What Is Pleuritic Chest Pain?

Pleurisy (pleurisy) refers to the inflammation of the pleura caused by the stimulation of the pleura by pathogenic factors (usually viruses or bacteria). The pleural cavity can be accompanied by fluid accumulation (exudative pleurisy) or aneroid accumulation (dry pleurisy). After the inflammation is controlled, the pleura can return to normal, or two layers of pleura can adhere to each other. The main clinical manifestations are chest pain, cough, chest tightness, shortness of breath, and even dyspnea. More common in young people and children.

Basic Information

nickname

pleurisy

English name

pleurisy

Visiting department

Thoracic Surgery

Multiple groups

Tuberculosis patients, tumor patients

Common causes

Mostly caused by pneumonia, lung cancer, tuberculosis, etc.

Common symptoms

Chest pain, cough, chest tightness, shortness of breath, or even shortness of breath

Contagious

Contagious with tuberculosis

Causes of pleurisy

Pleuritis can be caused by infections (bacteria, viruses, molds, amoeba, lung flukes, etc.) and infectious factors such as tumors, allergies, chemical and traumatic diseases. Among pleurisy caused by bacterial infection, tuberculous pleurisy is the most common. Common diseases causing pleurisy: pneumonia, pulmonary infarction due to pulmonary embolism, cancer, tuberculosis, rheumatoid arthritis, systemic lupus erythematosus, parasitic infections (such as amebiasis), pancreatitis, injuries (such as rib fractures) ), Irritants (such as asbestos) that reach the pleura from the airways or other parts, drug allergic reactions (such as hydrazine, procainamide, isoniazid, phenytoin, chlorpromazine), etc.

Clinical manifestations of pleurisy

Most exudative pleurisy is acute. The main clinical manifestations are chest pain, cough, chest tightness, shortness of breath, and even dyspnea. Infective pleurisy or pleural effusion secondary infection may have chills and fever. Those with mild condition may be asymptomatic. Different causes of pleurisy can be accompanied by clinical manifestations of the corresponding disease.

Chest pain is the most common symptom of pleurisy. It often occurs suddenly, and the degree varies greatly. It can be unclear discomfort or severe tingling, or it only occurs when the patient takes a deep breath or cough. It also persists and is exacerbated by deep breath or cough. Chest pain is caused by inflammation of the parietal pleura, which occurs on the chest wall facing the site of inflammation. It can also manifest as an involved pain in the abdomen, neck, or shoulders. Deep breathing can cause pain, causing shallow breathing, and weak muscle movement on the affected side compared to the opposite side. If a large amount of accumulation occurs, the two layers of pleura can be separated from each other, and chest pain can disappear. A large amount of pleural effusion can cause unilateral or bilateral lung limitation during breathing, and dyspnea can occur. Examination revealed pleural friction.

The symptoms of tuberculosis are mainly fever, chills, sweating, fatigue, loss of appetite, and night sweats. Local symptoms include chest pain, dry cough and dyspnea. Chest pain is mostly located below the front axillary or posterior axillary line with the largest range of thoracic breathing movements. As the pleural effusion gradually increased, chest pain gradually reduced or disappeared after a few days. The pleural irritation can cause reflex dry cough, which is more obvious when the body is turned. When the volume of fluid is small, there is only chest tightness and shortness of breath. If a large amount of fluid is used to force the lungs, heart and mediastinum, breathing difficulties may occur. The faster and more effusions are produced and accumulated, the more difficult it is to breathe, and there may even be sitting breathing and cyanosis.

Pleurisy

Blood routine

The white blood cell count was normal or slightly increased at an early stage, rarely exceeding 12 × 10 ⁹ / L. ESR increased faster.

2. Sputum examination

Sputum is positive.

3. Pleural fluid examination

For exudative, transparent, yellow grass, specific gravity is greater than 1.018, positive for Rifavan test, protein quantification is greater than 30g / L.

4. Chest X-ray

Large and dense areas of the middle and lower lungs increase the density and darken the shadows. Only a small amount of effusion shows that the costosacral angle becomes blunt.

5. Pleural biopsy

Pleural biopsy is an important method to diagnose tuberculous pleurisy. In addition to the feasible pathological examination of biopsy pleural tissue, the culture of tuberculosis bacteria can also be performed. For example, changes in parietal pleural granulomatosis suggest the diagnosis of tuberculous pleurisy. Although other diseases such as fungal diseases, sarcoidosis, tuaremia, and rheumatic pleurisy can have granulomatous lesions, more than 95% Pleural granulomatous lesions are tuberculous pleurisy. If a pleural biopsy fails to detect a granulomatous lesion, the biopsy specimen should be stained with acid-fastening, and multiple biopsies may be performed. If biopsy specimens are cultured together with microscopy, the positive diagnosis rate of tuberculosis is 90%. Pleural biopsy under direct vision can also be performed with thoracoscopy, and the positive rate is higher.

6. Ultrasound inspection

Ultrasonic detection of pleural effusion has high sensitivity, accurate positioning, and can estimate the depth and volume of pleural effusion, indicating the puncture site. It can also be distinguished from pleural thickening.

Diagnosis of pleurisy

Exudative pleurisy can usually be diagnosed based on the etiology, clinical manifestations, and laboratory tests. The clinical manifestations are mainly moderate fever, relief after the onset of chest pain, and dyspnea. Physical examination, X-ray examination and ultrasound examination can make a diagnosis of pleural fluid. Diagnostic thoracentesis, routine examination of pleural fluid, biochemical examination, and bacterial culture are necessary measures for diagnosis, and 75% of the causes of pleural fluid can be diagnosed. .

Differential diagnosis of pleurisy

This disease should be distinguished from pleural metastasis of bronchial lung cancer and pleural effusion caused by liver, kidney, and heart disease.

Pleurisy treatment

General treatment

Exudative pleurisy often has fever, and should be lying down and rested. The affected side should be used to fully compensate the healthy lung. Strengthen nutrition, increase appetite, and give high-protein, high-calorie, multivitamin-digestible diet. For patients with high fever should be physically cooled, antipyretics should be given if necessary

2. Antibiotics

Antituberculosis treatment is suitable for the treatment of tuberculous (dry or exudative) pleurisy. The principle of antituberculosis treatment is early treatment, and the drug should be used in sufficient amount and for a long time. Isoniazid, rifampicin, ethambutol and streptomycin were used alternately for a total of 6 to 9 months. Tuberculous pleurisy is often treated with a combination of streptomycin and isoniazid. During the use of streptomycin, patients should be observed for lip numbness, tinnitus, deafness and other toxic reactions. If they occur, the drug should be stopped immediately. Hearing impairment caused by streptomycin is permanent and vigilance must be exercised, and caution should be exercised in children's medication. Isoniazid has a strong bactericidal effect, can penetrate into the tissues, penetrate the blood-brain barrier, and can be administered intratracheally or intrathoracically. The long-term use of isoniazid should observe liver damage, periodically test liver function, and timely add liver protection drug. For central nervous system reactions such as dizziness, insomnia, or convulsions, symptomatic treatment with vitamin B ₆ can be added. Non-tuberculous pleurisy should be selected according to the primary disease (such as infection, tumor, etc.). Patients with purulent pleurisy or tuberculous empyema with infection are treated with penicillin.

3. relieve pain

Oral aspirin, indomethacin, or codeine.

4. Thoracentesis

Applicable to patients with exudative pleurisy pleural effusion, mediastinum or heart pressure, obvious breathing difficulties or long-term non-absorption of fluid. Exudate to relieve symptoms and avoid thickening of pleural adhesions caused by fibrin deposition. The pumping speed should not be too fast. You can pump 400 to 600 ml for the first time, and then gradually increase it. The amount of each pump should not exceed 1000 ml, so as not to cause circulatory disturbance or shock due to sudden decrease in chest pressure and displacement of the mediastinum. 2 to 3 times a week.

5. Hormone therapy

The combination of adrenocortical hormone and antituberculosis drugs is suitable for acute tuberculous exudative pleurisy, and has a positive therapeutic effect on eliminating systemic toxicity symptoms, promoting the absorption of effusion, and preventing pleural thickening and adhesion. Hormones can be administered systemically or locally. Prednisone can be taken orally. When the systemic symptoms improve and the effusion is clearly absorbed, the hormone withdrawal should be gradually reduced to avoid rebound. Medication for 4 to 6 weeks.