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Pleuritis

It is collection of inflammatory fluid in the pleural cavity. It is of two types:
  • Primary
  • Secondary
Primary pleuritis is defined as an inflammatory process in the layer of pleura produced by the gunshots, blunt trauma etc. Secondary pleuritis is due to the pathological inflammatory processes such as pneumonia, tuberculosis and other types of inflammatory processes in the other parts of the body which are spread via haematogenous and lymphogenic routes to the pleura. Tuberculosis is the most common type of secondary pleuritis. Bacterial flora produces specific and non-specific pleuritis. TB causes specific pleuritis and non-specific pleuritis is caused by staphylococcus aureus, streptococcus, pneumonia etc.
According to the type of inflammation we have different form of pleuritis such as:
  • Serose
  • Purulent
  • Fibrinose
  • Haemorrhagic
  • Mixed
In surgery, purulent pleuritis is considered pleural empyema. On the contrary to the lung abscess, pyema is the pus accumulation in already anatomically constructed areas.

On the basis of their localization and severity of the process, we have free and localized form of the empyema. If the process has quite a severe character and if the fluid accumulation increases rapidly, there is no time for the creation of the fibrinous strings (adhesions) which are usually confined to the separate areas (free form) in the pleural cavity. Localized empyemas may be apical, intralobal, basal and marginal according to their localization.

Clinical features:
  • High hectic fever
  • Pain in the affected area
  • Dyspnea
  • Dry cough
  • High leucocytosis with dramatic shift to the left side
Treatment:
  • Opening of the pleural cavity and evacuation of the pus is done via pleural puncture. This is done on the 7th or 8th intercostals space on the posterior midscapular line on the superior margin of the ribs because on the inferior surface are localized nerves and arteries
  • Drainage, antiseptic and antibiotic therapy
  • Postural drainage is when one drainage tube is put anteriorly into the second intercostals region and second drainage is placed on the side of the puncture, especially in the 8th intercostal space. Pneumothorax is the common complication after the drainage
  • We can administer fluid into the inferiorly localized tube and take out the fluid from the superiorly positioned tube
  • Vitamin therapy and parental feeding are necessary. In some cases when the pus occupies the large areas of pleura and the puncture is insufficient, then surgical intervention like pleurotomy and thoracotomy is indicated. In some cases if adhesion occurs then some part of pleura may also be removed
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This article has been written by Dr. M. Javed Abbas.
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13:51 06/02/2003