Dry inflammation of the pleural membranes

The pleurae of the lungs

The lungs are covered by the pleurae; the visceral pleura and the parietal pleura are distinguished, between them is the cavity of the pleura The inside of the envelope, the pleural cavity is a potential space filled only with a few milliliters of a lubricating fluid It normally has a vacuum or negative pressure which holds the lungs tightly against the chest wall, the lungs slide smoothly and noiselessly up, and down during respiration, lubricated by a few milliliters of fluid. Think of this as similar to two glass slides with a drop of water between them; although it is difficult to separate the slides, they slide smoothly back and forth, the two pleurae extend about 3 cm below the level of the lungs forming the costodiaphragmatic recess, this is a potential space; when it abnormally fills with air or fluid, it compromises lung expansic

Visceral Pleura
The visceral pleura covers the parenchyma of the lung directly and being closely fused with it penetrating deeply into the interlobular fissures of the lung Beneath it, there is an extensive lymphatic and capillary network for absorption of the fluid It contions no sensory nerve endings It receives blood from the pulmonary circulation

Parietal Pleura
The parietal pleura is fused with the walls of the cavity of the thorax a forms the costal pleura and the diaphragmatic pleura as well as the mediastinal pleura by which the mediastinum is bounded on either sir It is attaches to inside the chest wall by loose connective tissue, that allows its easy stripping from the chest wall lt contains sensory nerve endings It receives blood from the systemic circulation

Primary Pleurisy
Infections Tuberculous infection Viral infection as bornholum disease which usually caused by a Coxackie B virus that usually affects children and young adults Metabolic disease: as uremia Malignancy: as mesothelioma of the pleura Collagenic diseases: as rheumatoid arthritis and SLE Cardiac diseases Post myocardial infarction and post - cardiotomy syndrome Familial mediterranean fever Recurrent attacks of arthritis and polyserositis

Secondary Pleurisy
Lung diseases Tuberculosis and pneumonia Lung abscess and bronchial carcinoma Chest Wall diseases Osteomyelitis and fracture rib Mediastinal diseases Mediastinitis, malignancy and pericarditis Subdiaphragmatic diseases Subphrenic abscess Pancreatitis Amoebic liver abscess

Symptoms
Pleuritic chest pain Site: localized chest pain Characters; sudden stiching pain Radiation: to upper abdomen and shoulders Increased with: inspiration, straining and coughing Decreased with: holding breaths and development of pleural effusion Dry cough It is due to irritation of the pleural membranes

 Dyspnea due to Underlying lung diseases Restriction of the respiratory movement Development of the pleural effusion as a complication General symptoms: as anorexia, fever and headache Symptoms of the cause: as malignancy and tuberculosis

Symptoms of complication: as pleural effusion

Signs
Inspection Shape: normal Respiratory Movements: limited over the affected side Palpation Mediastinum: central TVF: normal Tenderness and may be palpable pleural rub Percussion Tenderness with a normal note of percussion

 Auscultation Breathing sound: may be decreased on the affected side Pleural rub: it is produced when inflammation of the parietal visceral pleura causes a decrease in the normal lubricating fluid, than the opposing surface makes a coarse grating sound when rubh together during breathing, disapears on holding breath and it become more audible on pressing the stethoscope against the chest wall

Complications
Pleural effusion It is due to increase of capillary permeability Pleural fibrosis It occurs in sever and recurrent cases

ifferential diagnosis
Other causes of acute chest pain Oesophageal spasm, angina pectoris and pericarditis

Different causes of pleurisy Primary or secondary pleurisy

Radiological investigations
Chest X- ray It may be normal or It may show a small amount of pleural effusion It may detect the underlying chest diseases as - Lung abscess, bronchial carcinoma or tuberculosis

er investigations

Investigations of the cause as Collagenic diseases Malignancy or tuberculosis Viral antibodies in viral infection ocardial infarction

Symptomatic treatment
Relief of pain Analgesic and anti-inflammatory drugs Injections of local anaesthetics if needed The patients prefers to lie on the affected side

Treatment of the cause

Primary or secondary causes as : drainage with antibiotic injection Lung abscess Tuberculosis : anti-tuberculous drugs Bronchial carcinoma : cytotoxic drugs