Disease of the Pleura and Pulmonary Cysts
Inflammation of the Pleura is called Pleurisy. In dry Pleurisy, the pleural surfaces are inflamed without fluid in between them. In many cases pleurisy is associated with effusion. Both dry pleurisy and pleural effusion may develop at different stages of the same disease process.
Dry or fibrinous pleurisy: The pleura gets involved from the disease of the underlying lung. Trauma to the chest may also lead to Pleurisy. The suggestive symptom is the catching pain felt acutely over the affected area by inspiratory movements brought about by deep breathing, coughing or sneezing. Its etiology are as follows: Pulmonary tuberculosis, Pneumonia, bronchogenic carcinoma, pulmonary infarction, connective tissue disorders (such as systemic lupus erythematosus, polyarteritis nodosa, and rheumatoid disease), rheumatic fever, viral infections (especially Coxsackie [Bornholm disease), hepatopulmonary amoebiasis, and uraemia.
The physical examination reveals diminution of movement on the affected side and the presence of pleural friction rub on auscultation. Pleural rub has a superficial grafting quality. The rub is heard better by gentle pressure of the chest piece of the stethoscope on the chest wall. Unlike rales, it is not altered by coughing. With the development of pleural effusion, the rub may disappear in most cases. Pleural rub has to be distinguished from crepitations and sounds arising from movements of the chest wall. Other painful conditions like Pneumonia, myocardial infarction, and herpes Zoster have to be differentiated from pleurisy.
Pleural effusion: In this condition, fluid accumulates between the two layers of the pleura. Normally, pleura contains only a small amount of fluid. The pleural fluid remains in dynamic equilibrium with blood. Movements of the lung favour the movement of the fluid in and out of the pleural space. In most of the disease states, absorption of the fluid is reduced. The fluid may be contained in the general pleural space or it may be loculated in the interlobar fissure, infrapulmonary space or may remain adjacent to the mediastinum. The fluid progressively compresses the subjacent lung which undergoes collapse.
Dry or fibrinous pleurisy: The pleura gets involved from the disease of the underlying lung. Trauma to the chest may also lead to Pleurisy. The suggestive symptom is the catching pain felt acutely over the affected area by inspiratory movements brought about by deep breathing, coughing or sneezing. Its etiology are as follows: Pulmonary tuberculosis, Pneumonia, bronchogenic carcinoma, pulmonary infarction, connective tissue disorders (such as systemic lupus erythematosus, polyarteritis nodosa, and rheumatoid disease), rheumatic fever, viral infections (especially Coxsackie [Bornholm disease), hepatopulmonary amoebiasis, and uraemia.
The physical examination reveals diminution of movement on the affected side and the presence of pleural friction rub on auscultation. Pleural rub has a superficial grafting quality. The rub is heard better by gentle pressure of the chest piece of the stethoscope on the chest wall. Unlike rales, it is not altered by coughing. With the development of pleural effusion, the rub may disappear in most cases. Pleural rub has to be distinguished from crepitations and sounds arising from movements of the chest wall. Other painful conditions like Pneumonia, myocardial infarction, and herpes Zoster have to be differentiated from pleurisy.
Pleural effusion: In this condition, fluid accumulates between the two layers of the pleura. Normally, pleura contains only a small amount of fluid. The pleural fluid remains in dynamic equilibrium with blood. Movements of the lung favour the movement of the fluid in and out of the pleural space. In most of the disease states, absorption of the fluid is reduced. The fluid may be contained in the general pleural space or it may be loculated in the interlobar fissure, infrapulmonary space or may remain adjacent to the mediastinum. The fluid progressively compresses the subjacent lung which undergoes collapse.
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