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Diagnosis of pleurisy
Last reviewed: 23.04.2024
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Accumulation of exudate in the pleural cavity occurs with many diseases of the lungs, pleura and other organs, which complicates etiologic diagnosis. In adolescents pleurisy are more often tubercular (75%). From pleurisy of non-tubercular etiology, exudation should be noted for pneumonia of various nature, rheumatism, collagenoses, circulatory insufficiency, tumors, trauma, etc.
In the differential diagnosis of pleurisy, evidence from the anamnesis indicates a tubercular nature of pleurisy: contact with a tuberculosis patient, hyperergic reaction in a Mantoux test or a turn of a tuberculin test. If the exudative pleurisy appeared on the background of a bend, it is most likely a pleurisy of tuberculosis etiology, and the child needs urgent chemotherapy.
Parapneumonic and metapneumonic pleurisy develop in an acute period or in a short time after pneumonia. The disease is often preceded by the upper respiratory tract, colds. In the analysis of blood in patients with tuberculous pleurisy, an increase in ESR, moderate leukocytosis, a stabbed shift of the leukocyte formula, lymphocytopenia, monocytosis is noted. In pleurisies complicating pneumonia, higher leukocytosis and a shift of the leukocyte formula to the left, sometimes anemia, and lupus erythematosus are detected in lupus pleurisy.
In rheumatic pleurisy, decisive importance is given to the indication of repeated exacerbation of rheumatism, indices of rheumatic activity, simultaneous damage to the pleura and heart (rheumatic carditis).
Hydrotorax is a consequence of circulatory insufficiency, it is detected with pathology from the heart (for example, myocarditis, heart defects).
Oncological pleurisy is characterized by malignant course, anemia, weight loss, decreased sensitivity to tuberculin.
Traumatic pleurisy is associated with a bruised chest, fracture of the ribs or artificial pneumothorax.
In differential diagnosis, the study of effusion is mandatory. The liquid can be both an exudate, and an exudate, for example, with hydrothorax. With a specific pleurisy fluid is more often serous, lymphocytic, it can detect mycobacteria and anti-tuberculosis antibodies in high titers. If the exudate is not suppurating, then its culture is sterile. The volume of pleural fluid with nonspecific pleurisy rarely exceeds 300 ml, when sowing is determined by the growth of nonspecific microflora, and in the cytological study - neutrophilic granulocytes. In the case of lupus pleurisy, exuviae sometimes find lupus cells. With oncological pleurisy, exudate immediately hemorrhagic or transformed from serous, characterized by persistent accumulation ("inexhaustible"), cytologically can be identified atypical cells and erythrocytes in large numbers. X-ray and X-ray tomography, conducted before and after the evacuation of the fluid, make it possible to distinguish the free fluid from the pleura in the cavity and to detect changes in the lungs, mediastinum, pleura.
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