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 sub-diaphragmatic space. The main clinical features of diaphragmatic pleurisy are the following:

• the pain is localized in nizhneperednih departments chest, often radiating to the right and on the phrenic nerve in the shoulder area and in the lower intercostal nerves in the abdominal wall that resembles the clinic of acute appendicitis, cholecystitis, stomach ulcer, 12 duodenal ulcer;
• pain can be accompanied by muscle tension in the anterior abdominal wall;
• often a painful hiccup is observed (cases of uncontrolled hiccough lasting 1-2 days) and pain during swallowing are described;
• Moussy's painful points are revealed (the upper one between the legs of the sternocleidomastoid muscle, the lower one at the intersection of the extension of the X-th rib and the parasternal line). The pain in these points is due to the involvement of the diaphragmatic nerve in the inflammatory process; it often determines the soreness along the attachment line of the diaphragm to the chest;
• the patient takes a forced position - sits with the inclination of the trunk forward;
• the noise of friction of the pleura can be heard in the lower anterior sections of the chest, more often on the right, but in most cases it is absent;
• X-ray signs can be determined: high standing of the dome of the diaphragm, lagging behind it with deep inspiration, restriction of mobility of the lower pulmonary margin.

These 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 rays of the diaphragmatic pleura, the skin and muscles of the anterior abdominal wall, the branches of these nerves being both sensitive and motor. With diaphragmatic pleurisy, irritation of these nerves leads to the spread of pain to the anterior abdominal wall and the reflex tension of its muscles.

Symptoms of apical pleurisy

In the apical pleurisy, an inflammatory process is involved in the pleura covering the apex of the lungs. The apical pleurisy is very characteristic for pulmonary tuberculosis, the main clinical features of these pleurisy are as follows:

• the pains are localized in the shoulder and shoulder area and, in connection with the involvement of the brachial plexus in the inflammatory process, the arms can spread along the nerve trunks;
• at a comparative palpation of the upper parts of the trapezius muscle, the large thoracic, deltoid muscles, their painfulness on the side of the lesion is marked - the muscular pain syndrome of Sternberg. Often, simultaneously with the soreness of these muscles, their stiffness (densification) is determined during palpation - a symptom of Potenzher. Symptoms of Sternberg and Pottinger gradually decrease and disappear as the apical pleurisy subsides;
• the noise of friction of the pleura in the region of the apex of the lungs can turn out to be quiet because of their low respiratory mobility, often this quiet noise of friction is mistaken for rales.

Symptoms of paramediastinal pleurisy

With paramediastinal pleurisy, the focus of inflammation usually adjoins the anterolateral areas of the pericardium. In this case, the pain can be localized in the heart, strengthened by palpation of the precordial region, there is pleuropericardial friction noise. This noise can have a rhythmic character, i.e. To listen simultaneously to the activity of the heart, at the same time it can intensify at the height of inspiration (at this moment, the pleura and pericardium come together), the retention of breath on inspiration, on the contrary, sharply weakens its intensity, but completely the noise does not disappear.

Symptoms of parietal (costal) pleurisy

Pristenochny (costal) pleurisy is the most common form of fibrinous pleurisy, the symptomatology of it is described above. The main symptoms of this variant of dry pleurisy are pains in the chest (in the projection of fibrinous overlays), increasing with breathing and coughing, and a typical pleural friction noise.

The course of dry (fibrinous) pleurisy

The course of dry pleurisy, as a rule, is favorable. The disease lasts about 1-3 weeks and usually ends with recovery. A prolonged recurrent course is characteristic of the tuberculous etiology of the disease.