pleuritis (pleurisy)
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Introduction
Inflammation of the pleura (from french: pleura: side & itis: inflammation), parietal pleura & visceral pleura.
Etiology
- pulmonary infection
- pulmonary embolism
- pneumothorax
- chest trauma
- thoracic surgery
- connective tissue disease
- autoimmune hepatitis
- lung cancer (rarely)
- idiopathic
Clinical manifestations
- pain with inhalation & exhalation
- pain aggravated by coughing
- dyspnea
- dry cough
- fever & chills, depending on cause
- whn pleural effusion is associated with pleurisy, the pain usually disappears because the fluid serves as a lubricant
- friction rub may be heard on auscultation
Laboratory
Diagnostic procedures
Radiology
- chest X-ray PA, lateral, decubitus positions
- computed tomography (CT)
Complications
Management
- depends upon etiology
- NSAIDs may provide symptomatic relief
- cough suppressant may relieve pain associated with coughing
- pleural infection
- antibiotics should cover anaerobic infection, except those with culture proven pneumococcal infection
- macrolides are not indicated unless suspicion of atypical pathogens
- penicillins, penicillins combined with beta-lactamase inhibitors, metronidazole & cephalosporins penetrate the pleural space well
- aminoglycosides should be avoided
- empiric antibiotics for hospital-acquired empyema should include treatment for MRSA & anaerobic bacteria
- intravenous antibiotics should be changed to oral therapy once there is clinical & objective evidence of improvement in sepsis
- intrapleural antibiotics are not recommended[3]
- intrapleural injection to promote drainage
- intrapleural t-PA + DNase therapy improves fluid drainage, & reduces surgical referral & duration of hospital stay[4][6]
- intrapleural streptokinase does not improve mortality, need for surgery, or length of hospital stay[4][5]
More general terms
More specific terms
Additional terms
References
- ↑ Pleurisy Mayo Clinic Health Manager http://www.mayoclinic.com/health/pleurisy
- ↑ Kass SM, et al. Pleurisy. American Family Physician. 2007;75:1357. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17508531
- ↑ Jump up to: 3.0 3.1 Davies HE et al for the BTS Pleural Disease Guideline Group Management of pleural infection in adults: British Thoracic Society pleural disease guideline 2010. Thorax 2010 Aug;65(Suppl 2):ii41-53 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20696693 corresponding NGC guideline withdrawn Dec 2015
- ↑ Jump up to: 4.0 4.1 4.2 Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018.
- ↑ Jump up to: 5.0 5.1 Maskell NA, Davies CW, Nunn AJ et al U.K. Controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med. 2005 Mar 3;352(9):865-74. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15745977 Free Article
- ↑ Jump up to: 6.0 6.1 Rahman NM, Maskell NA, West A et al Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med. 2011 Aug 11;365(6):518-26. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21830966 Free Article
- ↑ What are pleurisy and other disorders of the pleura? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/pleurisy/pleurisy_whatare.html
- ↑ Pleurisy fact sheet. American Lung Association. http://www.lungusa.org/site/apps/nlnet/content3.aspx?c=dvLUK9O0E&b=2060321&content_id=%7B653829A9-6104-4561-BFC5-528F5419BEC2%7D oc=1