Tuberculous pleurisy is a disease caused by infection of the pleura by Mycobacterium tuberculosis, which mainly manifests as fever, cough, chest pain, dyspnea and pleural fluid accumulation.
According to the focal changes of pleurisy, tuberculous pleurisy can be divided into dry pleurisy and exudative pleurisy. Dry pleurisy often develops due to the spread of tuberculosis to the pleura, and in addition to general inflammation, chest pain is particularly severe. Exudative pleurisy develops from dry pleurisy, where the inflammation of the pleura causes water to come out of the blood vessels and accumulate in the pleural cavity to become exudative pleurisy.
Effects of tuberculous pleurisy on respiratory function.
The effect of dry pleurisy on pulmonary function is related to the site of pleurisy, the presence or absence of pleural adhesions and its degree. At the beginning of pleurisy, the respiratory rate increases and breathing is shallow and fast. After the inflammation dissipates, lung function can return to full normal if there are no pleural adhesions. However, if pleural adhesions occur they can affect lung function.
The effect of exudative pleurisy on lung function depends mainly on the amount of fluid in the pleural cavity. A small amount of fluid does not affect the expansion of the lungs and respiratory movements, and there is no change in lung function, but if there is a large amount of fluid it can compress the lungs and restrict breathing.
Symptoms of tuberculous pleurisy.
The onset of the disease is often characterized by mild to moderate fever, dry cough, and fatigue. The main symptom of dry pleurisy is sharp, pinprick-like chest pain that is intense. The pain is more severe with deep breathing and coughing. The chest pain can be relieved by shallow breathing, lying down or lying sideways to the diseased side, so the patient often breathes sharply and superficially.
In exudative pleurisy, chest pain also occurs when there is little fluid, but when there is more fluid, chest pain decreases or disappears. When a large amount of fluid accumulates, it can cause breath-holding and chest tightness, and the more fluid accumulates, the more obvious the symptoms of breath-holding and chest tightness are. If a large amount of fluid accumulation appears in a short time, dyspnea, cyanosis, and reflex dry cough may appear.
Symptoms that can be detected on physical examination.
Dry pleurisy has limited respiratory movement on the side of the affected area and localized pressure pain. The physician can feel pleural friction with the hand and auscultate pleural friction sounds. In exudative pleurisy with more fluid in the pleural cavity, the pleura on the pleurisy side is full, the rib space is widened, and the respiratory motion becomes smaller. If pleural adhesions are present, this can lead to localized depression of the thorax and diminished breath sounds.
Laboratory tests.
(a) X-ray chest radiograph: There is usually no significant change in the chest X-ray during the dry pleurisy stage, or only diminished respiratory motion is seen on fluoroscopy. In the exudative pleurisy stage, when the fluid accumulation reaches a certain amount, a large uniform, dense shadow can be seen on the X-ray. In massive effusion, the mediastinum shifts to the healthy side, the rib space widens, and the diaphragm drops.
(B) Ultrasonic examination: It can help to understand the amount of fluid, determine the site of thoracic puncture, and distinguish pleural effusion from pleural hypertrophy.
(iii) Other tests: blood tests may show increased white blood cells and neutrophils, and increased blood sedimentation. Laboratory tests of effusion may detect Mycobacterium tuberculosis.
Diagnosis.
Symptoms such as low fever, cough, chest pain, night sweats, weakness, loss of appetite, and symptoms such as dyspnea and shortness of breath caused by high fluid accumulation can help confirm the diagnosis. Chest X-ray examination and laboratory tests of pleural fluid can help determine if the pleurisy is caused by tuberculosis infection.
Treatment of dry tuberculosis pleurisy
Dry tuberculous pleurisy is treated with anti-tuberculosis treatment depending on the tuberculosis disease if the lungs are also found to have tuberculosis lesions. If there is no tuberculosis in the lungs but only a pleural infection with Mycobacterium tuberculosis, it can be treated with oral isoniazid for about a year and regular chest X-ray review. Chest pain can be relieved by oral analgesics.
Treatment of exudative tuberculosis pleurisy
The principles of treatment for exudative tuberculosis pleurisy are anti-nodular drug therapy and thoracentesis and aspiration. Anti-tuberculosis treatment is the same as that for pulmonary tuberculosis.
If exudative pleurisy forms a large amount of fluid, it will compress the heart and lungs, and symptoms such as difficulty in breathing, panic and chest tightness will occur, which must be treated immediately in a hospital. Doctors can quickly relieve the condition by pumping fluid through thoracentesis, so that symptoms such as dyspnea, panic and chest tightness improve significantly or disappear. At the same time, fluid extraction can also avoid pleural thickening and adhesions.
In case of massive fluid accumulation, the fluid is pumped 2~3 times a week until the fluid is completely absorbed. Each pumping should not exceed 1000 ml. Too much and too fast pumping can cause a sudden decrease in chest pressure and the occurrence of pulmonary edema and circulatory disorders.