pleurisy Pleurisy, also known as pleuritis, is an inflammation that occurs within the pleural cavity. The pleura is a membrane that covers the inner surface of the chest wall and the surfaces of the thoracic organs (such as the lungs and the mediastinum). The pleural cavity is a sealed space enclosed by the pleura and normally exists in a negative pressure state. When various pathogenic bacteria, such as bacteria or mycobacteria, invade the pleura, it leads to a series of inflammatory reactions, resulting in pleurisy.

Pleurisy, also known as pleuritis, is an inflammation that occurs within the pleural cavity, which is also referred to as the "pleural space." The pleura is a membrane located in the chest, covering the inner surface of the chest wall and the outer surface of thoracic organs such as the lungs and mediastinum. The pleural cavity is a sealed space enclosed by the pleura, which is normally under negative pressure. When various pathogenic microorganisms, such as bacteria or mycobacteria, invade the pleura, it leads to a series of inflammatory reactions, resulting in pleurisy.

Classification Based on Effusion Status

Fibrinous Pleurisy

Also known as dry pleurisy, this condition is commonly caused by the involvement of the parietal pleura. It usually does not involve effusion and is often associated with conditions such as tuberculosis, silicosis, or advanced stages of asbestosis. Most patients are asymptomatic, while a small portion may experience stabbing pain, and the condition tends to resolve on its own.

Parapneumonic Pleural Effusion

This type of pleurisy is often caused by bacterial pneumonia, lung abscess, or bronchiectasis, leading to inflammation spreading to the pleura. Most patients develop pleural effusion and, with aggressive treatment of the underlying condition, the prognosis is generally good. In cases of large effusion, treatment may involve thoracentesis or chest tube drainage.

Empyema

Empyema is commonly caused by bacterial infection, leading to the accumulation of purulent pleural effusion. Clinical manifestations mainly include high fever, rapid breathing, chest pain, and poor appetite.

Classification Based on Etiology

Tuberculous Pleurisy

Tuberculous pleurisy is mostly caused by invasion of the pleura by mycobacteria. Tubercle bacilli can be found in the pleural effusion, and symptoms typically include fever, dry cough, and chest pain.

Neoplastic Pleurisy

This condition is primarily caused by direct invasion of the pleura by malignant tumors, commonly associated with lung cancer, breast cancer, or lymphoma. Patients may present with bloody pleural effusion, often with a large and uncontrollable volume of effusion, and malignant tumor cells can be found in the pleural effusion.

Fungal Pleurisy

Fungal infections involving the pleura are mainly seen in immunocompromised patients, such as those with AIDS.

Cholesterol Pleurisy

Patients with cholesterol pleurisy often present with right-sided pleural effusion, in which cholesterol crystals can be found. Clinical manifestations may include cough, fatigue, chest pain, and dyspnea.

Connective Tissue Disease-Related Pleurisy

This type of pleurisy is primarily caused by connective tissue diseases such as:

Rheumatoid arthritis

Systemic lupus erythematosus

Churg-Strauss syndrome

Mixed connective tissue disease, etc.

Specifically, it can be further subdivided into:

Rheumatoid Pleurisy: Commonly seen in patients with a history of rheumatoid arthritis for over 10 years, presenting with pleural effusion, which is a yellowish exudate. Clinical manifestations can include cough, chest pain, dyspnea, and joint pain.

Lupus Pleurisy: This condition is often observed in young women with systemic lupus erythematosus, presenting with moderate to large amounts of bloody pleural effusion bilaterally, along with characteristic facial rash and other signs of organ damage.

Rheumatic Pleurisy: This is a rare condition, usually seen in patients with rheumatic fever, presenting with small amounts of pleural effusion, which is fibrous in nature. Clinical manifestations include fever, cough, chest pain, and difficulty breathing.

Eosinophilic Pleurisy: This clinical condition is rare, and patients may experience pneumothorax and hemothorax.

Chest pain and tightness, often described as stabbing or pulling pain, usually exacerbated during deep coughing, localized to the area where pleurisy occurs.

Coughing and sputum production.

Severe cases may lead to shortness of breath.

Establishing a health follow-up record for the patient, documenting their medical history and medication use.

Active participation of the patient and their family in health education, understanding the etiology and early symptoms of the disease, as well as the timing of seeking medical care and daily health care methods.

Patients should adhere to medication schedules, closely monitor changes in their condition, and seek medical attention promptly if they experience any discomfort.

Regular follow-up visits.

Patients can undergo respiratory function training, including deep breathing, breath-holding, and slow exhalation, for 5-10 minutes each time, 1-2 times a day.

Patients should rest in bed and maintain a calm state of mind, while also engaging in appropriate physical activity.

Patients should maintain a high-protein, high-calorie, and balanced diet.

During pleural puncture, if the patient experiences pleural reactions, such as sudden palpitations, chest tightness, restlessness, profuse sweating, and pallor, the doctor should be informed immediately. The physician will promptly cease the aspiration, have the patient lie flat, and provide appropriate treatment.

When treating tuberculous pleurisy, patients need to undergo regular liver and kidney function tests, and if necessary, they should use hepatoprotective drugs.

Strengthening nutrition, avoiding trauma, and enhancing immunity are basic methods for preventing pleurisy.

Aggressive treatment of underlying diseases (such as pneumonia) is an effective measure for preventing pleurisy.

Strict aseptic techniques are crucial for preventing iatrogenic pleurisy.