Overview.
Rheumatic pneumonia (RP) is a connective tissue inflammation of the lungs caused by rheumatic fever. Rheumatic fever is a systemic connective tissue disease that occurs after infection with group A, type 2 hemolytic streptococci. Patients have irregular mild solid changes in the lungs, with inflammatory cells exuding from the interstitium and alveoli. Clinical manifestations can be divided into two types: light type with moderate fever and dry cough; heavy type with obvious dyspnea and cyanosis. x-ray chest film or lung CT examination shows pulmonary edema-like changes. Treatment can be salicylic acid preparations, and in severe cases, adrenocorticotropic hormone or immunosuppressant is added.
Etiology
The disease is caused by rheumatic fever. Fibrin-like necrosis of alveolar walls, mononuclear cell infiltration in the interstitium of the lungs, formation of hyaline membranes from protein exudates in the alveoli, hyaline membrane formation and fibrin-like changes in small pulmonary arteries and alveolar capillaries.
Symptoms
In addition to the typical manifestations of rheumatic fever such as carditis, polyarthritis, annular erythema and fever, there are also pulmonary symptoms such as cough and sputum.
1. Mild
Only mild cough, occasionally with blood sputum, lungs may have wet sound, lesions are limited, and may be complicated by rheumatic fever. The prognosis is good because the symptoms are mild and the disease is limited and may be complicated by pleurisy. Because of the mild symptoms, it is easy to be neglected clinically.
2. Severe
Widespread lesions, rapid progression, the patient may appear palpitations, shortness of breath, cyanosis, chest pain, sputum with blood and other symptoms, temperature fluctuations, the condition is more serious, lung auscultation may have extensive wet? X-ray chest radiograph or lung CT shows a variety of manifestations, appearing rapidly and dissipating quickly, sometimes appearing repeatedly in a wandering manner. There may also be clinical manifestations of carditis, arrhythmia and pericarditis.
Examination
1. Chest X-ray or lung CT examination
Chest imaging changes include patchy, wandering or persistent infiltrative lung shadows, or acute pulmonary edema-like shadows centered on the hilum. These lung lesions are most commonly seen in the left lower lobe and may be associated with pulmonary edema caused by left heart failure, left heart enlargement that compresses the pulmonary hilar vascular structures in the left lower lobe.
2. Sputum examination
Most of them are sterile, or non-pathogenic or conditionally pathogenic.
3. Electrocardiogram
Right ventricular hypertrophy and strain changes, as well as pulmonary P waves and right bundle branch block may be seen.
Diagnosis
1. Symptoms: symptoms of rheumatic fever, combined with symptoms and signs of respiratory disease.
2. Consecutive chest imaging examinations, which play an important role in clinical diagnosis.
3. Anti-streptococcal hemolysin “O” assay and C-reactive protein assay are helpful in the diagnosis of this disease.
Treatment
The main treatment is to treat the primary disease, such as antirheumatic therapy, application of antibiotics such as penicillin therapy, and symptomatic treatment.