Pleural Syndrome
Last reviewed: 23.04.2024
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Pleural syndrome is a combination of symptoms characteristic of lesions of pleural leaves (inflammation, swelling) and (or) accumulation in the pleural cavity of fluid (exudate, transudate, blood, pus) or gas; sometimes inflammation of the pleura (dry pleurisy) precedes the appearance of pleural fluid; In addition, fluid and gas can be simultaneously detected in the pleural cavity.
With dry pleurisy during respiration there is a lag in the affected half of the chest, because because of the pronounced soreness the patient spares this area. Auscultatory over the affected half of the thorax is a gross pleural friction noise that sounds equally loud throughout the inhalation and exhalation, overlapping vesicular breathing; sometimes friction pleura well significantly during palpation.
The accumulation of fluid in the pleural cavity of the fluid (hydrothorax), which can be exudate, transudate, pus (piothorax, empyema of the pleura ), blood ( hemothorax ) or a mixed character, is accompanied by a smoothing of the intercostal spaces and even bulging of the affected half of the chest, shaking on this side is not carried out. With comparative percussion, a sharp blunting or absolute dullness of percussion sound is determined, above the upper border of which the poorly ventilated preloaded lung gives it a blunted-tympanic shade. With topographic percussion, features of the upper blunting boundary are revealed, which, as already mentioned, may have a different direction depending on the nature of the fluid, as well as a significant limitation of the mobility of the lower edge of the contracted lung. Auscultatory over the zone of dullness, a sharp weakening of vesicular breathing or more often its absence is revealed, above this zone is the weakening of vesicular breathing, and in the oblique direction of the upper line of the dullness zone ( exudative pleurisy ) part of the more compressed lung (closer to the spine) is due to the large bronchi, site, where against a background of dull-tympanic percussion sound, bronchial breathing is heard (Garland's triangle). With exudative pleurisy, another small area adjacent to the spine at the bottom of the stupidity zone is sometimes isolated and already on the healthy side, where as a result of some displacement of the aorta blunting of percussion sound and absence of respiration during auscultation are determined (Rauchhuss-Gröcko triangle).
The presence of gas in the pleural cavity ( pneumothorax ) is evidenced by characteristic symptoms, which make it possible to diagnose this condition before x-rays. When examined and palpated on the affected half of the chest, smoothness of the intercostal spaces, a lag in breathing, a weakening of the vocal tremor are revealed. The percussion sound over this zone is tympanic in nature, with a large pneumothorax, the lower border of the tympanite falls below the usual border of the lungs for the light of the expansion of the pleural sinuses.
With the simultaneous presence of gas and liquid (hydropneumothorax, pyopneuromotorax, hemopneumothorax) percutaneously over the affected half of the chest, a combination of blunt (lower) and tympanic (upper) shades of sound is found.
Auscultation allows to detect the absence of vesicular breathing (or its sharp weakening), and with the so-called valve pneumothorax, when there is a communication of the pleural cavity and respiratory tract, and with each inspiration a new portion of air enters it, one can listen to bronchial breathing (also only on inspiration) .
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