pleurisy
Introduction
Introduction to pleurisy Pleuritis, also known as "pleural inflammation", is inflammation of the pleura. Pleuritis is a causative factor (usually a virus or a bacterium) that stimulates pleural inflammation caused by the pleura. There may be fluid accumulation (exudative pleurisy) or no fluid accumulation (dry pleurisy) in the chest. After the inflammation subsides, the pleura can return to normal, or two layers of pleura adhere to each other. Caused by a variety of causes, such as infections, malignant tumors, connective tissue disease, pulmonary embolism. basic knowledge The proportion of illness: 0.3%-0.5% Susceptible people: no special people Mode of infection: non-infectious Complications: myocarditis
Cause
Cause of pleurisy
Pleuritis is caused by a variety of causes, such as:
Causes of inflammatory response (35%):
Pneumonia; pulmonary infarction due to pulmonary embolism; cancer; tuberculosis; rheumatoid arthritis; systemic lupus erythematosus; parasitic infections such as amebiasis;
Causes of poisoning (20%):
Asbestosis and drugs, mainly including amiodarone, bleomycin, bromocriptine, cyclophosphamide, methotrexate, mesalamine, minoxidil, mitomycin, oxylenol, pu Lalor, procarbazine and sclerotherapy, and drugs that cause lupus pleurisy, such as hydralazine, procainamide, and quinidine.
Gastrointestinal causes (20%):
Inflammatory bowel disease and spontaneous bacterial pleurisy. Hereditary causes: familial Mediterranean fever. Hematology and tumor causes: malignant tumors and sickle cell disease. Causes of infection: virus (adenovirus, coxsackie virus, cytomegalovirus, EB virus, influenza virus, mumps virus, parainfluenza virus and respiratory syncytial virus), bacteria (mediterranean spotted fever, pneumonia pleurisy or tuberculosis) Pleurisy) and parasites (amebiasis and paragonimiasis).
Prevention
Pleuritis prevention
1. Pay attention to rest, high protein and high vitamin diet.
2. Treatment should be persistent and thorough.
3. Tuberculous pleurisy can not be stopped at random, because it will make tuberculosis resistant, which is not convenient for future treatment.
Complication
Complications of pleurisy Complications
It can form interlobular pleurisy, mediastinal pleurisy, encapsulated effusion and lung fund.
Symptom
Common symptoms of pleural inflammatory disease Chest pain Painful breathing Breathing chest pain Chest pain Chest tightness Sneezing sneezing Chest pain Persistent fever Chest area pain Chest pain
The most common symptom of pleurisy is chest pain. Chest pain often occurs suddenly and varies widely. It can be unclear discomfort or severe tingling. It can occur only when the patient takes a deep breath or cough. It can also persist and is exacerbated by deep breathing or coughing. Chest pain is caused by inflammation of the parietal pleura and usually occurs in the chest wall facing the site of inflammation. It can also be manifested as pain in the abdomen, neck or shoulders.
Clinical manifestation
1. The condition is mild and asymptomatic.
2. The main clinical manifestations are chest pain, cough, chest tightness, shortness of breath, and even difficulty breathing. When infected with pleurisy or pleural effusion, there may be aversion to cold and fever.
3. The pleurisy caused by different causes may be accompanied by the clinical manifestations of the corresponding diseases.
4. Pleuritis is a forced lateral position.
Examine
Examination of pleurisy
(1) Blood routine: The white blood cell count is normal or slightly increased in the early stage, but rarely exceeds 12 × 109 / L. ESR increased.
(2) TB test: sputum positive.
(3) Chest fluid examination: exudative, transparent, grass yellow, specific gravity greater than 1.018, positive for Lifanta test, protein quantitation greater than 30g / L.
(4) Tuberculin test: positive.
(5) Chest X-ray examination: the density of the middle and lower lung fields is deepened, and only a small amount of effusion is blunt. When there is more effusion, the density of the lung field is increased, and the upper edge of the shadow is curved from the underside of the sac.
(6) Ultrasonic examination: A liquid dark area with good sound penetration can be found, which can indicate the scope, location and depth of the puncture.
Diagnosis
Diagnostic diagnosis of pleurisy
Diagnostic criteria
1. Generally divided into the following 10 types:
1 fibrinous pleurisy: "dry pleurisy", a small amount of fibrin exuded from the pleura without pleural effusion. Most of the inflammation caused by the spread of lung inflammation to the pleura, most asymptomatic, a small number of patients have localized acupuncture-like pain.
2 serous fibrinous pleurisy: "exudative pleurisy", the accumulation of serum and fibrin in the chest cavity, often caused by tuberculous pleurisy, suppurative pleurisy, tumor pleurisy. Chest pain and shortness of breath are the main manifestations.
3 tuberculous pleurisy: caused by tuberculosis from the lymph nodes of the primary syndrome through the lymphatics to the pleura, or the subpleural tuberculosis spread to the pleura. Clinically, there are tuberculous dry pleurisy, tuberculous exudative pleurisy, and tuberculous empyema. Often have chest pain, shortness of breath and tuberculosis symptoms.
4 neoplastic pleurisy: caused by intrathoracic or extrathoracic cancer, directly invaded or transferred to the pleura. Mainly manifested as chest tightness, progressive dyspnea, and the corresponding symptoms of the primary lesion.
5 suppurative pleurisy: mostly caused by the spread of lung, esophagus, abdominal infection, etc. to the pleura. It is characterized by aversion to cold, high fever, chest pain, cough and vomiting.
6 fungal pleurisy: caused by actinomycetes, Candida albicans involving the pleura.
7 connective tissue disease pleurisy: common in rheumatoid arthritis and systemic lupus erythematosus and other diseases. Chest pain, shortness of breath and symptoms of the primary disease are the main manifestations.
8 cholesterol pleurisy: contains a large amount of free cholesterol crystals in the pleural fluid, may be related to lipodystrophy, clinical symptoms are mild.
9 chylothorax: for lymphatic sputum in the pleural effusion, mostly due to tumor, lymph node tuberculosis, filariasis granuloma compression or damage to the thoracic duct and chyle pool. Chest tightness and shortness of breath are the main performances.
10 hemothorax: refers to obvious intrathoracic hemorrhage. It is caused by spontaneous pneumothorax, vascular pleural adhesion tear, or hemorrhagic pancreatitis. Mainly manifested as chest pain, chest tightness, and even shock and other symptoms.
2. Physical examination: dry pleurisy: limited respiratory movement, local tenderness, weakened breath sounds, audible and pleural friction sounds. Exudative pleurisy: When the amount of fluid is large, the respiratory movement of the affected side is limited, and even the body position is forced, the breathing is rapid, the heart rate is accelerated, the thorax is full, the trachea is shifted to the healthy side, the percussion is a real sound, and the tremor is weakened or disappeared.
3. X-ray examination: There is no significant change in the limitations of pleural effusion. When the pleural effusion is small, the rib angle is blurred and blunt. When there is more pleural effusion, the density of the lung field is increased, and the upper edge of the shadow is curved from the underside of the sac.
4. Ultrasonic examination: A liquid dark area with good sound penetration can be found, which can indicate the range, location and depth of the puncture.
5. Laboratory inspection:
1 pleural effusion routine, biochemical, culture can determine the nature of the effusion, and found tuberculosis or other pathogenic bacteria.
2 tuberculin test and tuberculosis antibody positive for the diagnosis of tuberculous pleurisy.
3 blood routine examination white blood cell count can be normal or increased, ESR often accelerates.
6. This disease should be distinguished from pleural metastasis of bronchogenic carcinoma and pleural effusion caused by liver, kidney and heart diseases.
