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Pleural effusion: an overview of information
Last reviewed: 29.11.2021
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Exudative pleurisy is characterized by an accumulation of effusion in the pleural cavity during inflammatory processes in the pleura and adjacent organs. According to the nature of effusion, exudative pleurisy is divided into serous-fibrinous, purulent, putrefactive, hemorrhagic, eosinophilic, cholesteric, and chyle. The most common cause of these pleurisy are tuberculosis, as well as pneumonia (para- or metapneumonic exudative pleurisy).
Pleurisy - Causes and pathogenesis
Symptoms of exudative pleurisy
The clinical symptoms of exudative pleurisy are quite similar for different types of effusion. Finally, the nature of the effusion is established with the help of a pleural puncture.
Complaints of patients are quite typical and depend on the variant of the onset of the disease. If the development of exudative pleurisy was preceded by acute fibrinous (dry) pleurisy, then it is possible to establish the following chronological sequence of subjective manifestations. Initially, patients are concerned about acute, intense pain in the chest, worse with breathing, coughing. With the appearance of an effusion in the pleural cavity, pain in the chest weakens or even disappears completely due to the fact that the pleural sheets are separated by a liquid appearing in the pleural cavity. At the same time, a feeling of heaviness in the chest, dyspnea (with a significant amount of exudate), dry cough (its reflex origin is assumed), a significant increase in body temperature, sweating.
Diagnosis of exudative pleurisy
The program of examination with exudative pleurisy
- General analysis of blood, urine.
- Biochemical analysis of blood: determination of the content of total protein, protein fractions, bilirubin, aminotransferases, cholesterol, glucose, lactate dehydrogenase, seromucoid, haptoglobin, fibrin, sialic acids, lupus cells, rheumatoid factor.
- Radiographic examination of the lungs and computed tomography of the lungs.
- Ultrasound of the heart.
- ECG.
- Pleural puncture and pleural fluid research: assessment of physical and chemical properties (determination of protein, lactate dehydrogenase, lysozyme, glucose), cytological and bacteriological studies.
- Consultation phthisiatrician.
Exudative pleurisy - Diagnosis
Differential diagnosis of exudative pleurisy
Pleural effusion is the accumulation of pathological fluid in the pleural cavity with inflammatory processes in adjacent organs or pleural sheets or when the ratio between colloid osmotic pressure of the blood plasma and hydrostatic pressure in the capillaries is disturbed.
Pleural fluid of inflammatory origin is exudate. The fluid accumulated due to the disbalance between the colloid osmotic pressure of the blood plasma and the hydrostatic pressure in the capillaries is a transudate.
After receiving pleural fluid, it is necessary to determine, depending on the color, transparency, relative density, biochemical and cytological composition, whether the effusion is exudate or transudate.
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