Pleurisy. Causes, symptoms, signs, diagnosis and treatment of pathology. Purulent pleurisy

Many complications of lung diseases pose a danger to the patient's life. Purulent pleurisy is no exception. The percentage of timely diagnosis is small, and death When a process is running, it terminates frequently.

Purulent pleurisy is the presence of infected fluid in, accompanied by an inflammatory process in the surrounding tissues. Doctors call this condition pleural empyema (pyothorax). The liquid is an exudate.

Pyothorax develops as a consequence of the underlying disease. It is extremely rarely diagnosed separately. Despite active development medicine, the occurrence of pathology is very common and there is no tendency to reduce such patients.

Causes and pathogenesis of the disease

There are many reasons for the occurrence of pleural empyema, which explains the sufficient prevalence of this problem. These include:

The main trigger factors for the occurrence of purulent pleurisy are:

decreased immunity;
penetration of pathogenic bacteria into the pleural cavity.

The result of this current situation is an inflammatory response from the pleura, which is a serous membrane covering the lungs and chest from the inside.

When bacteria get on it, they produce various toxins. Their effect is reduced to damage to pleural cells. The body responds to such irritation by producing an inflammatory fluid - exudate, which is absorbed by the serous membrane in large quantities.

If diagnosis and treatment are not timely at this stage, bacterial toxins continue to damage the pleura. The result is the impossibility of reabsorption of exudate. It accumulates in the pleural cavity and gradually becomes purulent.

The inflammation continues to increase. Above the liquid are leaves and chest connect with each other. They begin to grow together, forming adhesions. Thus, the accumulation of pus is demarcated. It is possible to form pleurisy with several chambers, or encysted.

The consequence of the progression of this process can be fistulas, when pus “makes” its way out through the chest wall under the skin or into the bronchi. The latter option is characterized by the appearance purulent cough with copious sputum. This situation often leads to chronicity of the disease.

Clinical picture

The severity of symptoms depends on:

Frequent complaints with the development of acute purulent pleurisy are:

high temperature up to 39ᵒС, accompanied by chills and heavy sweat;
severe weakness;
lack of appetite;
cough with varying amounts of sputum;
pain in the chest on the affected side, aggravated by breathing, coughing, or changing body position;
dyspnea different intensity(depending on the degree of lung damage);
vomit;
increased heart rate, rhythm disturbance;
headache;
insomnia;
irritability.

Relief of the condition is observed when lying on the sore side.

Due to high and constant intoxication, multiple organ failure develops, which significantly worsens general state sick. Rarely, with advanced pleurisy, coma may occur, which is extremely unfavorable factor for forecast.

Empyema (pyothorax) of the pleura occurs:

primary (develops on the unchanged pleura);
secondary (as a consequence of another disease).

According to the pathogens that cause the purulent process, there are:

nonspecific (staphylococcal, pseudomonas, intestinal, pneumococcal, proteus);
specific (tuberculosis, syphilitic and fungal);
mixed.

Based on the volume of purulent exudate, pleurisy can be:

total (affects the entire lung);
subtotal.

According to the duration of clinical manifestations:

acute (up to 3 months);
chronic (more than 3 months).

The ability of pleural empyema to “melt” (damage) the lung underlies the division into:

simple;
destructive.

With the development of purulent pleurisy against the background of pneumonia, the following are distinguished:

If the consequence of a purulent process is the formation of a message with environment, then such an empyema is considered open. When fistulas (passages) do not form, the pyothorax is called closed.

This multifactorial division of purulent pleurisy of the lungs helps to more rationally prescribe therapy and prevent the development of complications.

Diagnostics

The difficulty of timely detection of pleural empyema lies in:

When diagnosing purulent pleurisy, a doctor must carry out a whole range of measures, summing up all the results obtained.

The mandatory list of examinations includes:

What do you pay attention to during an objective examination?

The patient is pale, lips are cyanotic. Upon careful examination, the doctor notices restriction of respiratory movements in the affected half of the chest, smoothness of the intercostal spaces.

Percussion (tapping) and... These methods allow the doctor to determine the extent and nature of the lesion.

When percussion occurs over the site of exudate accumulation, the sound becomes dull. On auscultation with large pleurisy, breathing in the lower parts of the lungs may be completely absent.

Laboratory research

Carrying out general analyzes is not very specific. They indicate the presence of active inflammation in the body. Important has their dynamic purpose. When treating the underlying disease using a blood test, the doctor monitors the therapy.

If there is an acceleration of ESR, an increase in the number of leukocytes and the appearance of anemia, then this indirectly indicates the development of a purulent process.

Bacteriological and bacterioscopic methods

An important component of diagnosing pyothorax is the examination of sputum and fluid obtained during pleural puncture. With the help of this, the main pathogen is determined, the presence of atypical cells (if they are of a tumor nature). Smears are prepared from the material in a special way and examined under a microscope.

When pathogenic microorganisms are detected, they must be sown on nutrient media, followed by determination of sensitivity to antibiotics. This is important for selecting adequate antibacterial therapy, especially with mixed flora.

The disadvantage of these methods is long term completion - up to 10-14 days. Gas-liquid chromatography is currently widely used. It helps to quickly identify the pathogen.

Additional Methods

X-ray of the lungs is considered the fastest and informative method diagnosis of purulent pleurisy.

It helps determine:

localization of the lesion;
degree of lung collapse (presence of air in the pleural cavity);
mediastinal shift;
amount of exudate.

Based on the results of the x-ray, the doctor decides on emergency surgical treatment and marks a point for pleural puncture and drainage. The disadvantage of the method is the inability to detect small amounts of exudate.

CT scan of the lungs is one of the methods modern diagnostics. Helps determine the same indicators as radiography. However, tomography is uninformative in cases of lung collapse and large volumes of pleurisy.

Ultrasound of the pleural cavity determines the amount and nature of exudate, the condition of the pleura.

Thoracoscopy is performed if the results obtained are incomplete. Assess the nature of the spread pathological process and the presence of complications. In such cases, it is also a therapeutic procedure. Pleural puncture is performed for all patients with suspected purulent pleurisy!

Treatment

Treatment of pleural empyema is carried out only by surgeons. Preference is given to highly specialized thoracic departments.

Main conditions medical care patients with pyothorax are:

timeliness;
complexity;
rationality.

This is implemented using:

diet, rich in proteins and vitamins;
frequent sitting up in bed and walking;
full sleep.

The choice of drugs and drainage methods is made by the thoracic surgeon based on the results of all the data obtained.

Complications

Complications of empyema include:

Diagnosis and treatment of purulent pleurisy are the scourge of modern thoracic surgery. These activities still require a lot of time, which causes a fairly high mortality rate in the category of patients with pyothorax.

Reasons for development, pathogenesis. The main reason for the development of purulent pleurisy is pathogenic staphylococcus, pneumococcus, streptococcus, less often - Pseudomonas aeruginosa, Proteus, Escherichia.

As a rule, purulent pleurisy is caused by a single pathogen, but it also happens that the disease is caused by several pathogens together. The occurrence of purulent pleurisy is based on a severe form of polysegmental or focal bronchopneumonia or staphylococcal destruction (destruction) of the lungs. Also, the development of purulent pleurisy is promoted by bronchiectasis and perforation (ruptures) of the esophagus (during bougienage (expansion). As a rule, the pathogen enters the pleural cavity by contact directly from pneumonic foci of inflammation, which are located subpleurally, or from small abscesses. Primary purulent pleurisy is rare , in its development, the hematogenous route of transmission of the pathogen from the primary foci of inflammation plays an important role. This form pleurisy is possible with osteomyelitis, otitis, navel phlegmon, purulent appendicitis, pyelitis, peritonitis. Significant fibrinous accumulations on the pleura, covered with pus, are the main sign of purulent pleurisy. The pleural layers reveal areas of hemorrhage, sharp redness (hyperemia), desquamation and destruction of the endothelium, abundant infiltration of poly- and mononuclear cells. Destruction of the endothelium and the formation of adhesions between the layers of the pleura lead to limitation of pleural exudate. This process leads to the formation of encysted pleurisy. According to the nature of its occurrence, purulent pleurisy is divided into primary and secondary, according to its course - into acute and chronic pleurisy, according to the nature of the process - into total and limited, according to localization - into parietal (paracostal), apical, interlobar, mediastinal, basal (diaphragmatic) . Secondary pleurisy is divided into para- and metapneumonic.

Clinic, diagnostics

Clinical manifestations of purulent pleurisy depend on the age of the child. For example, in children in the first 3 months of life, purulent pleurisy develops slowly and has symptoms characteristic of umbilical sepsis, septicopyemia or staphylococcal pneumonia. The asymmetry of the chest is determined by eye, with its enlargement on the affected side. There is drooping of the shoulder, limited mobility of the arm, and the chest lags behind when breathing on the affected side. The intercostal spaces, the line of attachment of the diaphragm and the supraclavicular fossa completely lose mobility. A purulent effusion covers the border of the lung with a thin layer and resembles a cloak (cloak-like pleurisy), as a result of which a shortening of the percussion sound is observed. The zone of greatest shortening of sound is located, as a rule, in lower section lung above the diaphragm area. The Ellis-Sokolov-Damoiseau line, the Grocco-Rauchfuss and Garland triangle and Traube space are insignificant in young children. Breathing, as a rule, can be heard throughout, but is slightly weakened and has a bronchial character. A large number of crepitating and fine bubbling rales are heard in the lungs. In some cases, a pleural friction rub may be heard. In older children, symptoms of total purulent pleurisy are most often observed. They have a painful dry cough with a small amount of sputum, which is purulent in nature (if purulent contents have entered from the pleural cavity into bronchial tree). The fever is hectic (wavy) or low-grade in nature. The thorax on the affected side takes on the shape of a barrel, its lag is noticeable breathing movements, expansion of the intercostal spaces and thickening of the skin fold occur. Dullness of percussion sound is most pronounced posteriorly and laterally in the axillary (axillary) region. The Ellis-Sokolov-Damoiso line, the Grocco-Rauchfuss and Garland triangle are clearly defined. While listening to the lungs above the zone where the shortening of the sound is noted, bronchial breathing is noted; sometimes a pleural friction noise can be heard, which disappears with the accumulation of fluid in the pleural cavity, it is noted complete absence breathing sounds. With a sharp accumulation of effusion, wheezing. In the lateral and lower part of the dullness of purulent exudate, the mediastinal organs shift to the healthy side and a respiratory catastrophe develops: sharp pain behind the sternum, shortness of breath, the skin becomes bluish (cyanosis), anxiety, and the heartbeat increases.

Upon examination, a shift in the heart impulse to the healthy side is observed, which becomes more diffuse in nature. Enlarged veins and pulsation of large vessels of the neck are clearly visible. Children who have suffered purulent pleurisy are inferior to their peers in development and are exhausted. Such children may develop chronic pulmonary empyema. A general blood test reveals a huge number of leukocytes (30-50 x 103 μl) with an increase in the number of neutrophils, a band shift of up to 15-20%, hypochromic anemia, increase in ESR up to 50-60 mm/h. To the earliest X-ray signs Acute purulent pleurisy includes the appearance of a shadow of mantle-shaped pleurisy and a uniform decrease in transparency lung tissue. With pleural empyema, the images show a uniform darkening of the lung tissue with a clear boundary of the exudate and airy lung tissue above it, the dome of the diaphragm is not determined, the sinus is invisible. When exudate accumulates, a shift of the mediastinal organs to the healthy side is observed. As for other forms of purulent pleurisy, their radiological characteristics resemble serous pleurisy. Chronic pleural empyema on an x-ray is characterized by a collapsed lung, which is covered with a thick mooring, a dry pleural cavity or with exudate having a horizontal border. To confirm the diagnosis, a puncture of the pleural cavity is performed. As a rule, it contains pus. It is rare, but it happens that the punctate has a cloudy appearance. The resulting liquid is sent for testing to a bacteriological laboratory.

Despite the similarity of clinical and radiological parameters between purulent and serous pleurisy, they can still be distinguished. Purulent pleurisy, as a rule, occurs in young children and in most cases is synpneumonic, which is not typical for serous pleurisy. Active purulent processes in the lungs are also detected ( lung abscess, abscess pneumonia), severe toxicosis and a characteristic blood test picture ( high content leukocytes with shift leukocyte formula towards neutrophils, progressive anemia, increase in ESR). The final point in making a diagnosis is pleural puncture with its further laboratory testing. Purulent inflammation of the pleura must be distinguished from confluent lobar pneumonia. Main distinctive features purulent pleurisy are asymmetry and almost complete absence of chest movements during breathing, soft tissue pastiness, enlargement venous vessels skin on the affected side. During percussion, there is an increase in percussion dullness downwards. On auscultation, bronchophony is heard. Breath sounds in the lungs are sometimes heard, and in some cases completely absent. The boundaries of dullness in pneumonia are tapped only in the area of the middle or lower lobe and do not extend beyond this area. During auscultation, strong bronchial breathing, bronchophony, and a large number of moist rales of various sizes are heard. On an x-ray, purulent pleurisy has a uniform thick shadow over the entire lung tissue and a shift of the mediastinum to the healthy side is observed, which is not observed with pneumonia. Pure purulent pleurisy must be distinguished from an abscess of the lower lobe of the lung. With a lung abscess, as a rule, there is a wet cough with the discharge of a large amount of purulent, foul-smelling sputum. Radiologically, a lung abscess looks like a round or oval densely darkened shadow with clear lower limits and an air cavity above the horizontal liquid level. Unlike pleurisy, distinctive features which are the filling of the costophrenic sinus and changes in the boundaries of the fluid when changing body position, in a lung abscess there is a slight shift in the fluid level.

Treatment

In the treatment of purulent pleurisy, one of the key places is occupied by the treatment of the underlying disease - pneumonia. If we talk about treatment methods, they can be both surgical and conservative. Very often the method of simultaneous administration of antibacterial drugs through a vein or intramuscularly through the trachea is used. Ultrasonic or simple aerosol inhalations are also indicated. As a rule, it is prescribed maximum doses antimicrobial drugs.

Intrapleural administration of antibiotics into currently is considered unfounded. As a rule, antimicrobial therapy is carried out simultaneously by several medicines, while taking into account their compatibility with each other and the drug sensitivity of the pathogen. It is recommended to carry out several consecutive courses of treatment (7-10 days). Full course Antibacterial therapy ranges from 1 to 1.5 months or more. Sulfonamides are used in combination with antibiotics long acting- sulfadimethoxine or sulfapyridazine, biseptol or nitrofurans. 0.25% has a strong antimicrobial effect alcohol solution chlorophyllipt. It is used intravenously at 0.5-2 ml twice a day. A good effect is observed with transfusion of hyperimmune anti-staphylococcal plasma, blood transfusion, plasma albumin, red blood cells, native staphylococcal toxoid. Blood transfusions are carried out at least 2 times a week at 5-10 mg/kg body weight. Antistaphylococcal plasma is administered daily at a dose of 5-10 ml/kg of body weight until positive results are obtained.

To replenish lost fluid and relieve symptoms of intoxication, intravenous drip administration of polyglucin, rheopolyglucin, neocompensan, Ringer's solution and a 5% solution of glucose, alvesin, aminon is used, which are prescribed at the rate of 10 ml/kg of weight and at a rate of 10-12 drops in 1 minute. The volume of infused liquid should not exceed 70% of daily requirement child in liquid, which averages 50-80 ml/kg body weight. In this case, it is necessary to strictly monitor the volume of urine excreted. Correction of the acid-base state is carried out by intravenous administration of a 4% sodium bicarbonate solution. The use of hormones (prednisolone, hydrocortisone) is advisable in the first 2 days in order to remove the patient from toxic shock. The antishock effect is caused by intravenous, intramuscular or subcutaneous use 0.25% solution of dro-peridol 0.1-02 ml/kg body weight or 0.5% solution of haloperidol at a dose of 0.1-0.2 ml/kg body weight. Neuroplegic drugs are prescribed - seduxen, aminazine, luminal, sodium hydroxybutyrate (50-100 mg/kg body weight) intravenously, 1% solution of promedol per 1 year of a child’s life, 0.1 ml (single dose) intramuscularly. If the intestines are weak, an enema with a hypertonic solution is prescribed, proserin is administered intramuscularly, and potassium chloride is administered intravenously.

For therapy, it is recommended to use semisynthetic penicillins, cephalosporins, aminoglycosides, antimicrobials different groups(lincomycin, rifampicin, ristomycin, vancomycin), semisynthetic tetracyclines (doxycycline, metacycline).

To treat purulent pleurisy, puncture of the pleural cavity is also used to pump out pus. This manipulation is carried out in children from 6 months to treat cape-like and limited pleurisy. With extensive purulent inflammation of the pleura, this method of treatment is usually used in children over 1 year old and only in cases where the effusion is not very thick and there is a tendency to reduce its volume after the first punctures. In the first 2 days of therapy, punctures are performed daily, then at intervals of 1-2 days, and when the child’s condition is stabilized - after 3-4 days under the control of radiological and clinical trials. In case of severe total pleural empyema in children older than six months, in the absence of effect from punctures and in the presence of viscous effusion, thoracoceggesis and drainage of the pleural cavity using passive drainage according to Bulau or through active aspiration of the contents are advisable. In case of severe purulent pleurisy in children under 2 years of age, immediate surgical treatment is recommended. Children with a history of a diagnosis of purulent pleurisy are subject to dispensary observation at the pediatrician. Such children are shown Spa treatment. The outcome of the disease depends on the age of the child, how quickly and correctly the diagnosis was made, and on the correct treatment regimen. In children early age Possible death.

Pleurisy is common name for diseases in which inflammation of the serous membrane around the lungs - the pleura - occurs. The disease usually develops against the background of pre-existing diseases and may be accompanied by the formation of effusion on the surface of the membrane (exudative pleurisy) or fibrin (dry pleurisy). This problem is considered one of the most common pulmonary pathologies (300–320 cases per 100 thousand population), and the prognosis for treatment depends entirely on the severity primary disease and stages of inflammation.

Description of the disease

What is pleura? This is a two-layer serous membrane around the lungs, consisting of two so-called layers - the internal visceral and external parietal. Visceral pleura directly covers the lung, its vessels, nerves and bronchi and separates the organs from each other. The parietal membrane covers the inner walls of the chest cavity and is responsible for ensuring that no friction occurs between the layers of the lung when breathing.

IN healthy condition between the two pleural layers there is a small space filled serous fluid– no more than 25 ml. The fluid appears as a result of filtration of blood plasma through vessels in the upper pulmonary part. Under the influence of any infections, serious illnesses or injury, it rapidly accumulates in the pleural cavity, and as a result, pulmonary pleurisy develops.

If the vessels are functioning normally, excess fluid is absorbed back, and fibrin protein settles on the pleura. In this case, they talk about dry or fibrinous pleurisy. If the vessels do not cope with their function, effusion (blood, lymph, pus) forms in the cavity - the so-called effusion, or exudative pleurisy. Often in a person, dry pleurisy subsequently turns into effusion.

Secondary pleurisy is diagnosed in 5–10% of patients therapeutic departments. It is believed that both men and women are equally susceptible to this pathology, but statistics more often indicate damage to the pleura in adults and elderly men.

Causes

Pleurisy very rarely occurs as an independent disease; it is usually recorded against the background of other pathologies of an infectious and non-infectious nature. In accordance with this, all types of the disease (both fibrinous pleurisy and effusion) are divided into 2 large groups based on the reasons for their appearance.

Infectious causes

Infectious lesions of the pleura most often cause inflammation and the formation of purulent exudate between the pleural layers. The pathogen enters in several ways: as a result of direct contact with the source of infection (usually in the lung), through lymph or blood, and also due to direct contact with the environment (trauma, penetrating wounds, unsuccessful operations).

Non-infectious causes

Non-infectious pleurisy may occur due to systemic diseases, chronic pathologies, tumors, etc. The most popular causes of such ailments are:

Malignant formations in the pleura or metastases from other organs;
Connective tissue pathologies (vasculitis, etc.);
Myocardial infarction and pulmonary embolism (pulmonary infarction);
Chronic renal failure;
Other diseases (leukemia, hemorrhagic diathesis, etc.).

When a tumor forms, the pleura is damaged and the formation of effusion increases. As a result, effusion pleurisy begins to develop.

After a pulmonary embolism, inflammation spreads to the pleural membrane; with myocardial infarction, the disease develops against a background of weakened immunity. In systemic pathologies (vasculitis, lupus), pleurisy develops due to vascular damage; renal failure causes exposure of the serous membrane to uremic toxins.

Varieties

Modern medicine knows of various types of pleurisy different types and forms, and there are several classifications of this pathology. But in Russian practice, the classification scheme of Professor N.V. Putov is traditionally used. In accordance with it, the following types of pleural pathologies are distinguished.

By etiology:

Infectious (staphylococcal, tuberculous pleurisy, etc.);
Non-infectious (indicating the disease that became the cause);
Unclear etiology (idiopathic).

According to the presence of effusion and its nature:

Exudative pleurisy (with serous exudate, serous-fibrinous, cholesterol, putrefactive, etc., as well as purulent pleurisy);
Dry pleurisy (including adhesive pleurisy, in which adhesions are fixed between the pleural layers).

According to the course of inflammation:

Acute pleurisy;
Subacute;
Chronic.

According to the location of the effusion (degree of pleural damage):

Diffuse (total inflammation);
Enclosed pleurisy, or delimited (diaphragmatic, parietal, interlobar, etc.).

The types of disease are also distinguished according to the scale of distribution: unilateral (left- and right-sided) or bilateral inflammation of the pleural membrane.

Symptoms

Traditionally, inflammation of the serous membrane in adults and children begins with the development of fibrinous pleurisy.

Typically, this form of the disease lasts 7–20 days, and then, if recovery does not occur, it develops into effusion or chronic. Launched forms pleural inflammation can also cause dangerous consequences – a sharp decline immunity, pleural adhesions, empyema (large accumulation of pus), kidney damage and even death. One of the most dangerous forms, which most often provokes complications, is encysted effusion pleurisy, a transitional stage between acute and chronic inflammation.

Symptoms of dry (fibrinous) inflammation

With dry pleurisy, the disease begins acutely and suddenly. The first symptoms of pleurisy are:

Sharp pain in the chest (on the side where inflammation develops);
When coughing, sneezing and bending over painful sensations increase;
When you inhale forcefully, a dry cough may begin;
The temperature with fibrinous pleurisy is normal, if it increases, it is not higher than 38–38.5ºС;
Weakness, malaise, and headaches appear.
The patient suffers from aching joints and intermittent muscle pain.

One of the main diagnostic symptoms of fibrinous pleurisy is auscultatory (noise) signs. When listening, the noise of friction of the pleural layers against each other (due to fibrinous deposits) or wheezing is noticeable.

Dry pleurisy of different types has its own specific manifestations. Most often, the parietal form of inflammation is diagnosed; the main symptoms are chest pain, which always worsens when coughing and sneezing.

With diaphragmatic inflammation, pain can radiate to the shoulder, the anterior part of the peritoneum; there is discomfort when swallowing and hiccups. Apical dry pleurisy can be recognized by pain in the shoulders and shoulder blades, as well as in the arm, along the nerve endings. Dry pleurisy in this form usually develops with tuberculosis and can subsequently develop into encysted pleurisy.

Symptoms of effusion (exudative) inflammation

In contrast to the dry form of the disease, the symptoms of effusion inflammation of the pleura are almost the same for different types and locations of effusion fluid. Typically, exudative pleurisy begins with the fibrinous stage, but soon pain and discomfort in the chest are smoothed out due to the fact that the visceral and parietal layers are separated by fluid and no longer touch.

Sometimes this form of the disease develops without the traditional dry stage. In such a situation, the patient does not feel any discomfort in the chest for several days, and only then do characteristic signs appear: fever, weakness, heaviness in the chest, shortness of breath, etc.

Basic external manifestations exudative pleurisy is:

Fever (temperature reaches 39–40ºС);
Shortness of breath, frequent and shallow breathing;
The face and neck swell, turn blue, and the veins in the neck swell;
The chest at the site of the lesion increases, intercostal spaces may bulge or smooth out;
The lower fold of skin on the sore side of the chest swells noticeably;
Patients lie on their healthy side, avoiding unnecessary movements;
IN in some cases– hemoptysis.

Symptoms of purulent inflammation

Purulent pleurisy is quite rare, but is one of the most severe forms of this disease, which entails serious consequences. Half of all complications of such inflammation end in death. This disease is especially dangerous for young children in the first year of life and elderly patients. The purulent variety usually develops against the background of a lung abscess.

Symptoms of this pathology vary depending on age: in young patients, the disease can be disguised as umbilical sepsis, staphylococcal pneumonia, etc. In children older signs purulent inflammation of the pleura are the same as in adults.

Purulent pleurisy can be recognized by the following signs:

Stitching pain in the chest, which subsides as the pleural cavity fills with pus;
Heaviness and pain in the side;
Shortness of breath and inability to breathe deeply;
The cough is dry and infrequent at first, then intensifies, purulent sputum appears;
The temperature jumps to 39–40ºС, pulse – 120–130 beats per minute.

If the disease develops due to a pulmonary abscess, then the abscess rupture begins with a protracted painful cough, which ends with a sharp and severe pain attack in the side. Due to intoxication, the skin turns pale, becomes covered in cold sweat, blood pressure drops, and the patient cannot breathe fully. Shortness of breath increases.

Symptoms of tuberculosis inflammation

Tuberculous pleurisy is the most common pathology among all exudative forms. With respiratory tuberculosis, pleural inflammation is more often diagnosed in children and young people.

IN clinical practice three main forms of tuberculous pleurisy:

Allergic tuberculous pleurisy;
Perifocal inflammation of the pleura;
Pleural tuberculosis.

The allergic stage begins with sharp increase temperatures up to 38ºС and above, tachycardia, shortness of breath, pain in the side are observed. As soon as the pleural cavity fills with effusion, these symptoms disappear.

Perifocal tuberculous pleurisy usually occurs against the background of an existing one and proceeds for a long time, with periods of remission and exacerbation. Symptoms of the dry form of tuberculous pleurisy are smoothed out: chest pain, noise from pleural friction. With the effusion form, more distinct signs appear - fever, sweating,...

With pulmonary tuberculosis, the classic clinical picture of effusion inflammation of the pleura develops: shortness of breath, pressing pain in the chest and side, wheezing, fever, bulge on the sore side of the chest, etc.

Diagnostics

In order to make the correct diagnosis and select the appropriate treatment for pleurisy, it is important to determine the cause of inflammation and the formation of exudate (in effusion forms).

Diagnosis of this pathology includes the following methods:

Conversation with the patient and external examination;
Clinical examination (listening for chest sounds, palpation and percussion - tapping the area of pleural effusion);
X-rays of light;
and pleural exudate (puncture);
Microbiological examination of pleural effusion.

The most effective method for diagnosing pleural pathology today is x-ray. An x-ray allows you to identify signs of inflammation, the volume and location of exudate, as well as some causes of the disease - tuberculosis, pneumonia, tumors, etc.

Treatment

When diagnosing pleurisy, treatment pursues two important goals - to eliminate the symptoms and eliminate the cause of the inflammation. How to treat pleurisy, in a hospital or at home? Dry forms of the disease in adults can be treated on an outpatient basis, while exudative forms require mandatory hospitalization. Tuberculous pleurisy is treated in tuberculosis dispensaries, purulent - in surgical departments.

Pleurisy is treated with medications depending on the type:

Antibiotics (for infectious forms);
Non-steroidal anti-inflammatory drugs and painkillers;
Glucocorticosteroids and immunostimulants;
Diuretics and antitussives;
Cardiovascular drugs.

Complex treatment of pleurisy also includes physiotherapeutic procedures, taking multivitamins, and a gentle diet. Surgical removal of exudate from the pleural cavity is indicated in the following cases: when there is too much fluid and the effusion reaches the second rib or the fluid begins to compress neighboring organs, and also when there is a threat of developing purulent empyema.

After successful recovery, patients who have suffered pleurisy are monitored at the dispensary for another 2–3 years.

Prevention

Prevention of pleurisy is the prevention and timely diagnosis of diseases that can provoke the development of inflammation of the pleural layers.

To do this, you need to follow simple recommendations:

Strengthen the immune system: exercise regularly, take multivitamins, eat right;
Train the respiratory system: protozoa breathing exercises together with morning exercises will help to avoid inflammation of the respiratory system;
Avoid seasonal complications;
At the slightest suspicion of pneumonia, you need to take an x-ray and begin full-fledged complex therapy;
Stop smoking: nicotine often causes tuberculosis and tuberculous lesions of the pleura.

Strengthening the immune system, paying attention to your health and timely consultation with a doctor will help not only protect yourself from inflammation of the pleura, but also prevent such dangerous consequences as pleural adhesions, empyema, pleurosclerosis and overgrowth of the pleural cavity.

Purulent pleurisy, which can also be called “pleural empyema” or “pyothorax,” is a variant in which the effusion is represented by purulent masses. Pus, in turn, is called effusion, which contains large quantities of fragments of dead white blood cells - leukocytes and pathogenic microorganisms. It has a thick consistency and white-yellow color.

The figure shows a diagram of the pleural cavity in normal conditions and with purulent pleurisy.

Acute purulent pleurisy is characterized by the rapid accumulation of pus in the pleural cavity, its effect on the body - intoxication, as well as the development of respiratory failure, which can also be combined with signs of heart failure.

Purulent pleurisy is usually identified as an independent disease, because the main symptoms that form the clinical picture of the disease and its possible consequences differ from those with other types of exudative pleurisy. At the same time, treatment of patients, as a rule, requires active efforts at the local level and must be accompanied by their stay in a surgical hospital.

By origin this type pleurisy may result from:

Complicated pneumonia
Purulent-destructive diseases of the lungs, the most common of which should be considered abscess and gangrene of the lung.
Injuries and surgical interventions on the lungs
Acute inflammatory processes in the abdominal cavity: for example, subphrenic abscess
Spread of infection through the bloodstream from a distant purulent focus: for example, in cases of osteomyelitis - damage to the vertebral bodies. In this case, a lung abscess forms again. The abscess, in turn, leads to pleural empyema.

The figure shows the upper lobe of the left lung, in which an abscess has formed. In this case, the pathological process has already melted the lung tissue and is ready to move into the pleural cavity.

Nowadays, an abscess in the lungs gives an incidence of pleural empyema of about 10%, while pneumonia is 5%. But in patients with lung gangrene, this frequency is about 97%. This is due to the fact that gangrene is a very dangerous condition, which is characterized by the death of tissues in contact with external environment. It is caused by a special group of pathogenic microorganisms, usually characterized by particularly pronounced viability and pathogenic properties.

It is worth talking about abscesses in a little more detail. Most often, a lung abscess is a consequence general decline immunity, or inhalation foreign body. Often, an abscess is formed as a result of aspiration, that is, inhalation, by the patient of vomit, food particles, or other foreign particles. Usually the abscess is surrounded by a dense capsule.

However, over time, pus can melt its wall: then the abscess breaks through, and nearby tissue melts. It is at the moment of breakthrough of the abscess and spread of inflammation throughout lung tissue pleural empyema can form towards the visceral pleural layer. Therefore, it is important to diagnose an abscess in a timely manner and prevent its complications.

It is important to remember that purulent inflammation in the lining of the lungs can be a consequence of puncture of the pleural cavity or subclavian vein, if these manipulations are performed roughly and illiterately, resulting in injury to the pleural layers. However, nowadays such a complication occurs quite rarely.

Microorganisms that cause purulent inflammation of the lung lining are most often the following bacteria:

Quite often, the above microorganisms are found in association with anaerobes bacteroides, fusobacteria or prevotella. Anaerobes are microorganisms that do not require oxygen for adequate life. In patients who have been on artificial ventilation for a long time, in general, anaerobes may be the only causative agents of a purulent pathological process in the cavity of the lung lining.

Clinical picture of pleural empyema

In the first few tens of hours from the onset of the disease, signs of purulent pleurisy are usually masked. The patient mainly complains of symptoms characteristic of most pathological processes in the lungs: chest pain, weakness, lethargy, slight shortness of breath, fever.

By the third day of illness, the patient's condition usually deteriorates quickly and significantly. Appear severe pain in the chest, which intensify or occur when breathing and coughing: so-called “pleural pain”. Body temperature rises to 39-40 degrees. In this case, fluctuations in body temperature per day can reach 2 degrees. The patient experiences shaking chills, increasing shortness of breath, becomes lethargic and gradually loses interest in reality, his face may be haggard, his eyes sunken, his features sharpened: all these are signs of intoxication syndrome, that is, the harmful effect of accumulated pus on the patient’s body. Upon examination, the doctor’s attention is immediately drawn to such symptoms as increased breathing, sweating, difficulty breathing and diffuse cyanosis, that is, blueness skin patient.

As pus accumulates, it tends to spread: it simply melts nearby structures and spreads to soft fabrics chest wall. This may lead to the formation of a fistula, that is, an anastomosis between the pleural cavity and the external environment.

If a fistula forms between the cavity of the lung membrane and the bronchus, then spontaneous removal of purulent exudate from the pleural cavity occurs. In this case, the patient develops or significantly intensifies a cough, and a large amount of purulent sputum is released, often containing an admixture of blood. Moreover, the cough with the separation of purulent masses becomes stronger when the patient is positioned on the healthy side: the so-called “drainage position.”

A blood test reveals an increase in white blood cells– leukocytes: up to 15-20 thousand per 1 microliter with a norm of up to nine thousand. The erythrocyte sedimentation rate increases to 50-60 mm/h, which is 4 times higher than normal. Leukemoid reactions are possible. This means that the number of young and juvenile forms of leukocytes in the blood formula increases significantly.

Confirmation of the diagnosis of purulent pleurisy usually occurs during the examination of the actual contents of the cavity of the lung membrane, which is obtained through puncture. Purulent exudate is usually cloudy and viscous. It can have different colors. This depends mainly on the causative agent of the pathological process and its properties. If the causative agent is pneumococcus or staphylococcus, then the pus will have a yellow tint, if streptococcus - grayish. If the pathogens are mainly anaerobic, then the pus will be dirty gray in color and have a sharp, very unpleasant odor.

Later, a bacteriological examination of the purulent effusion is carried out. It allows you to accurately determine the causative agents of the process and their individual sensitivity to antibacterial drugs. This makes it possible to assign adequate treatment.

Warning

If the prevalence of the purulent process in the lungs is quite high, and treatment is insufficient and untimely, then an acute inflammatory process in the pleura can develop into chronic pleural empyema. In this case, the pus in the pleural cavity over time becomes surrounded by a kind of “bag”, the walls of which consist of dense and rough connective tissue, poor in blood vessels. The reason for the transition of an acute inflammatory process in the lining of the lungs to a chronic one, as a rule, is late detection and incomplete, “poor” drainage of pleural empyema. This outcome is also an obstacle to the complete expansion of lung tissue, previously compressed by purulent exudate.

Often, after delimitation of what has passed into chronic form process, the inflammatory focus is completely replaced by connective tissue. This condition is called fibrothorax.

Bright external sign fibrothorax is a visible decrease in the affected half of the chest and its lag in movement during breathing.

Necessary treatment measures

If the diagnosis of purulent pleurisy is confirmed in a patient, it is necessary to urgently prescribe adequate treatment. This will avoid the transition of acute purulent inflammation into a chronic form and other complications, such as increasing respiratory failure, for example.

The patient must be prescribed antibacterial therapy. The choice of a specific drug should be dictated by the results of bacteriological examination of the pleural effusion obtained during puncture.

In addition, detoxification therapy should be carried out aimed at reducing harmful effects the causative microorganism and the exudate itself on the patient’s body. It consists of intravenously introducing solutions into the patient’s body that improve the properties of the blood and promote the accelerated functioning of the kidneys as a filter, that is, the accelerated removal of harmful waste products of the causative bacteria from the patient’s body.

In addition to treatment aimed at the patient’s body as a whole, it is important to carry out active and regular local therapy. The latter consists of providing regular pleural punctures, which will allow the evacuation of exudate from the pleural cavity. The pleural cavity is washed antiseptic solutions, a drainage tube is inserted into it, through which the newly formed exudate drains, and drugs that accelerate tissue healing and solutions for washing the pleural cavity are also introduced.

Sometimes the drainage tube is connected to a special pump, which makes the work of medical personnel easier.

At its core it is secondary disease, which occurs as a complication after suffering from lobar or influenza-type pneumonia.

Etiology and types of disease

There are two types of purulent pleurisy:

Parapneumonic pleurisy of the lungs is considered a peculiar complication of pneumonia that occurs during its progression. The second type begins to develop after pneumonia has ended. It is more common in medicine. In addition, their appearance almost always provokes the development of serous-purulent or purulent exudation.

Most often, the appearance of purulent pleurisy is caused by the presence of staphylococci, streptococci, Pseudomonas aeruginosa or coli. Often, in the process of analyzing cultures of the contents of the pleura, the presence of pneumococcus, Proteus, Klebsiella and yeast is determined. Currently, the presence of anaerobic bacteria in test contents is very common. They are more characteristic of putrefactive empyema, which complicates the course of pulmonary gangrene.

Data from domestic and foreign research indicate that the number of staphylococcal diseases is rapidly increasing. At the same time, there is a progressive increase in the percentage of strains characterized by a high degree of resistance to antibiotics.

There has also been a significant increase in cases of discharge containing penicillin-resistant bacteria. At the same time, the number of types of microorganisms found in secretions is constantly increasing in the dynamics of treating pneumonia with antibiotics.

Symptoms of the disease

Patients who have been diagnosed with purulent pleurisy most often complain of the following signs of the disease:

the presence of pain and a feeling of heaviness in the lateral area, cough;
difficulty breathing and inability to take full breaths;
the appearance of shortness of breath;
significant increase in body temperature;
appearance of weakness.

In the first stages of the disease, symptoms such as stabbing pain in the chest area occur. But with the expansion of the area of inflammation and the formation of exudate, they become less intense, and a feeling of heaviness appears in the side.

Over time, shortness of breath becomes more severe. In many cases there is a dry cough. If secondary pleurisy develops, which occurs as a result of pneumonia or lung abscess, the cough is accompanied by sputum production. It has the appearance of mucus or purulent consistency.

When another disease develops along with pleurisy, a change is observed characteristic features cough. It becomes more intense and painful, and begins to occur more often at night. In some cases, it can have the character of attacks and is significantly intensified when a person lies on the sore side of the body.

Abscess rupture process

What happens if the patient is not provided with timely medical care? Shortness of breath becomes pronounced. Its intensification is observed, as in the case of cough, when the patient lies on his side. Therefore, the patient must always occupy the same body position to avoid the occurrence of discomfort, to ease breathing and reduce chest pain.

Body temperature rises to its maximum and is stable or hectic in nature. The pulse is beats per minute. This is affected not only by intoxication with purulent masses, but also by a shift in the cardiac and vascular position in the opposite direction from the accumulated exudate.

When a lung abscess ruptures, pus and air masses enter the pleural cavity. This provokes the onset of pleural shock. An intense cough that practically never stops is the most important precursor to a purulent outbreak.

The person fails to take a deep breath, the face gradually turns pale, and cold sweat appears on the skin. At the same time, the heart rate increases and a significant decrease occurs blood pressure. The sensation of pain provokes shallow, rapid breathing. Acrocyanosis appears and shortness of breath increases.

The reasons for this are irritation of the pleura. It is the source of pain, air pressure and purulent masses of the lung, changes in the position of organs and disruption of the heart.

After they subside acute manifestations illness and the patient is taken out of state of shock, the development of intoxication begins. She tends to be more dangerous form than with one of the types of pleural empyema.

If pleurisy is advanced, scars and adhesions form, bronchiectasis develops, inflammation becomes chronic, and exacerbations occur from time to time.

Methods of treating the disease

The main task of therapy for purulent pleurisy is to eliminate the infection and symptoms of emerging intoxication. In addition, it is necessary to restore the normal functioning of diseased organs.

First of all, you need to eliminate the purulent focus and then straighten the lung. Only after the layers of the pleura have fused and obliteration of the lesion cavity has occurred can we talk about recovery. The most important thing is to start treatment on time, which prevents the appearance of moorings in the pleural area and the disease becoming chronic.

Treatment of the patient consists of pumping out the exudate. The procedure is accompanied by intramuscular injection of penicillin into the cavity. If indicated, plasma or red blood cells are transfused.

Complex cases require surgical treatment, during which rib resection is performed.

Possible consequences

Pulmonary pleurisy is an extremely serious illness. If it has been neglected or not completely cured, there is a high probability of complications that are dangerous to human health. This could be an emerging adhesion, a bronchopleural fistula, or impaired blood circulation, which provokes exudate pressure on the vessels. In addition, there is a threat of the occurrence and development of kidney diseases.

The most dangerous consequence of this disease is pleural empyema. The essence of this pathological process is that pus accumulates in the lungs and, under the influence of this, a free cavity is formed. A kind of “pocket” is formed. After this, the pleura becomes scarred and completely blocks one of the lungs.

Another serious consequence of purulent pleurisy is the appearance of amyloidosis of parenchymal organs. Almost ½ of all cases of occurrence this complication had a fatal outcome. The development of amyloidosis is typical for people with weakened bodies, the elderly and children.

A small amount of exudate may resolve without intervention. After the underlying disease has been eliminated, exudation stops after a week. If the fluid is removed, then sometimes a persistent flow may occur, and the effusion again accumulates in the pleural cavity. This is especially typical for the infectious type of pleurisy. If the cause of the disease is oncological, then the disease always progresses and the outcome in almost 100% of cases is not favorable. Purulent pleurisy also has the same type of disease course.

Patients with a history of this disease are under long-term observation at the dispensary. In addition, among the recommendations of doctors, the first place is to avoid fortified and high-calorie diets, prevent colds and hypothermia, limit work in especially harmful conditions related to chemicals.

The essence of preventing purulent pleurisy is the timely and high-quality treatment of those diseases that provoke its appearance and development.

You should definitely increase your body’s resistance to various infections.

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JMedic.ru

Purulent pleurisy, which can also be called “pleural empyema” or “pyothorax,” is a variant of exudative pleurisy, the effusion in which is represented by purulent masses. Pus, in turn, is called effusion, which contains large quantities of fragments of dead white blood cells - leukocytes and pathogenic microorganisms. It has a thick consistency and white-yellow color.

The figure shows a diagram of the pleural cavity in normal conditions and with purulent pleurisy.

Origin of pleural empyema

Purulent pleurisy is usually identified as an independent disease, because the main symptoms that form the clinical picture of the disease and its possible consequences differ from those of other types of exudative pleurisy. At the same time, treatment of patients, as a rule, requires active efforts at the local level and must be accompanied by their stay in a surgical hospital.

By origin, this type of pleurisy can be the result of:

Complicated pneumonia
Purulent-destructive diseases of the lungs, the most common of which should be considered abscess and gangrene of the lung.
Injuries and surgical interventions on the lungs
Acute inflammatory processes in the abdominal cavity: for example, subphrenic abscess
Spread of infection through the bloodstream from a distant purulent focus: for example, in cases of osteomyelitis - damage to the vertebral bodies. In this case, a lung abscess forms again. The abscess, in turn, leads to pleural empyema.

Nowadays, an abscess in the lungs gives an incidence of pleural empyema of about 10%, while pneumonia is 5%. But in patients with lung gangrene, this frequency is about 97%. This is due to the fact that gangrene is a very dangerous condition, which is characterized by the death of tissues in contact with the external environment. It is caused by a special group of pathogenic microorganisms, usually characterized by particularly pronounced viability and pathogenic properties.

It is worth talking about abscesses in a little more detail. Most often, a lung abscess is a consequence of a general decrease in immunity, or a foreign body entering the respiratory tract. Often, an abscess is formed as a result of aspiration, that is, inhalation, by the patient of vomit, food particles, or other foreign particles. Usually the abscess is surrounded by a dense capsule.

However, over time, pus can melt its wall: then the abscess breaks through, and nearby tissue melts. It is at the moment of breakthrough of the abscess and spread of inflammation through the lung tissue to the visceral pleural layer that pleural empyema can form. Therefore, it is important to diagnose an abscess in a timely manner and prevent its complications.

Microorganisms that cause purulent inflammation of the lung lining are most often the following bacteria:

Staphylococcus aureus or Staphylococcus aureus.

Microphotograph of Staphylococcus aureus. The bacterium has spherical shape and is arranged in the form of grape bunches.

Micrograph of Streptococcus pyogenes. The bacterium has a spherical shape and is arranged in the form of chains.

Micrograph of Escherichia coli. The bacterium has a rod-shaped form. Located in groups.

Micrograph of Haemophilus influenzae. It has a rod-shaped shape. It is located more scattered. Compared to E. coli.

Clinical picture of pleural empyema

By the third day of illness, the patient's condition usually deteriorates quickly and significantly. Severe pain appears in the chest, which intensifies or occurs when breathing and coughing: the so-called “pleural pain”. The body temperature rises to several degrees. In this case, fluctuations in body temperature per day can reach 2 degrees. The patient experiences shaking chills, increasing shortness of breath, becomes lethargic and gradually loses interest in reality, his face may be haggard, his eyes sunken, his features sharpened: all these are signs of intoxication syndrome, that is, the harmful effect of accumulated pus on the patient’s body. Upon examination, the doctor’s attention is immediately drawn to such symptoms as increased breathing, sweating, difficulty breathing and diffuse cyanosis, that is, the bluish color of the patient’s skin.

As pus accumulates, it tends to spread: it simply melts nearby structures and spreads to the soft tissue of the chest wall. This may lead to the formation of a fistula, that is, an anastomosis between the pleural cavity and the external environment.

A blood test reveals an increase in white blood cells - leukocytes: up to a thousand per 1 microliter, with a norm of up to nine thousand. The erythrocyte sedimentation rate increases by 100 m/h, which is 4 times higher than normal. Leukemoid reactions are possible. This means that the number of young and juvenile forms of leukocytes in the blood formula increases significantly.

Warning

Often, after delimitation of a process that has become chronic, the inflammatory focus is completely replaced by connective tissue. This condition is called fibrothorax.

A striking external sign of fibrothorax is a visible reduction in the affected half of the chest and its lag in movement during breathing.

Necessary treatment measures

The patient must be prescribed antibacterial therapy. The choice of a specific drug should be dictated by the results of bacteriological examination of the pleural effusion obtained during puncture.

In addition, detoxification therapy should be carried out, aimed at reducing the harmful effects of the causative microorganism and the exudate itself on the patient’s body. It consists of intravenously introducing solutions into the patient’s body that improve the properties of the blood and promote the accelerated functioning of the kidneys as a filter, that is, the accelerated removal of harmful waste products of the causative bacteria from the patient’s body.

In addition to treatment aimed at the patient’s body as a whole, it is important to carry out active and regular local therapy. The latter consists of providing regular pleural punctures, which will allow the evacuation of exudate from the pleural cavity. The pleural cavity is washed with antiseptic solutions, a drainage tube is inserted into it, through which the newly formed exudate drains, and drugs that accelerate tissue healing and solutions for washing the pleural cavity are also introduced.

Sometimes the drainage tube is connected to a special pump, which makes the work of medical personnel easier.

Causes of purulent pleurisy, characteristic symptoms, possible consequences and treatment methods

The most complex and dangerous pathology of the lungs is pleurisy, and people of any gender are at risk. As this disease progresses, an inflammatory process develops on the outer surface of the lung tissue, and pus accumulates inside the organ.

Acute purulent pleurisy causes an increase in body temperature and constant shortness of breath, and the patient is in extremely serious condition.

The reasons for the development of such pathologies may be different, and in the absence effective therapy Possible death.

Causes of development and forms of the disease

Experts say that pleurisy is not an independent disease. Mostly this disease develops as a result of the progression of various ailments in other organs.

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All causes that provoke pulmonary pleurisy are conventionally divided into:

Medical practice shows that the following pathologies can cause infectious pleurisy:

the appearance of problems with the functioning of the gastrointestinal tract;
diabetes;
chronic lung pathologies;
alcoholism.

Non-infectious causes include various malignant tumors, and their place of localization becomes the outer surface of the lungs. In addition, various damage and injuries to the connective tissue can cause pleurisy of the lung tissue.

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Experts identify several forms of pulmonary pleurisy, taking into account clinical picture. The dry form of the disease is considered the initial stage of the development of the disease. This form of pathology is characterized by damage to the circulatory system, and no infectious pathogens are detected in the pulmonary cavity.

The dry form of the disease is accompanied by an increase in vascular permeability under the influence of anti-inflammatory components. In addition, the patient has leakage of liquid plasma, and this results in the appearance of fibrous threads on the pulmonary surface. Such pleurisy is characterized by a violation of the outflow of fluid, which causes severe friction of the pleural layers. The consequence of this is the emergence of strong painful sensations at the patient.

In the absence of timely effective therapy, the dry form of the disease transitions to the next stage. There is an increase in the focus of inflammation and exudative disease develops.

At this stage of the development of the disease, the activity of enzymes decreases significantly and a kind of cavity appears, where pus subsequently accumulates. Exudative form pleurisy is accompanied by a significant increase in pleural fluid, and under its influence the volume of the lung is significantly reduced.

In a situation where the disease progresses to advanced stage, then the patient begins to suffer respiratory failure. There is a decrease in friction in the pleural layers due to increased fluid accumulation, which causes a decrease in pain.

The next stage in the development of the disease is purulent pleurisy or pleural empyema. This form of the disease is quite complex and poses a serious threat to the patient’s life. There is an accumulation of a large amount of pus in the serous membrane, and the general intoxication of the patient’s body increases. Medical practice shows that empyema most often forms with the progression of complex pathologies of other organs or in patients with impaired functioning of the immune system.

With purulent pleurisy in acute form a rise in body temperature and the appearance of shortness of breath are noted, and the general condition of the patient is diagnosed as extremely serious.

Symptoms of the disease

Purulent lung disease is characterized by the following symptoms:

the occurrence of acute painful sensations and a feeling of heaviness;
breathing problems when it is impossible to breathe deeply;
there is a feeling of fullness in the side;
rise in body temperature;
severe cough and shortness of breath;
weakness of the body.

With purulent pleurisy, the patient complains of the appearance of severe painful sensations, but with the accumulation of pus they begin to decrease. Purulent pleurisy is accompanied by the appearance of a dry cough, which especially bothers the patient at night. In a situation where pleurisy develops as a complication after inflammation or a lung abscess, sputum mixed with pus begins to appear.

A characteristic sign of purulent lung disease is a rise in temperature up to several degrees. Fever may persist all the time or appear periodically. The pulse reaches beats per minute and the cause of this condition is purulent intoxication of the body, as well as a displacement of the heart to one side.

This patient's condition is considered serious and requires immediate medical attention. If effective therapy is not carried out, pus may leak into the pleural cavity. During the development of the inflammatory process, not only pus, but also air accumulates in the pleural cavity. This pathological condition in medical practice is called “pyopneumothorax” and is accompanied by the patient experiencing severe shortness of breath and pain.

If purulent pleurisy enters an advanced stage, the result is tissue scarring and the appearance of adhesions. In addition, bronchiectasis is diagnosed, and the inflammatory process becomes chronic with relapses.

Possible consequences and diagnosis

In the absence of effective therapy, the pathology can pose a serious threat to the patient's life. This is due to the fact that the progression of purulent pleurisy in the human body can result in the development of a lung abscess.

If a purulent pocket breaks through, the infection spreads into the pleural cavity. The consequences of this pathological condition are pneumonia, cystic formations and gangrene.

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Breakouts of a pocket of pus in a patient are accompanied by a rise in temperature, as well as increased coughing and increased heart rate. In addition, breathing becomes more frequent and when the abscess breaks through, hypoxia begins to develop.

If pleurisy reaches an advanced stage, this causes a significant increase in the affected area of the chest. The progression of pleurisy in the human body causes general intoxication, and the content of a large amount of pus provokes expansion of the intercostal space and respiratory arrest.

In the absence of effective therapy, the consequences of such a disease can develop in the form of adhesions and pleural calcification. In addition, restriction of lung mobility and the development of acute heart failure may occur.

The main and only method for identifying purulent pleurisy is X-ray examination chest. The images obtained during the procedure show darkening of the lung tissue and an oblique upper fluid level. The location of the fluid accumulation is determined by its quantitative volume.

Another effective method for diagnosing purulent pleurisy is pulmonary puncture. Fluid is taken from the patient's lungs, which is subsequently carefully studied. Thanks to this procedure, it is possible to diagnose the type of pathology and select an effective course of treatment.

Features of treatment of the disease

If purulent pleurisy is suspected, the patient is subject to mandatory hospitalization.

Treatment of this pathology involves solving the following problems:

stabilization of the patient's condition;
restoration of normal breathing;
eliminating the cause that provoked pleurisy.

In most cases, this pathology is of infectious origin, so drug therapy is carried out using antibiotics and anti-inflammatory drugs.

When fighting purulent pleurisy, the following antibacterial drugs are prescribed:

Taking antibiotics to treat pleurisy helps prevent further dissemination bacteria and cause their death.

It is possible to restore water and electrolyte balance using saline or glucose. This drug treatment helps speed up kidney filtration and quickly get rid of waste products.

Therapy for purulent pleurisy can be carried out using the following medicines:

diuretics help the body get rid of fluid and slow down the absorption of sodium and potassium;
non-steroidal anti-inflammatory drugs help get rid of severe pain;
glucocorticosteroids prevent the synthesis of anti-inflammatory components.

If dry pleurisy is detected, treatment involves following bed rest. In addition, medications that have an antimicrobial, analgesic and anti-inflammatory effect on the body are prescribed. Cupping and warm compresses help speed up the healing process.

When diagnosing a form of the disease such as purulent exudative pleurisy, the patient is placed in an inpatient setting at a medical institution. Conservative therapy involves taking drugs with antitumor and anti-infective effects on the body.

An important role in this form of the disease is compliance with special diet with sufficient vitamins and proteins. Special food involves the complete exclusion of salt from the diet and the consumption of a limited amount of liquid.

If an increased amount of fluid appears in the pleural cavity, then specialists decide to perform a puncture. To perform this procedure, a special needle is inserted into the pleural area on the side of the scapula. Thanks to the puncture, it is possible to remove it from the body. excess liquid, will significantly reduce the pressure in the pulmonary cavity and restore breathing. After the puncture, the patient is prescribed therapeutic exercises and physiotherapy.

Treatment of purulent pleurisy is carried out only in inpatient conditions. Self-treatment illness at home can pose a threat to the patient’s life and cause severe consequences.

The main task in the treatment of such pathology is to prevent the process of tissue destruction. Daily puncture is performed, the cavity is washed with antiseptic agents, and drainage is applied.

For purulent pleurisy, drug treatment may not bring the desired result, so they resort to surgical intervention. During the operation, specialists remove dense scars of the pleura or its parietal sheets, and this is determined by the degree of damage to the lung.

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