Pleurisy

A pleuritis ( pleurisy, pleurisy majority ) is an inflammation of the pleura (ribs or pleura ). The pleura covers the lungs and lines the chest cavity from the inside out. Pleurisy make typically by respiratory -related pain usually on one side of the chest noticeable. Pleurisy may be underlying diseases and affect the general condition of painful, and significantly a character. The frequent tuberculous pleurisy earlier has become very rare in Western Europe. The cause of infectious pleurisy remains mostly unclear, since an invasive diagnosis is not indicated in benign course.

Classification

Pleurisy is based on the degree of severity in different forms ( leichtgradig to severely ) or on the basis of the timing of an acute ( sudden ) or chronic ( longer running ) divided form. Based on the possible causes, one can try to make a distinction between an infectious and a noninfectious form:

• Infectious forms of bacterial, viral or mycotic related ( caused by fungi ),
• Non-infectious forms occur in the context of pancreatitis on pulmonary embolism, pneumonia or pleural ( tumor involvement of the pleura ) and rheumatic diseases, postoperative or traumatic and after instillation of pleurareizenden drugs.

Based on the accompanying pleural effusion can be a dry distinguished from a wet pleurisy. In most dry pleurisy is nevertheless detects ultrasound minimal effusion, so that such a classification can not be strictly carried out.

Symptoms

Decisive symptom of pleurisy is the breath -dependent pain in the chest, especially in the dry pleurisy (dry pleurisy ). Another symptom of this stage is the vocal by auscultation so-called " leather creaking " of the two rubbing together Pleurateile. The pain can be right, left, both sides, front or rear occur in the chest. However, go hand in hand without pain pleurisy, especially when by an accompanying pleural effusion ( exudative pleurisy ) no rubbing of the mucous membranes occurs. Other non-specific symptoms of pleurisy can be fever, shortness of breath and cough.

Diagnostics

The etiological ( causal ) clarification of pleurisy can offer considerable difficulties, since a variety of infectious or non-infectious diseases may underlie. In addition, the differential diagnosis for a number of reasons thoracic pain must be considered.

Basic diagnostics

• Characteristic symptoms with painful inhalation and exhalation
• Pleural when listening ( " leather creaking " )
• Ultrasound often less pleural effusion and lung irregular contour
• Measuring temperature, CRP laboratory values ​​, blood count to detect the degree of inflammation

Further clarification of cause

• Leg vein ultrasound for possible evidence of thrombosis
• Chest x-ray to rule out pneumonia
• Occasionally cytology and bacteriology from the pleural
• Blood culture with high fever
• Diagnosis of tuberculosis may
• Rheumatology Diagnostics

Therapy

The treatment of simple uncomplicated pleurisy is aimed at reducing or eliminating pain.

Can detect a cause, treatment of the underlying disease is useful.

• Symptomatic treatment of pain with analgesics
• Still coughing end measures by a antitussive (not useful for ejection )
• Causal therapy: Antibiotics in bacterial pleuropneumonia or purulent pleurisy
• Cortisone in rheumatoid pleurisy
• Instillation of a cytostatic in pleural

Sometimes a larger pleural effusion, which arose in the context of inflammation, are punctured. In a purulent pleurisy flushing and drainage of the pleural space with a systemic antibiotic therapy are useful. In case of heavy breathing difficulties, one may administer oxygen.

The patient with pleurisy must comply with bed rest. After an improvement of symptoms should be started with specific breathing exercises. As long as the symptoms persist, the body should be conserved as much as possible. Therefore, strenuous activities and sports should be avoided during this time.

The storage while sleeping can be left to the sufferers themselves. With strong pain on the side he is usually lying on the affected side, as it can so move and aerate the healthy lungs free. On the other hand, the storage is recommended on the healthy side, to allow for better ventilation on the ( stronger) the affected side.

Course

The majority of pleurisy heals without consequence. Some pleurisy lead to scarring adhesions. A purulent or tuberculous pleurisy can also lead to death but untreated.

• Disease in pneumology