What are the symptoms of pleurisy and pneumothorax?

Written by Zhang Zhi Gong
Cardiothoracic Surgery
Updated on September 05, 2024
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The pleural cavity in healthy individuals is a potential space and is under negative pressure. Its main purpose is to allow the lungs to fully adhere to the chest wall, and the lubricating fluid present serves to prevent too much friction between the lungs and chest wall during deep inhalation, which could cause pain. For various reasons, such as a ruptured lung bulla or trauma to the chest wall, a certain amount of air can enter the pleural cavity, leading to pain in patients. Due to the presence of pleurisy, friction occurs between the lungs and chest wall—particularly between the lower chest wall and the lungs—causing intense pain during deep inhalations. If a large volume of air is present, it can prevent the lungs from fully expanding, potentially leading to symptoms of breathing difficulties or an obstructed exhalation.

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Written by Wang Chun Mei
Pulmonology
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How to treat pleurisy without effusion?

Pleurisy is a very common type of inflammatory response of the pleura caused by pathogenic factors in clinical practice. In clinical settings, some patients may develop pleural effusion, while others may not. Therefore, the treatment for pleurisy without pleural effusion mainly involves symptomatic management with anti-tuberculosis drugs. Typically, the treatment with anti-tuberculosis drugs should follow a regimen that is early, combined, adequate, regular, and complete. For the treatment of such pleurisy patients, it is known that most cases are caused by infection with Mycobacterium tuberculosis. Therefore, when treating such patients, it is crucial to strictly follow the treatment regimen of anti-tuberculosis medications to effectively control the uncomfortable symptoms caused by pleurisy.

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Written by Shen Jiang Chao
Radiology
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Can pleurisy be seen on a chest X-ray?

Pleurisy can also be detected in chest radiographs, but it depends on the type. There are two types of pleurisy: dry and wet. Dry pleurisy cannot be clearly identified, while wet pleurisy, which is mostly caused by tuberculosis, can show more typical characteristics. Tuberculous pleurisy primarily manifests as pleural effusion. A small amount of pleural effusion on an X-ray appears as blunting of the costophrenic angle on the same side and blurring of the diaphragm. A moderate amount of pleural effusion is shown on the chest radiograph as a uniformly consistent high-density shadow on the same side, which appears higher on the outside and lower on the inside, with an arc-shaped shadow. The muscle costophrenic angle and diaphragm are obscured. A large amount of pleural effusion presents as a high-density shadow in the pleural cavity on the same side, with the mediastinal cardiac silhouette clearly shifting to the interlateral side.

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Written by Yuan Qing
Pulmonology
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What should I do about pleurisy calcification?

Pleural calcification, mainly results from long-term unresolved pleuritis or inadequate timely treatment, causing adherence between the two pleural layers. Following this adhesion, calcium salts may deposit, leading to calcification. Usually, the primary consideration is whether the patient's lung function has been impacted. If so, a thoracotomy and pleural decortication might be performed to restore the pleural structure. If the patient only shows pleural calcification on imaging without significant discomfort, it may be observed without immediate intervention, and regular monitoring of the calcification is recommended to see if it enlarges. If the condition remains stable over time, it might not require treatment since this represents a tendency towards healing, or the residual scarring may not necessitate special management.

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Written by An Yong Peng
Pulmonology
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What are the symptoms of pleurisy?

Common symptoms of pleurisy include chest pain, which often worsens with deep breathing. This condition is also called pleuritic chest pain. It is important to note that the presence of such chest pain does not necessarily indicate pleurisy; it could also be due to pneumonia, pulmonary embolism, or even rib fractures. Patients with pleurisy may also experience a sensation of chest tightness, especially when there is a significant amount of pleural effusion. Furthermore, severe chest pain caused by pleurisy may lead to patients avoiding deep breaths, which can also result in symptoms of chest tightness. Fever is another common symptom in patients with pleurisy, and the severity of fever can vary depending on the infection causing the pleurisy. For example, tuberculous pleurisy, caused by tuberculosis infection, often results in a low-grade fever in the afternoon, but high fevers can also occur. In the case of purulent pleurisy, which is usually due to a bacterial infection leading to pus formation in the pleural cavity, high fevers are common.

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Written by Yuan Qing
Pulmonology
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Sequelae of pleurisy with pulmonary effusion

The main sequelae of pleurisy with pleural effusion are pleural adhesions, which can affect respiratory function. Pleurisy is mostly caused by infectious diseases, although a portion is also due to non-infectious diseases. In the case of pleural effusion caused by infectious diseases, it contains a large amount of fibrinogen, which has the function of adhering to our pleura, thereby causing the pleura to thicken. At this time, the pleura will compress our lungs, significantly reducing the respiratory volume of our lungs, which greatly affects our respiratory function. Patients mainly exhibit symptoms such as shortness of breath, chest tightness, and rapid breathing even with slight activity or while lying in bed. Therefore, if pleurisy is detected, it is crucial to drain the fluid from the patient as soon as possible to avoid delaying treatment and the subsequent development of severe sequelae.