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Exudative pleurisy - Information Overview
Last reviewed: 07.07.2025
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Exudative pleurisy is characterized by the accumulation of effusion in the pleural cavity during inflammatory processes in the pleural sheets and adjacent organs. According to the nature of the effusion, exudative pleurisy is divided into serous-fibrinous, purulent, putrefactive, hemorrhagic, eosinophilic, cholesterol, chylous. The most common cause of this pleurisy is 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 uniform for different types of effusion. The nature of the effusion is finally determined by pleural puncture.
Complaints of patients are quite typical and depend on the type of 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. At first, patients are bothered by acute, intense pain in the chest, which intensifies with breathing and coughing. With the appearance of effusion in the pleural cavity, the pain in the chest weakens or even disappears completely due to the fact that the pleural sheets are separated by the fluid appearing in the pleural cavity. At the same time, a feeling of heaviness in the chest, shortness of breath (with a significant amount of exudate) are characteristic, a dry cough may be noted (its reflex genesis is assumed), a significant increase in body temperature, sweating.
Diagnosis of exudative pleurisy
Examination program for exudative pleurisy
- General blood and urine analysis.
- Biochemical blood test: determination of total protein, protein fractions, bilirubin, aminotransferases, cholesterol, glucose, lactate dehydrogenase, seromucoid, haptoglobin, fibrin, sialic acids, lupus cells, rheumatoid factor.
- X-ray examination of the lungs and computed tomography of the lungs.
- Ultrasound of the heart.
- ECG.
- Pleural puncture and examination of pleural fluid: assessment of physical and chemical properties (determination of protein, lactate dehydrogenase, lysozyme, glucose), cytological and bacteriological examination.
- Phthisiatrician consultation.
Exudative pleurisy - Diagnostics
Differential diagnosis of exudative pleurisy
Pleural effusion is an accumulation of pathological fluid in the pleural cavity due to inflammatory processes in adjacent organs or pleural layers, or due to a disturbance in the relationship between the colloid osmotic pressure of blood plasma and the hydrostatic pressure in the capillaries.
Pleural fluid of inflammatory origin is an exudate. Fluid accumulated due to a violation of the relationship between the colloid-osmotic pressure of the blood plasma and the hydrostatic pressure in the capillaries is a transudate.
After obtaining the pleural fluid, it is necessary to determine whether the effusion is an exudate or a transudate, depending on the color, transparency, relative density, biochemical and cytological composition.
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