Inflammation of the pleura

Synonyms in the broader sense

Synonyms: pleurisy, pleurisy

Technical term: pleurisy

definition

The Pleura or pleura is a layer of skin that covers the outside of the lungs and lines the inside of the chest. With this type of coating, the pleura produces a fine, almost watery one liquidto some Sliding ability of the organs within the chest cavity.

The term "pleurisy" describes a disease in which there is too inflammatory processes comes inside the rib cage.
In this context either that Lungs or pleura be inflamed. In some cases, the inflammatory processes even involve both structures at the same time.

General

An inflammation of the pleura usually goes through acute pain during breathing noticeable (breath-dependent pain) which are mostly limited to one side of the chest.

These complaints can severely limit the general well-being of the patient concerned and make a normal daily routine impossible.
The inflammation on Pleura is often a sign of another underlying disease and in these cases is more than symptom than as an independent disease. In most cases, however, the underlying cause of the pleura inflammation cannot be determined. This fact is due to the fact that an extensive Diagnosis does not have to be carried out if the course is benign.

The inflammation on the pleura is medically divided into different forms.
The division of pleurisy based on the is particularly popular Severity (mild to severe) or using the over time the symptoms felt by the affected patient (sudden or prolonged; acute or chronic Progressive form).
In addition, the inflammation can be classified on the Pleura starting from the possible causes respectively.
In this context one differentiates between infectious forms (bacterial, viral or caused by fungi) by non-infectious forms pleurisy.
Another form of subdivision relates to whether there is a so-called development in the course of the inflammation on the pleura Pleural effusion (Fluid accumulation between the pleura and pleura) comes or not. In this context, pleurisy turns into a dry and a damp Divided course form.
However, since ultrasound can detect at least a minimally pronounced pleural effusion even with most dry inflammations on the pleura, this classification is rather doubtful.

causes

The inflammation of the pleura is not itself considered to be an independent disease.

In most cases, the inflammatory processes arise in the course of other underlying diseases that affect the pleura.
The main cause of inflammation in the pleura is pneumonia (technical term: pneumonia). In this disease, pronounced inflammatory processes occur within the lung tissue that can spread to the pleura.

In addition, tuberculosis is one of the typical diseases that are usually associated with inflammation of the pleura.
The term "tuberculosis" refers to a chronic infectious disease that primarily affects the lungs. The cause of this disease is an infection with immobile, acid-stable bacteria (Mycobakerium tuberculosis). The infection usually occurs through direct contact with people suffering from open tuberculosis.
At the beginning of the infection, the affected patients typically develop non-specific symptoms such as cough, night sweats and loss of appetite. In addition, there is a slight temperature increase in the infected people a short time after the infection. In the further course, inflammation of the pleura with pronounced fluid retention, impairment of the liver and spleen, as well as the onset of meningitis (technical term: meningitis) can develop.
Tuberculosis is a serious disease that urgently needs immediate treatment.

Another cause of inflammation on the pleura is the so-called "lung infarction" (death of lung tissue as a result of a vascular occlusion).

If there is inflammation of the pleura, cancer (for example, bronchial carcinoma or pleural mesothelioma) should also be excluded. Above all, pleural mesothelioma, which can lead to inflammation of the pleura, occurs primarily in people who are exposed to asbestos due to work.

Furthermore, inflammation of the pleura can be caused by various autoimmune diseases. A classic example of such a disease is lupus erythematosus.

In rare cases, the inflammation on the pleura is caused by an acute viral infection. Above all, the Coxsackie B virus or the herpes virus are possible pathogens.

Symptoms

The symptoms caused by inflammation of the pleura depend largely on the type of disease present in the respective patient. In this context, the question of whether the inflammation of the pleura is associated with a pleural effusion plays a decisive role.

Symptoms of dry inflammation on the pleura

Occur in the affected patient severe stabbing pain in the area of ​​the chest, it can be assumed that it is a dry inflammation of the pleura. Typically, the discomfort decrease during the inhalation and des Cough clearly in intensity. For this reason, the sufferer can usually be very shallow breathing observe. In addition, a dry cough without sputum is one of the most common symptoms of dry inflammation on the pleura. During the physical examination, a typical pleural rubbing can also be heard with the stethoscope. These rubbing noises are caused by the sliding of the individual layers of the inflamed pleura. Since the dry form of the inflammation on the pleura can lead to minimally pronounced accumulations of fluid, these typical signs mostly disappear as the disease progresses.

Symptoms of moist inflammation on the pleura

In contrast to dry inflammation on the pleura, the wet form does not lead to painful discomfort in the chest area. The reason why there is no pain on the pleura with the damp inflammation is the fact that fluid accumulates between the pleura and the pleura. Typical symptoms of moist inflammation on the pleura are a feeling of pressure in the chest and pronounced shortness of breath. In rare cases, the wet form of the inflammation on the pleura causes initial pain in the shoulder area. The reason for this is an irritation of the diaphragmatic nerve (nervus phrenicus) caused by the accumulation of fluid. In addition, the damp inflammation on the pleura can be caused by further

Complaints can be distinguished from the dry form. In particular, the increase in weight caused by the accumulation of fluid between the pleura and the pleura is a decisive differentiating feature. Furthermore, wet pleurisy usually leads to a high fever, while patients suffering from dry inflammation of the pleura usually only have one small increase in temperature can be observed.

diagnosis

The diagnosis of inflammation on the pleura is carried out in several steps.

The first and most important step in diagnosing inflammation on the pleura is a detailed doctor-patient discussion (anamnesis). During this conversation, the patient concerned should describe as precisely as possible which complaints are present and when they were noticed for the first time. The quality of the pain (stabbing, dull, burning) can also provide an initial indication of the underlying disease.

This doctor-patient consultation is usually followed by a physical examination tailored to the symptoms.
If there is a dry inflammation of the pleura, the attending physician can hear typical rubbing noises with the stethoscope during this physical examination (so-called pleural rubbing). This rubbing noise occurs when the pleura, which lines the inside of the chest, slides over the pleura surrounding the lungs.

Another important measure in the diagnosis of inflammation of the pleura is to take a chest x-ray (chest x-ray). This image can be used to decide whether the inflammation of the pleura was caused by pneumonia. In addition, the accumulations of fluid between the pleura and the pleura (pleural effusions) that are typical for a damp inflammation on the pleura are visible in the chest x-ray.

Read more on the topic: Chest x-ray (chest x-ray)

An ultrasound scan can also help to find out whether the inflammation on the pleura has caused fluid to accumulate in the chest.

The extent of the inflammation on the pleura, or the exact extent of inflammation, can be determined with the help of a blood test. In patients suffering from inflammation of the pleura, the general inflammation values ​​in the blood are typically significantly increased. In addition to the white blood cells (leukocytes), the so-called C-reactive protein (CRP) also shows a significant increase.
In addition, the sedimentation rate (ESR) is usually accelerated in affected patients.

therapy

Since an inflammation of the pleura is usually only the side effect of another disease, the treatment is primarily aimed at the underlying disease that is causing it.

Is the origin of the inflammation on the pleura one lung infection under certain circumstances, a antibiotic therapy be initiated. Whether taking one Antibiotic This depends on whether the pneumonia is required bacterial or viral caused.
Only bacterial pneumonia will respond to antibiotic treatment.
However, if the pneumonia is caused by a virus, only the symptoms can be alleviated. For this reason, the affected patients usually receive pain reliever and anti-inflammatory Medication.

In some cases, direct treatment of the inflammation on the pleura can also be useful. This is usually especially the case with dry inflammation on the pleura (Pleurisy sicca) necessary. The therapy takes place in the affected patients via a special Breathing training. In this way it can be prevented that the different parts of the pleura grow together.
Since there is typically no pain-related flattening of breathing in patients suffering from damp inflammation of the pleura, breathing training is not necessary in these cases.

Besides the pain reliever drugs should also antitussive drug (Antitussives) be prescribed.

In addition, a so-called Chest drain become necessary. In this procedure, the chest is opened with a small incision and a thin plastic tube is inserted, which pumps the fluid out of the body.

Patients who suffer from pronounced inflammation of the pleura should also note that during the treatment phase bed rest must be adhered to. The inflammatory processes in the area of ​​the chest place enormous demands on the body's defenses. The healing process can therefore be positively influenced by physical rest. If treatment is initiated early if there is an inflammation in the pleura, the inflammatory processes usually heal without any problems.

Duration

The duration of the pleurisy depends on the severity and type of underlying disease.

It is hardly possible to give an exact time. Until one pleurisy is completely cured, several weeks can pass.

So the duration is included virally induced Pleurisy between one to two weeks.

At bacterial cause the disease process can up to four weeks expand. Taking an antibiotic in the second case can shorten the time frame somewhat.

Is the pleurisy a Cancer no statement can be made regarding the duration. In general, most of them heal without consequences. In some rare cases, such as tuberculosis or a tumor disease, pleurisy can lead to death if left untreated.

Complications

The inflammation on the pleura can lead to serious complications, especially if the disease is severe.

In this context, adhesions of the pleura play an important role. These adhesions mostly result from the inflammatory processes and the immigration of immune cells that this initiates.
During the healing phase, the individual layers of the pleura lie close together. Since there is hardly any movement over a long period of time in this area, due to the mostly very shallow breathing, the layers of the pleura can stick to one another for a long time. The result is a so-called pleural rind (synonym: pleural rash). As a result, the lungs are firmly connected to the chest and can no longer develop freely while breathing even after the inflammation on the pleura has healed completely.
As a result, the affected patients usually have a reduced tidal volume (amount of air that gets into the lungs per breath).

forecast

The prognosis of an inflammation of the pleura depends primarily on the underlying disease and its treatment options.
Patients who consult a doctor early when the typical symptoms occur usually have a good chance of recovery. In particular, the virally caused inflammation on the pleura usually has a very mild course and heals within a short time without complications.

Read our topic for more information: Pleurisy duration.

prophylaxis

Since the inflammation of the pleura is in most cases a direct consequence of another disease, it is difficult to prevent the development of such inflammatory processes.
Patients who suffer from a general immune deficiency can, however, by strengthening the Immune system reduce the risk of inflammation in the pleura.
Above all, a balanced diet and adequate intake of Vitamins can help to strengthen the body's immune system.
In addition, patients who frequently suffer from infections should make sure that they have enough zinc to take in. This important Trace element is found primarily in foods such as beef, cheese, fish and legumes. It should also be noted that the immune system can only really function if the body is regularly challenged.
Because of this, getting enough exercise plays a vital role in strengthening the immune system.