Purulent pleurisy is an accumulation of pus in the pleural cavity with secondary compression of the lung tissue.
Purulent pleurisy are secondary diseases, more often they complicate inflammatory diseases of the soft – croupous or post-influenza pneumonia. There are para- and metapneumonic purulent pleurisy. Parapneumonic pleurisy complicates pneumonia at the time of its height, and metapneumonic or postpneumonic pleurisy appears after the resolution of pneumonia. Metapneumonic pleurisy is more common than parapneumonic, and they often develop serous-purulent or purulent exudation.
The reasons
The disease often develops with a purulent process in the body. In the case of a weakening of the protective forces, with debilitating diseases, a breakthrough of a lung abscess into the pleural cavity, purulent pleurisy may also develop.
Symptoms
Patients with purulent pleurisy complain of pain in the side, cough, feeling of heaviness or fullness in the side, shortness of breath, the improbability of taking a deep breath, shortness of breath, fever, weakness. Pain in the chest is more pronounced at the onset of the disease, is stabbing in nature, and as inflammation spreads and exudate accumulates, it weakens, a feeling of heaviness or fullness in the side joins. Gradually, shortness of breath increases. The cough is usually dry, and with secondary pleurisy due to pneumonia or lung abscess – with mucus or purulent sputum, sometimes with a large amount of purulent sputum. When pleurisy is attached to the underlying disease, the nature of the cough changes, it becomes more stubborn, painful, worries more at night, can be paroxysmal in nature, intensifies in the position on the sore side.
Shortness of breath can be pronounced, intensifies, like pain, when the patient is positioned on a healthy side. Therefore, patients are forced to lie on their sore side, which facilitates breathing and reduces chest pain.
Body temperature rises to large numbers (39 – 40 ° C), is constant or hectic in nature. The pulse rate reaches 120-130 per minute, which is determined by both purulent intoxication and the displacement of the heart and mediastinal vessels to the healthy side due to the accumulation of exudate.
The breakthrough of an abscess of the lung located under the pleura, with the flow of pus and air into the pleural cavity, is accompanied by pleural shock. A breakthrough of pus is preceded by a strong, excruciating, incessant cough, which ends with the appearance of a sharp pain in the side, like a “stab with a dagger”. The patient cannot take a deep breath, the face becomes pale, the skin is covered with cold sweat. The pulse is frequent, its filling is small, blood pressure decreases. Due to severe pain, breathing becomes superficial, frequent, acrocyanosis appears, shortness of breath increases. The cause of a severe picture of the disease is irritation of the pleura, causing a pain reaction, compression of the lung by pus and air, displacement of the mediastinal organs to the healthy side with impaired activity of the heart. After the subsidence of acute phenomena,
Diagnosis
When examining the chest, the restriction of the respiratory movements of the chest, the backlog of the diseased side from the healthy side during breathing, or its non-participation in breathing at all, is determined. With the accumulation of a large amount of exudate in the pleural cavity, a bulging of the chest is determined in the posterior lower sections, the intercostal spaces are smoothed. On palpation of the chest, intercostal spaces, moderate pain can be determined. Voice trembling on the side of the lesion is weakened or not determined at all.
Treatment
Therapy of purulent pleurisy includes the fight against infection, detoxification therapy, restoration of impaired organ functions.
By quickly eliminating the focus of purulent inflammation in the pleura and straightening the lung, the main goal of treatment is achieved – the contact of the parietal and visceral pleura and their fusion. The advancing obliteration of the purulent cavity leads to the cure of the diseased. The sooner the treatment of pleural empyema is started, the better the outcome, since irreversible changes do not yet have time to occur in the collapsed lung, and dense fibrous tissue (moorings) has not formed in the inflamed pleura. In the presence of a mooring, complete expansion of the lung may not occur and a residual cavity with dense walls remains between the pleura, as a result of which an acute process can turn into a chronic one.