Dry (fibrinous) pleurisy - Symptoms

Symptoms of diaphragmatic pleurisy

Diaphragmatic (basal) pleurisy is characterized by the localization of the inflammatory process in the diaphragmatic pleura and often develops with basal pneumonia and inflammatory processes in the subdiaphragmatic space. The main clinical features of diaphragmatic pleurisy are the following:

• the pain is localized in the lower anterior parts of the chest, more often on the right, and radiates along the phrenic nerve to the shoulder area, and along the lower intercostal nerves to the anterior abdominal wall, which resembles the clinical picture of acute appendicitis, cholecystitis, gastric ulcer, and duodenal ulcer;
• pain may be accompanied by tension in the muscles of the anterior abdominal wall;
• painful hiccups are often observed (cases of uncontrollable hiccups lasting 1-2 days have been described) and pain when swallowing;
• painful Mussi points are revealed (the upper one is between the legs of the sternocleidomastoid muscle, the lower one is at the intersection of the continuation of the 10th rib and the parasternal line). Pain at these points is explained by the involvement of the phrenic nerve in the inflammatory process; pain is often determined along the line of attachment of the diaphragm to the chest;
• the patient takes a forced position - sits with the body tilted forward;
• pleural friction noise can be heard in the lower anterior parts of the chest, more often on the right, but in most cases it is absent;
• Radiological signs can be determined: high position of the dome of the diaphragm, its lag during deep inspiration, limited mobility of the lower edge of the lung.

The above symptoms of diaphragmatic pleurisy are explained as follows. The lower six intercostal nerves innervate the lower parts of the parietal pleura, as well as the lateral slopes of the diaphragmatic pleura, the skin and muscles of the anterior abdominal wall, and the branches of these nerves are both sensory and motor. In diaphragmatic pleurisy, irritation of these nerves leads to the spread of pain to the anterior abdominal wall and reflex tension of its muscles.

Symptoms of apical pleurisy

In apical pleurisy, the pleura covering the tops of the lungs is involved in the inflammatory process. Apical pleurisy is very typical for pulmonary tuberculosis, the main clinical features of this pleurisy are the following:

• the pain is localized in the area of the shoulders and shoulder blades and, due to the involvement of the brachial plexus in the inflammatory process, can spread along the course of the nerve trunks of the arm;
• comparative palpation of the upper parts of the trapezius muscle, pectoralis major, and deltoid muscles reveals marked pain on the affected side - Sternberg's muscle pain syndrome. Often, along with the pain of these muscles, their rigidity (hardening) is determined upon palpation - Potenger's symptom. Sternberg's and Potenger's symptoms gradually decrease and disappear as the apical pleurisy subsides;
• The pleural friction noise in the region of the apex of the lungs may be quiet due to their low respiratory mobility; often this quiet friction noise is mistaken for wheezing.

Symptoms of paramediastinal pleurisy

In paramediastinal pleurisy, the inflammation focus usually adjoins the anterolateral areas of the pericardium. In this case, the pain may be localized in the heart area, intensify during palpation of the precardial area, and pleuropericardial friction noise may appear. This noise may be rhythmic, i.e., heard synchronously with the activity of the heart, at the same time it may intensify at the height of inspiration (at this moment, the pleural and pericardial layers come together), holding the breath during inspiration, on the contrary, sharply weakens its intensity, but the noise does not disappear completely.

Symptoms of parietal (costal) pleurisy

Parietal (costal) pleurisy is the most common form of fibrinous pleurisy, its symptoms are described above. The main symptoms of this variant of dry pleurisy are chest pain (in the projection of fibrinous deposits), which intensifies with breathing and coughing, and a typical pleural friction noise.

The course of dry (fibrinous) pleurisy

The course of dry pleurisy is usually favorable. The disease lasts about 1-3 weeks and usually ends in recovery. A long recurrent course is typical for the tuberculous etiology of the disease.