Pleuritis or Pleurisy
Definition : Inflammation of the pleura ( covering of the lungs) called pleuritis or pleurisy.
Classification :
- Serous, Fibrinous and Serofibrinous Pleuritis
- Suppurative Pleuritis (Empyema Thoracis)
- Haemorrhagic Pleuritis
1. Serous, Fibrinous and Serofibrinous Pleuritis : Acute inflammatin of the pleural sac (acute pleuritis) can results in serous, serofibrinous and fibrinous exudate.
Causes :
INFECTIOUS CAUSE :
i. Tuberculosis
ii. Pneumonias
iii. Pulmonary infarcts
iv. Lung abscess
v. Bronchiectasis
OTHER CAUSES :
i. Collagen diseases - rheumatoid arthritis and disseminated lupus erythematous.
ii. Uraemia ( increase level of urea in blood)
iii. Diffuse systemic infections - typhoid fever, tularaemia, blastomycosis and coccidioidomycosis.
iv. Irradiation of lung tumours
Clinical Features :
i. Chest pain on breathing
ii. Friction rub is audible on auscultation
iii. After resolution, exudate become reabsorbed or minimized
Complications : Repeated attacks of pleurisy may leads fibrous adhesions and oblitreration of the pleural cavity.
2. Suppurative Pleuritis ( Empyema Thoracis) : Serofibrinous effusion converts into purulent exudate due to bacterial or mycotic infections called suppurative pleuritis or empyema thoracis.
Causes :
i. Direct spread of pyogenic infection from the lungs ( most common cause)
ii. Direct extension from subdiaphragmatic abscess or liver abscess.
iii. Penetrating injuries to the chest wall.
iv. Haematogenous or lymphatic routes (occasionally)
On Examination :
i. In empyema, the exudate is yellow green, creamy pus that accumulates in large quantity.
ii. Empyema is finally replaced by granulation tissue and fibrous tissue.
Complications :
i. When tough fibrocollagenic adhesions develop which obliterate the cavity.
ii. In later stage calcification may occur.
iii. Finally develop serious respiratory difficulty due inadequate pulmonary expansion.
On Examination :
i. In empyema, the exudate is yellow green, creamy pus that accumulates in large quantity.
ii. Empyema is finally replaced by granulation tissue and fibrous tissue.
Complications :
i. When tough fibrocollagenic adhesions develop which obliterate the cavity.
ii. In later stage calcification may occur.
iii. Finally develop serious respiratory difficulty due inadequate pulmonary expansion.
3. Haemorrhagic Pleuritis : It is different from haemothorax because it have inflammatory cells or exfoliated tumour cells in the exudate.
Causes :
i. Metastatic involvement of the pleura.
ii. Bleeding disorders.
iii. Rickettsial diseases - spotted fever, typhus fever rickettsioses, scrub typhus, anaplasmosis and ehrlichioses.
Causes :
i. Metastatic involvement of the pleura.
ii. Bleeding disorders.
iii. Rickettsial diseases - spotted fever, typhus fever rickettsioses, scrub typhus, anaplasmosis and ehrlichioses.
No comments:
Post a Comment
Please do not enter any spam link in the comment box