally. Then strain and consume daily 2 tbsp. l. 4 times a day before meals.
At the same time, I also advise you to additionally make a compress on your back using cottage cheese. Put cottage cheese for 3 hours three times a day. After finishing the procedures with a compress, you must take a bath. After the bath, drink a third of a glass of such a drink. Take 1 cup of elecampane roots, also pine needles or eucalyptus leaves, tricolor violet grass, pre-chopped, tie gauze into a knot and tie something heavy to it. Put in a jar with a volume of 3 liters, cover with 1 glass of sugar, put 1 tsp. sour cream and fill to the top of the jar with water. Tie the jar with gauze, which must first be folded in a couple of layers. Leave the composition to infuse for 14 days in a warm place where there is no access to sunlight. Then strain the infusion and take it warm. The composition itself must be stored in a cool place.

Possible Complications

Pleurisy can lead to irreversible respiratory diseases. But the most dangerous are complications in acute purulent pleurisy, that is, acute purulent inflammation of the pleura. In the vast majority of cases, it is a secondary disease, a complication of purulent lesions of various organs. Treatment of purulent pleurisy includes antibiotic therapy and punctures, during which the pus is pumped out and broad-spectrum antibiotics are injected into the pleural cavity with a preliminary determination of the sensitivity of the flora. The task is to prevent the development of infection by removing pus and creating favorable conditions for tissue repair.
In case of a purulent disease, it is necessary to take 2 parts of anise fruits, marshmallow root, licorice root, 1 part of pine buds and sage leaf. 1 st. l. brew the mixture in 1 cup boiling water, close tightly and leave for 5 hours, strain and take 2 tbsp. l. 4 times a day.
The complex composition of herbs is also quite suitable. Take 2 parts of coltsfoot leaves, 1 part of elecampane root, peppermint leaves, licorice root, cudweed grass. Infusion: 1 tbsp. l. mix pour 1 cup boiling water, leave for 5 hours and take 0.5 cup 3 times a day before meals.
If the disease is accompanied by a dry cough, I recommend preparing a herbal collection: coltsfoot (leaves) - 2 parts, naked licorice (root), marsh cudweed (grass), high elecampane (root), peppermint (leaves) - 1 part each . Insist night. Take 0.5 cup 3 times a day before meals. During the recovery period, I recommend taking general strengthening agents in combination with breathing exercises. These are such means as Aralia Manchurian and Eleutherococcus. Aralia Manchurian (tincture) is taken 40 drops 3 times a day 30 minutes before meals. Eleutherococcus (extract) - 20 drops 3 times a day, also 30 minutes before meals.

Pleurisy as a result of severe diseases

The most difficult to treat, of course, is pleurisy of tuberculous etiology. With such pleurisy, I recommend herbal collection: licorice naked (root), elecampane high (root), cudweed swamp (grass) - 1 part each, horsetail (grass), calendula officinalis (flowers), warty birch (buds) - 2 parts each . Infusion take 0.5 cup 3 times a day before meals.
It is advisable to combine fruits and roots. For example, take two equal shares of anise fruits, marshmallow roots and licorice. All ingredients are mixed. Take 1 tbsp. l. mixture and pour into a container. A little boiling water is poured into it and insisted for about five hours. After that, strain through gauze and use 1 spoon 4-5 times a day.
A good remedy for the treatment of pleurisy with tuberculous etiology is a tincture of potato flowers. Collect potato flowers during flowering, dry in a dark, well-ventilated place. Next 1 tbsp. l. crushed flowers pour 0.5 liters of boiling water, then insist in a thermos for 3 hours. Strain and squeeze the juice from the flowers. Store in glass containers. Take the infusion 3 times a day 30 minutes before meals, approximately 150 ml each. The course of admission is 2 weeks, then 1 week break and again 2 weeks of admission, and so on for 6 months.
By the way, to relieve pain with pleurisy, I recommend applying a bandage with mustard to the sore spot.
Now for something very important! With pleurisy, which sometimes, unfortunately, complicates lung cancer, I recommend plantain leaves along with seeds for treatment. They contain mucus, bitterness, carotene, vitamin C, vitamin K, a lot of potassium, resins, proteins, oleic and citric acids, saponins, sterols, aukubin glycoside, invertin enzymes and tannins, emulsions, alkaloids, essential oil, chlorophyll, phytoncides , flavonoids, a lot of carbohydrate mannitol, sorbitol. Seeds contain up to 44% mucus, up to 20% fatty oil, carbohydrate, oleic acid, saponins, steroids. They prevent both the primary occurrence of cancer (prevention) and metastasis (mainly for carcinomas). They are a powerful means of restoring immunity, impaired both during the course of the disease and as a result of chemotherapy. Protecting the alveolar epithelium with its healing mucus, they prevent the destruction of the surfactant, restore the function of the ciliated epithelium of the bronchi, thin the viscous sputum and contribute to its rapid expulsion. Stop pulmonary bleeding and increase hemoglobin levels. They kill pathogenic flora in the respiratory tract, are effective even against Pseudomonas aeruginosa.
1 st. l. fresh or dry plantain leaves pour 1 cup boiling water, leave for 2 hours, strain. Take 2 tbsp. l. 4 times a day 20 minutes before meals. Or a mixture of crushed fresh leaves with an equal amount of honey or sugar, leave for 4 hours in a sealed container in a warm place. Take 1 tbsp. l. 4 times a day with clean water, 20 minutes before meals.
I also advise in this case to take a course of recovery with celandine, licorice and cocklebur. In case of lung tumors, celandine (a close relative of the yellow poppy family) is used as a cough suppressant. You can also count on the immunomodulatory effect of the plant as part of the collection. The plant is poisonous, overdose is unacceptable! Infusion of celandine: 1 tbsp. l. dry grass pour 0.5 liters of boiling water, insist 2 hours. Take 2 tbsp. l. 4 times a day.
Licorice naked. Licorice root increases the secretion of the epithelium of the respiratory tract, improves the active properties of the lungs and stimulates the function of the cilia of the epithelium. In addition, licorice thins phlegm, making it easier to expectorate. It is important that licorice has antimicrobial and antiviral effects. The antitumor activity of licorice is associated with the presence of coumarins. Infusion of licorice: place 10 g of crushed root in an enamel bowl, pour 1 cup of hot water, heat in a boiling water bath under a tight lid for 20 minutes, leave for 40 minutes, strain, squeeze out the remainder, bring boiled water to the original volume. Take 2 tbsp. l. 4 times a day for 10 days.
Cocklebur (common and prickly) is a plant with a pronounced commitment to the respiratory system and everything that is near it. It contains a fair amount of iodine and immunomodulators. This determines the individual properties of the plant. Decoction: 1 tbsp. l. dry grass pour 1 cup boiling water, boil for 10 minutes on low heat, leave for 2 hours. Take 0.5 cup 3 times a day. I also recommend doing inhalations: take a metal kettle, heat it empty on the stove and, leaving it on the smallest fire, pour a pinch of cocklebur seeds on the bottom. Wrap the spout of the teapot with a clean cloth folded in several layers. Inhale smoke from the nose. After inhaling, hold your breath for 10 seconds and exhale

Yogic breathing exercises

For the final recovery, I also recommend placing banks. And during the period of remission, do therapeutic exercises. For example: first do yoga breathing exercises 5-6 times. Inhale and exhale through the nose.
I. p. - standing, feet shoulder-width apart, arms bent, hands at the back of the head. Turns of the body to the side. Do 4 - 5 times. The pace is average, breathing is arbitrary.
I. p. - standing, feet shoulder-width apart, arms lowered. Bending the arms with touching the shoulders, straightening the arms to the sides, bending the arms with the fingers touching the shoulders. Return to i. n. Run 3-4 times. Breathing is arbitrary, inhale and exhale through the nose, the pace is average.
I. p. - the same. Body tilts to the side. Repeat 4-6 times. The pace is average.
I. p. - the same. On inspiration, raise your hands up, on exhalation, lower them, followed by pressure on the chest in the area of ​​the diaphragm. Do 5 - 6 times. The pace is medium, exhale through the nose, long.
I. p. - standing, legs together, hands on the belt. Leading the straightened leg back with simultaneous abduction of the elbows back, return to and. n. Repeat 3-4 times. Breathing is arbitrary.
I. p. - standing, feet shoulder-width apart, gymnastic stick behind the back. Tilt the torso forward with the stick up - exhale. Return to i. p. - inhale. Do 4 - 6 times. Exhale vigorously.
I. p. - standing, legs together, arms lowered. Alternate abduction of the legs back on the toe while raising the opposite arm forward. Repeat 3-4 times. The pace is average.
I. p. - standing, legs together, arms along the body. Walking for 1 min. The pace is slow.
I. p. - sitting on a chair. Inflating rubber toys. Attention! Avoid pain when straining, tachycardia, shortness of breath. A set of exercises should be performed at least 3-4 times a day, individual exercises that promote resorption of exudate, tension of the pleura, straightening the affected lung and increasing its ventilation, increasing diaphragm mobility, especially on the diseased side, up to 10 times a day.
In the treatment of pleurisy of tuberculous etiology, much attention is also paid to recipes using animal fat, described above.
As an additional therapy in the treatment of pleurisy, you can use onion, garlic, radish - they have antibacterial properties (if the cause of pleurisy is infectious), as well as fees consisting of the following components: horsetail, aloe, birch buds, coltsfoot, mint, elecampane, licorice, pine buds, sage (in addition to antimicrobial, they also have a tonic, antipyretic, analgesic and other beneficial effects).
Of course, the treatment of pleurisy should be comprehensive and include an impact on the cause that caused it. If the pleural effusion is of a non-inflammatory nature, then the treatment should, first of all, be aimed at restoring cardiac activity, the function of the liver, kidneys, endocrine glands, and the like. In patients with inflammatory pleurisy, but aseptic process, treatment is aimed at eliminating allergic, autoimmune and other processes. Infectious pleurisy is treated with antibiotics.
Also, such patients are shown detoxification therapy (saline, glucose). Local treatment is also possible in the form of evacuation of the contents by introducing a drainage tube, sanitizing the pleural cavity and administering antiseptic and antibacterial, as well as fibrinolytic drugs, and subsequent drainage of the purulent cavity and other methods, depending on the severity.

Nutrition is an integral part of the recovery of the body

A health-improving diet for pleurisy is aimed at reducing the inflammatory process, lowering increased reactivity. This is ensured by the restriction of carbohydrates (200-250 g), salt (up to 3-5 g), an increase in the content of calcium salts in the diet (up to 5 g) per day. It is recommended to limit the amount of liquid to 500-700 ml. It is necessary to consume a sufficient amount of vitamins, especially vitamin A (liver, fish, egg yolk, milk, butter, cheese, boiled carrots, apricots, rose hips, sea buckthorn), vitamin P (citrus fruits, black currants, buckwheat, cherries, plums), vitamin D (brewer's yeast, liver, kidneys). The liver stewed in sour cream is nutritious: chopped liver is salted, rolled in flour, fried until half cooked (5-10 minutes), poured with sour cream and stewed for 15-20 minutes (600 g of liver, 2 cups of sour cream sauce).
You can cook a casserole with veal kidneys: cut veal and kidneys into cubes, fry, put in a saucepan, add fried onions and carrots, salt, broth and simmer. Separately, knead the dough, adding salt, eggs, melted fat to the flour. Put the finished dough in the refrigerator for half an hour, grease the form with fat and fill 2/3 of the volume with dough, put the rest of the dough on the cooled mass. Top the dough with yolk and put in the oven for 20-30 minutes (3 veal kidneys, 500 g of veal, a glass of broth, 100 g of fat, 2 onions, 1 carrot; for the dough: 1 cup flour, 2 tablespoons fat, 2 eggs). It is recommended to use carrot salads, cheese casseroles, milk soups. Dishes that cause thirst (salts, smoked meats, canned food) should be excluded from the diet.
Attention! After the subsidence of acute phenomena in the period of resorption of the exudate, it is advisable to take measures aimed at limiting the formation of adhesions and restoring lung function (breathing exercises, manual and vibration massage, ultrasound). Treatment of the pleura should be early, targeted and intense enough to achieve a quick effect.
Prevention of pleurisy consists primarily in the prevention, as well as the timely and proper treatment of diseases that can be complicated by the inflammatory process in the pleura. The basis for the prevention of purulent pleurisy is the early recognition and evacuation of accumulations of blood, air and exudate from the pleural cavity, which contribute to suppuration.

Vyacheslav VARNAVSKY,
doctor, physiotherapist.

Pleurisy is a serious disease of the respiratory system, in which inflammatory lesions of the serous membrane of the lungs occur. The disease may be accompanied by the accumulation of effusion in the pleural cavity or proceed in a fibrinous form.

Treatment of pleurisy at home includes a whole range of restorative procedures.

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Monastery collection of Father George

It consists of 16 medicinal plants that are extremely effective in the treatment of chronic COUGH, bronchitis and cough provoked by smoking.

In addition to drug therapy, you can also be treated with traditional medicine. With improperly prescribed therapy for the disease, various complications can occur. Therefore, full-fledged treatment can be started only after a detailed medical consultation with a competent specialist.

Warm compresses

The use of therapeutic compresses can effectively relieve pain and reduce the general weakness of the body. This method of therapy can be used already at the first signs of the disease.

Compress options:

1. To prepare a compress, you will need sea water or a solution with table salt. A dense gauze bandage should be well moistened in warm sea water or saline, and then applied to the painful area for about half an hour. For the best effect, wrap yourself in warm clothes. Such a compress is recommended to be done 2-3 times a day for no more than 14 days.
2. To make this compress, you need to mix 30 grams of camphor oil, 2.5 grams of lavender oil and 2.5 grams of eucalyptus oil. The resulting solution is applied in the form of a dense gauze bandage no more than 3 times in 24 hours. The course of therapy can be 2-3 weeks. Then you need to stop taking it for 30 days.

This version of the compress involves the use of a special ointment. To prepare it, you will need 60 grams of calendula inflorescences, 200 ml of vegetable oil (preferably olive oil). The ingredients of the composition must be mixed and infused in a dark and dry place for about 10 calendar days, then add 60 grams of mustard powder, 70-80 grams of flour, 60 grams of lime blossoms and 4 tablespoons of alcohol to them.

All this should be stirred until smooth and boiled on the stove for 4-7 minutes. The prepared mixture should be applied to a dense piece of tissue and applied to the chest. From above it is best to cover with compress paper and a warm scarf. The procedure should be carried out for half an hour no more than 2 times in 24 hours. The tool is limited in use after 7-10 days of admission.

Healing mixtures

All prepared mixtures are applied orally in the required dosage and allow you to achieve positive dynamics in the complex treatment of pleurisy with folk remedies.

In order to avoid the occurrence of side effects, it is recommended to adhere to the indicated time intervals and conduct treatment courses strictly according to the instructions. Mix options:

This is one of the most popular recipes used in the treatment of pleurisy with folk remedies. To prepare it, you need to take 1-1.5 cups of honey, 100-120 grams of pork fat and 6-7 large leaves of aloe. Pig fat must be melted on the stove, then cooled and mixed with honey. Carefully chopped aloe leaves, peeled of thorns, should be added to the resulting mixture.

Next, you need to mix all the ingredients and add 60 grams of cocoa to them. The mixture must be put on a preheated stove and boiled under a closed lid, stirring occasionally, until a homogeneous composition is obtained. Take the mixture should be no more than 3 times a day for 30 grams. The treatment time takes 25-30 days, it is recommended to continue therapy strictly after 3 months.

To prepare the recipe, you will need: half a glass of aloe juice, 100-120 grams of honey (preferably linden), 60 grams of vegetable oil, 150 grams of birch buds, 50-75 grams of linden inflorescences. First you need to put birch buds and lime blossoms in any suitable container and pour them with 200 ml of boiled liquid. This healing mixture must first be boiled, and then boiled for 20 minutes.

After the broth must be cooled and kept in a cold place for about 60 minutes. Next, honey and aloe juice are added to the mixture. The ingredients need to be stirred, boiled again for 5-10 minutes, and then pour vegetable oil into them. You need to drink the drug at 60 grams in the morning, afternoon and evening. Oral use may last more than a month, but should not exceed 60 calendar days.

1. To prepare this version of the mixture, you need to take 1 peeled large onion and 100 grams of honey. The onion should be finely chopped and mixed well with honey in any suitable container. The resulting mixture is taken 35-45 grams several times a day after meals for 2-3 weeks. After treatment, it is important to limit the use of the mixture for 7-14 days.

To obtain a medicinal mixture, you must have: 150 grams of horseradish root, 3 lemons. Rinse the horseradish root thoroughly, chop it and put it in a suitable dish. Then you need to peel 3 lemons and squeeze the juice out of them. Horseradish root should be mixed with lemon juice until a homogeneous mass is obtained.

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It is necessary to use a medicinal mixture of 5-6 grams after waking up in the morning and before going to bed. The recommended treatment time is 14 days. Before carrying out therapy, you need to make sure that there are no chronic diseases of the digestive tract, since horseradish can aggravate the condition of the gastric mucosa.

Herbal infusions

Most herbal infusions have a pronounced mucolytic and antimicrobial effect, which is very important in the presence of an infectious process in the lungs.

For the treatment of pleurisy at home, recipes are used that are as simple as possible to prepare and do not require special skills.

Types of infusions:

• It should be taken in the same amount: calendula flowers, black or red currant leaves, bird cherry berries, tansy inflorescences and immortelle leaves. All these plants must be mixed into a single mixture. A decoction is prepared in several stages: first, pour 1 tablespoon of the phytomixture with a glass (200 ml) of boiling water, and then leave the liquid in the refrigerator for 60 minutes. Take a solution of 60-80 grams several times a day for at least one week.

To prepare this infusion, you will need the following plants:

• cudweed - 30 g;
• elecampane root - 30 g;
• licorice - 30 g;
• calendula officinalis - 60 g;
• horsetail - 60 g;
• birch buds - 60 g.

All medicinal ingredients are thoroughly mixed, then 1 tablespoon of the phytomixture is poured into 200 ml of boiling water in any convenient container. The resulting liquid must be covered with a kitchen towel and insisted for 3-5 hours in a cool and dry place. The solution is recommended to strain and drink 100 ml 3-4 times a day. Therapy should last no more than 21 days. This recipe should be used with some caution if there are diseases of the urinary system.

Required to mix:

• 30 g coltsfoot;
• 30 g of a three-leaf watch;
• 30 g of cudweed;
• 60 g St. John's wort;
• 60 g of elecampane root;
• 30 g of licorice root.

1 tablespoon of the composition must be dissolved in 200 ml of boiling water and insisted for 4-6 hours. It is necessary to apply the solution in 100 ml 3 times in 24 hours for no more than 14-21 days.

Breathing exercises

Breathing exercises help to strengthen the pectoral muscles and facilitate the general well-being of the patient.

It is recommended to combine home gymnastics with additional physical activity: hiking in the fresh air, exercising on sports equipment. Therapeutic exercises for pleurisy can reduce the focus of inflammation in the lungs.

An approximate set of exercises in the treatment of pleurisy with folk remedies:

1. Lie on your back, stretching both arms along the body. Breathe calmly and deeply for 1-2 minutes, then rhythmically inhale and exhale through the nose. Repeat the breathing exercise 4-5 times.
2. Lying on your back, bend your right leg at the knee and pull it to the abdomen. Then repeat the same with the left leg. Exercise should be done 3-4 times.

Stand up straight and place your feet shoulder-width apart. Breathing calmly, put your hands on your shoulders.

Then raise your hands up and stretch, making the inhalation and exhalation deeper. Repeat steps 5-6 times.

Standing and keeping your legs at shoulder level, put your hands on your belt. Inhale deeply and tilt your torso to the right. Exhale calmly and repeat the steps, tilting the torso to the left.

3. Stand up and raise your arms up, while closing your hands. Take a deep breath and bend down, exhaling slowly. Repeat the same 4-5 times.

All types of exercises can be carried out only in the absence of pronounced signs of exacerbation (elevated body temperature, increased amount of exudate).

In addition to all the listed methods of treating pleurisy with folk remedies, it is necessary to adhere to a fortified diet and, if necessary, observe bed rest.

• nervousness, sleep disturbance and appetite…
• frequent colds, problems with the bronchi and lungs ....
• headache…
• smell from the mouth, plaque on the teeth and tongue ...
• change in body weight...
• diarrhea, constipation and stomach pain...
• exacerbation of chronic diseases ...

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