What is the connection between pleurisy and lung scarring. How does lung scarring affect breathing. What are the main causes of pulmonary fibrosis. How is idiopathic pulmonary fibrosis diagnosed and treated. Can lung scarring be reversed or cured.

Understanding Lung Scarring and Its Impact on Respiratory Health

Lung scarring, medically known as pulmonary fibrosis, is a condition where the lung tissue becomes thickened and loses its elasticity. This process can significantly impact a person’s ability to breathe and obtain sufficient oxygen. While pleurisy, an inflammation of the membrane surrounding the lungs, is not directly responsible for lung scarring, it can be associated with conditions that may lead to scarring.

Pulmonary fibrosis can occur due to various health conditions and environmental factors. The scars that form on lung tissue are permanent, and their impact on respiratory function depends on their extent. Small scars may not cause noticeable symptoms, but extensive scarring can severely impair breathing by affecting the transfer of oxygen into the bloodstream.

The Role of Pleurisy in Respiratory Health

Pleurisy, while not a direct cause of lung scarring, can be a symptom of underlying conditions that may lead to pulmonary fibrosis. It is characterized by inflammation of the pleura, the thin membrane that covers the lungs and lines the chest cavity. This inflammation can cause sharp chest pain, especially when breathing deeply or coughing.

Idiopathic Pulmonary Fibrosis: A Progressive Lung Disease

Idiopathic pulmonary fibrosis (IPF) is a specific type of lung scarring condition where the cause is unknown. It is a progressive disease that typically affects individuals between the ages of 50 and 70. IPF is relatively rare, affecting 13-20 people in every 100,000 worldwide, according to the National Library of Medicine.

The progression of IPF can vary from person to person, but it generally leads to worsening respiratory function over time. In some cases, patients may experience acute exacerbations, where symptoms suddenly worsen for a period before resolving.

Risk Factors for Idiopathic Pulmonary Fibrosis

• Advanced age
• Smoking history
• Exposure to environmental pollutants (e.g., asbestos, silica)
• Certain viral infections or pneumonia
• Gastroesophageal reflux disease (GERD)
• Family history of pulmonary fibrosis
• Previous radiation therapy to the chest
• Some chemotherapy treatments

Recognizing the Symptoms of Lung Scarring and Pulmonary Fibrosis

The symptoms of lung scarring and pulmonary fibrosis can be subtle at first and may progress over time. It’s crucial to recognize these signs early for prompt medical intervention. Common symptoms include:

• Shortness of breath, especially during or after physical activity
• Persistent dry cough
• Fatigue and weakness
• Unexplained weight loss and loss of appetite
• Rounded and swollen fingertips (clubbing)
• Fever and chills
• Night sweats

As the condition progresses, these symptoms may become more severe, significantly impacting quality of life. In advanced stages, pulmonary hypertension or respiratory failure can develop, posing life-threatening risks due to inadequate oxygen supply to vital organs.

Diagnostic Approaches for Lung Scarring and Pulmonary Fibrosis

Diagnosing lung scarring and conditions like idiopathic pulmonary fibrosis requires a comprehensive approach. Healthcare providers typically begin with a thorough medical history and physical examination. They will inquire about:

1. Individual and family medical history
2. Smoking habits
3. Potential exposure to environmental pollutants
4. Occupational history

Following the initial assessment, doctors may order a series of diagnostic tests to confirm the presence of lung scarring and rule out other potential conditions. These tests may include:

• Chest X-rays
• High-resolution CT scans
• Pulmonary function tests
• Echocardiogram (EKG) to assess heart function
• Blood tests to measure oxygen levels
• Pulse oximetry
• Lung tissue biopsy in some cases

In certain situations, additional tests may be necessary to exclude other respiratory conditions, such as tuberculosis or lung cancer.

Treatment Options for Lung Scarring and Pulmonary Fibrosis

While lung scarring is generally permanent, various treatment options aim to slow disease progression, manage symptoms, and improve quality of life. The approach to treatment depends on the underlying cause, extent of scarring, and overall health of the patient.

Medications for Idiopathic Pulmonary Fibrosis

For idiopathic pulmonary fibrosis, two medications have shown effectiveness in slowing disease progression:

• Pirfenidone (Esbriet): An anti-fibrotic drug that helps reduce lung tissue scarring
• Nintedanib (Ofev): A tyrosine kinase inhibitor that slows the decline in lung function

These medications can help manage symptoms and potentially extend life expectancy for some patients with IPF.

Supportive Therapies

In addition to medication, several supportive therapies can help manage symptoms and improve quality of life:

• Supplemental oxygen therapy
• Pulmonary rehabilitation programs
• Breathing exercises and techniques
• Nutritional support
• Vaccinations to prevent respiratory infections

Lung Transplantation

In severe cases of pulmonary fibrosis or when other treatments are ineffective, lung transplantation may be considered. This procedure is currently the only cure for idiopathic pulmonary fibrosis but comes with its own risks and challenges.

Living with Lung Scarring: Lifestyle Modifications and Self-Care

While medical treatments are crucial, lifestyle modifications and self-care practices can significantly impact the quality of life for individuals with lung scarring. These may include:

• Quitting smoking and avoiding secondhand smoke
• Maintaining a healthy diet rich in antioxidants
• Engaging in regular, gentle exercise as tolerated
• Managing stress through relaxation techniques
• Avoiding environmental pollutants and irritants
• Staying up-to-date with vaccinations
• Joining support groups for emotional and practical support

By adopting these practices, individuals with lung scarring can potentially slow disease progression and maintain better overall health.

Research and Future Directions in Treating Lung Scarring

The field of pulmonary fibrosis research is rapidly evolving, with scientists exploring new treatment approaches and potential cures. Some areas of ongoing research include:

• Gene therapy to address genetic factors in pulmonary fibrosis
• Stem cell therapies to regenerate damaged lung tissue
• Novel anti-fibrotic medications
• Personalized medicine approaches based on genetic profiles
• Combination therapies to enhance treatment efficacy

While a cure for lung scarring remains elusive, these research efforts offer hope for improved treatments and outcomes in the future.

The Importance of Early Detection and Intervention

Early detection and intervention are crucial in managing lung scarring and pulmonary fibrosis. Recognizing symptoms early and seeking prompt medical attention can lead to better outcomes and improved quality of life. Regular check-ups and open communication with healthcare providers are essential for individuals at risk or those experiencing respiratory symptoms.

As research continues to advance our understanding of lung scarring and related conditions, new treatment options and management strategies are likely to emerge. Staying informed about these developments and working closely with healthcare providers can help individuals with lung scarring make informed decisions about their care and potentially benefit from new therapeutic approaches as they become available.

Lung scarring and idiopathic pulmonary fibrosis

Scars on the lung tissue cause it to thicken and lose elasticity. Doctors call this pulmonary fibrosis and it can occur due to certain health conditions and exposure to hazardous materials.

Lung scars can result from illness or medical treatment, and they are permanent.

Small scars may not cause noticeable symptoms, but extensive scarring can make it hard for a person to breathe, as it can affect the transfer of oxygen into the bloodstream. As a result, the brain and other organs may not receive the oxygen that they need.

Idiopathic pulmonary fibrosis is a long-term condition in which lung scarring becomes gradually worse. It can be life threatening.

In this article, we look at why lung scarring happens and discuss some of the treatment options available.

Share on PinterestA person with lung scarring may experience a dry cough.

Several conditions can cause scarring of the lungs.

Interstitial lung disease

Interstitial lung disease involves inflammation of the air sacs or the web of tissue (interstitium) that surrounds them in the lungs. The inflammation can sometimes cause scar tissue to build up within the lungs, resulting in fibrosis.

Learn more here about interstitial lung disease.

Idiopathic pulmonary fibrosis is the most common type of interstitial lung disease. If doctors describe a condition as idiopathic, this means that they do not know exactly what causes it.

Idiopathic pulmonary fibrosis typically appears between the ages of 50 and 70 years. It affects 13–20 people in every 100,000 worldwide, according to the National Library of Medicine.

Other causes and risk factors

Other risk factors include:

• previous viral infection or pneumonia
• gastroesophageal reflux disease (GERD) or acid reflux
• smoking
• older age
• tuberculosis (TB)
• exposure to asbestos or silica
• chemotherapy
• radiation therapy to the chest cavity

In some cases, there may be a family history of the disease.

Some people experience exacerbations, during which symptoms suddenly worsen. These last for a while and then resolve. Exposure to triggers, such as tobacco smoke, may cause a flare.

What do the lungs do?

The scarring of lung tissue makes it thick and stiff. As the lung tissue thickens, it becomes increasingly difficult for the body to transfer oxygen from the lungs into the bloodstream. As a result, the brain and other organs may not receive enough oxygen.

The symptoms depend on the amount of scarring and how much of the lung it affects, but they may include:

shortness of breath, especially during or after physical activity

• a persistent dry cough
• tiredness
• weight loss and loss of appetite
• rounded and swollen fingertips and nails (clubbing)
• fever
• chills
• night sweats

Scarring may also increase the risk of lung cancer.

Idiopathic pulmonary fibrosis

The symptoms of idiopathic pulmonary fibrosis may not be noticeable at first, but they tend to develop and worsen over time, making it increasingly difficult to breathe.

Eventually, pulmonary hypertension or respiratory failure can develop, both of which can be life threatening because they prevent oxygen from reaching the body’s organs.

Many factors can lead to a cough or breathlessness, and many conditions can result in lung scarring.

Anyone who has concerns about breathing symptoms should seek medical help. A doctor will carry out a physical examination.

They will ask the person about:

• individual and family medical history
• smoking habits
• possible exposure to pollutants, such as asbestos

After this, the doctor may carry out some tests, such as:

• X-rays
• a CT scan
• an echocardiogram (EKG) to assess heart function
• lung function tests
• pulse oximetry and other tests to measure oxygen levels in the blood
• a tissue sample or biopsy

They may also carry out specific tests to rule out other conditions, such as TB.

As with scars on the skin, scars on the lung are permanent. It is not usually possible to remove them. The lungs are resilient, however, and small scars often do not cause any adverse effects.

Proper diagnosis and monitoring of the scars is key to treatment.

Scars that remain unchanged for 2 years or more are not usually a cause for concern. However, if they spread, they could indicate pulmonary fibrosis.

Idiopathic pulmonary fibrosis

Currently, a lung transplant is the only cure for idiopathic pulmonary fibrosis. However, a doctor can prescribe medications to help slow the progression of the disease and prevent flares. Pirfenidone (Esbriet) and nintedanib (Ofev) are two drugs that have proven effective.

As the disease progresses, the symptoms can become more severe. They can also worsen during a flare. In these cases, a person may need to spend time in the hospital. Treatment will include supplemental oxygen to support the person’s breathing.

Occasionally, a doctor may recommend a transplant. This procedure can cure the condition, but the person will need to take medications for the rest of their life.

Lifestyle tips that may help prevent or relieve symptoms include:

• quitting smoking, if applicable, or avoiding secondhand smoke
• eating a healthful and varied diet
• doing regular exercise
• maintaining a moderate weight to improve breathing capacity
• taking precautions to avoid catching infections from others
• avoiding exposure to pollutants and dust

It is important to talk to a doctor before making any significant lifestyle or dietary changes. A doctor can advise on a suitable exercise regimen, for example.

The outlook for pulmonary fibrosis varies among individuals and depends partly on a person’s age and overall health. The person will need regular assessments.

In the past, only about 50% of people who received a diagnosis of idiopathic pulmonary fibrosis lived another 3 years, while close to 20% lived another 5 years.

However, new medications may slow the progression of the condition and reduce the risk of death in the first few years after diagnosis. Doctors hope that the outlook will continue to improve.

Pleurisy – StatPearls – NCBI Bookshelf

Continuing Education Activity

Pleurisy is a symptom characterized by localized chest pain caused by a disease-causing inflammation of the pleura. Pleurisy can be caused by a primary pleural disease or secondary to a systemic illness. It can lead to significant morbidity and mortality if not treated expediently. This activity provides an overview of the anatomy of the pleura followed by history, exam, etiologies, evaluation, and treatment of pleurisy. It reviews the role of an interprofessional team.

Objectives:

• Identify the etiology pleurisy and pleuritic chest pain.

• Review the evaluation of pleuritic chest pain.

• Outline the management options available for pleurisy and pleuritic chest pain.

• Discuss interprofessional team strategies for improving care coordination and communication to advance pleurisy and pleuritic chest pain treatment and improve outcomes.

Access free multiple choice questions on this topic.

Introduction

Pleurisy is a symptom characterized by localized chest pain caused by a disease-causing inflammation of the pleura. Pleurisy can be caused by a primary pleural disease or secondary to a systemic illness. Hippocrates first described “pleuritis” in the 5 century B.C. as “pain in his side, fever and shivering” accompanied by “orthopnea” and tachypnea.”[1] Different types of pleuritis were described, including “bilious,” “sanguineous,” and “dry.”[1] Location of the pain was also used to describe pleuritis in these early texts, e.g., “pleuritis in the back,” “extending along the spine and to the chest and groin,” etc.[1] The definition was then expanded by Galen, who tied Hippocrates’ ideas on pleuritis to inflammation of the lining of the lungs.[1] The lining of the lungs was referred to in these texts as the “hypezokos membrane.”[1] Galen also noted tachycardia in pleurisy and described it as a “hard pulse” that was noted to be “fast and frequent. “[1] In 1723, the term “pleurisy” came from an English translation of a text by Giorgio Baglivi in 1699.[2] Baglivi also describes a “hardness of the pulse” as “an infallible sign of all pleurisies” and additionally mentions. “fever, spitting, and pain-in-the-side.”[1][2] The more recent definition of pleurisy was by Giambattista Morgagni in 1961, who performed post-mortem examinations on patients suffering from pleurisy.[1][2] He defined “pleurisy” as disease-related primarily to the pleura and “peripneumony” as disease relating to the lung tissue.[1] Through his work, he discovered that these were not distinct entities and re-termed this “pleuripneumony.”[1][2] Laennec, who invented the stethoscope, added egophony to the definition of pleurisy. Laennec also reclassified the terminology and referred to “pleuritic” to denote inflammation of the pleura and “pleurisy” to refer to the disease that caused the inflammation.[1] 

Pleural Anatomy

Two layers of pleura separate the lung and inner chest wall. Visceral pleura surrounding the lung tissue and is composed of a single mesothelial cell layer. They receive blood supply from the bronchial arteries supplying lung. The parietal pleura lines the inner chest wall, and in contrast to the visceral pleura, it contains stomata that drain pleural fluid to lymphatic capillaries in the loose connective tissue, which also contains systemic blood vessels and nerves. The lymphatics drain into their regional lymph nodes along the sternum or vertebra, and eventually into the thoracic and right lymphatic ducts. The lymphatics are 10um-12um in diameter, large enough to accommodate intact erythrocytes.

The normal volume of pleural fluid is 0.1 to 0.2 mL/kg, with an influx of 0.5 mL/hr in adults. The maximal removal rate, calculated from instilling artificial pleural effusion into a bovine model, is 0.28 mL/kg/hr. Pleural fluid accumulates when the inflow exceeds removal (increased capillary plasma filtration) or if the rate of removal is impaired (blockage of lymphatic drainage). The normal amount of pleural fluid separates the two pleura by 10 to 20 micrometers, except at the hilum of the lung where they are contiguous. The parietal pleura has connective tissue and is innervated by sensory nerve fibers, while the visceral pleura lacks connective tissue and is innervated by the vagus nerve, hence insensitive to pain. The parietal pleura in the central diaphragmatic region is supplied predominantly by the phrenic nerve, the involvement of which may cause referred pain to the ipsilateral shoulder. The other areas of the parietal pleura are supplied by the intercostal nerves of the corresponding intercostal spaces.

The primary function of the pleural membranes and pleural fluid is to allow for frictionless movement/sliding of the lung relative to the chest wall. On inspiration, a negative pressure caused by the outward movement of the chest cavity and the downward excursion of the diaphragm is transmitted to the pleural space leading to lung expansion. It generates a negative pressure relative to atmospheric pressure. This gradient allows atmospheric air to enter into the lungs.

Etiology

Pleural inflammation can occur in a variety of conditions. The hyperacute onset of pleurisy (minutes to hours) occurs in emergencies such as pneumothorax, acute coronary syndromes, pulmonary emboli, acute pericarditis, and chest wall trauma.[3] Acute and hyperacute causes generally present with tachypnea and dyspnea.[3] Viral and bacterial pneumonia-causing synpneumonic pleurisy can also develop over hours to days.[3] Parapneumonic effusions occur in 20 to 40% of hospitalized patients with pneumonia.[3][4] Thoracentesis is recommended for any new onset effusion, especially those associated with suspected pneumonia.[3][4] Recurrent pleuritis can occur in Familial Mediterranean fever, thoracic endometriosis, and recurrent spontaneous pneumothoraces.[5] 

Rheumatoid arthritis, malignancy, or tuberculosis are typical examples of subacute or chronic pleurisy (days to weeks). [3] Metastases to the pleura is more common than primary pleural tumors such as pleural lymphomas, a solitary fibrous tumor of the pleura, angiosarcoma of the pleura, pleuropulmonary blastoma and synovial sarcoma, all of which may also present with pleuritic pain. [6] Mesothelioma is a rare cause of pleurisy, occurs in men over the age of 60 years who have a history of occupational asbestos-exposure and causes chronic, severe, and refractory pleural pain.[7]

Epidemiology

The epidemiology depends on the cause of pleuritis or pleurisy. The causes of pleurisy vary depending on geographic, demographic, occupational, comorbid, and other host factors.

History and Physical

Pleuritis is characterized by sharp and localized thoracic or shoulder pain. It is exacerbated by respiratory movements, coughing, sneezing, or chest wall/trunk movement. Pain characteristics can be dull aching, burning, or simply as a “catch.” Duration and recurrence of symptoms may be helpful in determining the cause. As in the other causes of chest pain, diagnosis of the cause of pleurisy relies heavily on the history and physical exam.

The acuity of the onset (e.g., hyperacute – pulmonary embolism, primary spontaneous pneumothorax, and traumatic pleural inflammation/traumatic pneumothorax), duration, and progression of symptoms are useful in establishing a differential diagnosis. A comprehensive medical history may help to uncover underlying systemic illness such as systemic lupus erythematosus, human immunodeficiency virus infection, tuberculosis infection.

Social history, including travel history, tobacco/electronic cigarette use, alcohol use history, illicit (specifically intravenous) drug use history may provide clues to the underlying cause of pleurisy. Dullness to percussion and diminished breath sounds and vocal/tactile resonance in the affected hemithorax differentiates effusion from a pneumothorax (resonant to percussion). A pleural rub can be heard in auscultation during inspiration and may also be palpable, and is differentiated from a pericardial friction rub that is audible in both inspiration and expiration and can still be heard with the cessation of respiratory movements.  

Evaluation

Because chest pain is the most common symptom at presentation, it is left-sided, then evaluation for an acute coronary syndrome is important. A careful history, electrocardiogram, and serum troponin should be considered if clinical suspicion prevailed. Though pleuritic chest pain is not the typical presentation of ischemic heart disease, it can occur in acute pericarditis and aortic dissection, both of which can cause localized substernal pain or referred pain to the shoulder.

A chest radiograph may help to identify lung consolidation, pleural effusion, or pneumothorax. Laboratory testing should include complete blood counts, a metabolic panel including serum protein, albumin, and lactate dehydrogenase. If acute pancreatitis related pancreatic pleurisy and effusion are suspected then, serum lipase may be considered. If a pleural or pericardial effusion is present, a sample of the fluid should be obtained and sent for pH, glucose, cell count, lactate dehydrogenase, and bacterial Gram stain and cultures. 

A chest X-ray can be helpful, but smaller nodules and loculated or minimal pleural effusions may be missed. A computed tomography(CT) of the chest may be necessary for better assessment for pneumothorax, acute pulmonary embolism (with intravenous contrast), and pulmonary nodules/masses. The apparent involvement of the pleura should prompt pleural fluid cytological evaluation for malignant cells. 

Treatment / Management

Treatment depends on the cause. Acute coronary syndromes should be managed per local expert cardiologist’s guidance. Aortic dissections, especially type A (ascending aorta), should prompt emergent cardiovascular surgery consultation. If a pneumothorax is present, immediate evacuation of the air should be undertaken in patients with large pneumothorax (>2 cm from the chest wall at the level of the hilum), hemodynamic instability, new oxygen requirement, significant dyspnea or in those without a known underlying lung disease (secondary spontaneous pneumothorax) or trauma (traumatic pneumothorax).[8]  Options include a needle aspiration (non-inferior to tube thoracostomy) for hemodynamically stable primary spontaneous pneumothorax)and tube thoracostomy for hemodynamic unstable, secondary spontaneous pneumothoraces, traumatic pneumothoraces or hemopneumothoraces. [9][10][11][8]

Pulmonary embolism can be treated through multiple modalities, including home treatment with anticoagulants, inpatient initiation of anticoagulants, systemic fibrinolytic medications, catheter-directed fibrinolytic medications. The main determinants of in-hospital versus out-of-hospital management include oxygen requirement, the severity of pain, signs of right heart strain CT pulmonary angiography or echocardiogram, impending or apparent hemodynamic compromise despite volume resuscitation, social conditions which may impede immediate follow-up or comorbid acute or chronic conditions which may warrant hospitalization.[12]  

The treatment and analysis of pleural fluid in the case of pleural effusion depends on the size and imaging characteristics of the effusion. Categories of pleural effusion have been proposed based on the radiographic characteristics, culture, and chemistry values from the pleural fluid.

Category 1 pleural effusions are less than 10 mm on lateral decubitus film. [13] Category 1 pleural effusions are very low risk for poor outcomes and are generally not recommended to be sampled.

Category 2 pleural effusions are >10 mm but less than half of the hemithorax.[13] Category 2 to 4 pleural effusions are recommended to have diagnostic thoracentesis performed, and empyema ruled out (must have negative culture, gram stain, and a pH>7.20).  A category 3 effusion involves more than half of the hemithorax, loculations noted within the pleural space, or thickening of the parietal pleura.[13]

A category 3 effusion may also be defined as a pH of <7.20 or a positive gram stain/culture (empyema).[13] Category 4 effusions are defined by purulent material on thoracentesis.[13] Category 3 and 4 effusions are recommended to have thoracostomy drainage.[13] Empyema, or category 4 effusions, may require surgical evacuation and decortication. Due to the high mortality of the categories 3 and 4 pleural effusions (30%), additional methods for the complete drainage of the infected pleural fluid include intrapleural fibrinolytic followed by drainage and/or surgical decortication. [14] The MIST 2 trial compared intrapleural placebo, intrapleural DNase, intrapleural tPA, and combination tPA/DNAse in patients with category 3 or 4 effusions.

The combination of tPA/DNase showed significant improvements in hospital length of stay, effusion size on x-ray, and referral for surgery within 3 months compared to placebo.[14] The tPA alone and DNase alone groups did not show significant changes in hospital length of stay or effusion size on X-ray compared to placebo.[14] The DNase alone group showed an increase in surgical referral within 3 months compared to placebo.[14]

Differential Diagnosis

The most important disease states to evaluate in the setting of pleuritic pain are acute coronary syndromes, aortic dissection, pneumothorax, pericardial effusion/tamponade, and pulmonary embolism. Once these have been evaluated with imaging and serum chemistry, other considerations would be pleural effusions, pericarditis, pulmonary infectious processes, or intrathoracic malignancies.  

Prognosis

The prognosis of pleurisy and pleuritic chest pain depends on the etiology and effectiveness of treatment. Acute coronary syndromes, aortic dissection, pneumothorax, pulmonary embolism carry high morbidity and mortality if left untreated. Category 3 and 4 pleural effusion (alternatively known as complicated parapneumonic effusion or empyema) have a high mortality rate (30%) and high morbidity if left untreated or are treated suboptimally. Lupus pleuritis does not have high mortality but has significant morbidity.[15] Lupus pleuritis occurs in 43% of patients with systemic lupus erythematosus at some point in the course of their disease.[16] Malignant pleural disease has a very poor prognosis with one series reporting a median survival of 13 months after the time of diagnosis.[7]

Complications

Parapnuemonic effusions and empyemas may result in pleural thickening leading to trapped lung, recurrent pneumonia, bloodstream infections if not adequately evacuated. Malignant effusions may also lead to pleural thickening and fibrosis which may result in restrictive lung disease. Pulmonary emboli may lead to pulmonary hypertension, which can lead to chronic dyspnea, exertional intolerance, or hypoxemia. Pulmonary emboli may also lead to death or prolonged hospitalization if not treated in a timely manner.

Consultations

Acute coronary syndromes, pericarditis, and pericardial effusions may warrant cardiology consultation. Pneumothorax, pleural effusion (especially complicated pleural effusion and empyema), lung masses, pulmonary embolism may warrant pulmonary or thoracic surgery consultation. 

Enhancing Healthcare Team Outcomes

Pleuritis and pleurisy require an interprofessional approach. The treatment requires a broad differential diagnosis and exclusion of the emergent causes of pleurisy. History, physical examination, laboratory, and radiological evaluation provide useful diagnostic information.[3] Validated risk scores for coronary disease and pulmonary emboli are available and should be used to refine the list of differential diagnoses.  The treatment and prognosis of pleurisy depend on the etiology. Pain control should be generally be attempted with non-steroidal anti-inflammatory drugs until the cause can be determined.[3]

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

References

1.

Wilson A. On the history of disease-concepts: the case of pleurisy. Hist Sci. 2000 Sep;38 Pt 3(121):271-319. [PubMed: 11624656]

2.

Cohen HK, Luther A, Hart CA. Confusing medical terms: disease that may or may not exist. QJM. 2013 Jul;106(7):617-21. [PubMed: 23525161]

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Reamy BV, Williams PM, Odom MR. Pleuritic Chest Pain: Sorting Through the Differential Diagnosis. Am Fam Physician. 2017 Sep 01;96(5):306-312. [PubMed: 28925655]

4.

Shebl E, Paul M. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Aug 8, 2022. Parapneumonic Pleural Effusions And Empyema Thoracis. [PubMed: 30485002]

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de Paula MC, Escuissato DL, Belém LC, Zanetti G, Souza AS, Hochhegger B, Nobre LF, Marchiori E. Focal pleural tumorlike conditions: nodules and masses beyond mesotheliomas and metastasis. Respir Med. 2015 Oct;109(10):1235-43. [PubMed: 26094051]

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Attanoos RL, Pugh MR. The Diagnosis of Pleural Tumors Other Than Mesothelioma. Arch Pathol Lab Med. 2018 Aug;142(8):902-913. [PubMed: 30040453]

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Saunders J, Ashton M, Hall C, Laird B, MacLeod N. Pain management in patients with malignant mesothelioma: challenges and solutions. Lung Cancer (Auckl). 2019;10:37-46. [PMC free article: PMC6450333] [PubMed: 31037036]

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MacDuff A, Arnold A, Harvey J., BTS Pleural Disease Guideline Group. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010 Aug;65 Suppl 2:ii18-31. [PubMed: 20696690]

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Tan J, Chen H, He J, Zhao L. Needle Aspiration Versus Closed Thoracostomy in the Treatment of Spontaneous Pneumothorax: A Meta-analysis. Lung. 2020 Apr;198(2):333-344. [PubMed: 31927656]

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Wang C, Lyu M, Zhou J, Liu Y, Ji Y. Chest tube drainage versus needle aspiration for primary spontaneous pneumothorax: which is better? J Thorac Dis. 2017 Oct;9(10):4027-4038. [PMC free article: PMC5723764] [PubMed: 29268413]

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Zhu P, Xia H, Sun Z, Zhu D, Deng L, Zhang Y, Zhang H, Wang D. Manual aspiration versus chest tube drainage in primary spontaneous pneumothorax without underlying lung diseases: a meta-analysis of randomized controlled trials. Interact Cardiovasc Thorac Surg. 2019 Jun 01;28(6):936-944. [PubMed: 30608581]

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Pruszczyk P, Konstantinides S. Where to treat patients with acute pulmonary embolism? Kardiol Pol. 2020 Jan 24;78(1):15-19. [PubMed: 31939451]

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Light RW. Parapneumonic effusions and empyema. Proc Am Thorac Soc. 2006;3(1):75-80. [PubMed: 16493154]

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Rahman NM, Maskell NA, West A, Teoh R, Arnold A, Mackinlay C, Peckham D, Davies CW, Ali N, Kinnear W, Bentley A, Kahan BC, Wrightson JM, Davies HE, Hooper CE, Lee YC, Hedley EL, Crosthwaite N, Choo L, Helm EJ, Gleeson FV, Nunn AJ, Davies RJ. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med. 2011 Aug 11;365(6):518-26. [PubMed: 21830966]

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Pines A, Kaplinsky N, Olchovsky D, Rozenman J, Frankl O. Pleuro-pulmonary manifestations of systemic lupus erythematosus: clinical features of its subgroups. Prognostic and therapeutic implications. Chest. 1985 Jul;88(1):129-35. [PubMed: 3924488]

16.

So C, Imai R, Tomishima Y, Nishimura N. Bilateral Pleuritis as the Initial Symptom of Systemic Lupus Erythematosus: A Case Series and Literature Review. Intern Med. 2019 Jun 01;58(11):1617-1620. [PMC free article: PMC6599940] [PubMed: 30713311]

Disclosure: Michael Hunter declares no relevant financial relationships with ineligible companies.

Disclosure: Hariharan Regunath declares no relevant financial relationships with ineligible companies.

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If the coronavirus infection was severe, after it, patients may develop patches in the lungs. On x-rays, they look like scars, an associate professor at the Department of Hospital Therapy of the Moscow State Medical University named after M.V. Sechenov, pulmonologist Alexander Palman.

“In acute viral pneumonia, a ground-glass pattern is observed in the lungs on CT. It looks like it was thrown on a light cobweb. Subsequently, ground glass may disappear completely, but if the disease is severe, there may be areas of compaction – consolidation, ”he explained.

According to the scientist, it used to be thought that if “frosted glass” is found in the lungs of those who have been ill and a consolidation process occurs, then in the future this will necessarily transform into irreversible severe fibrosis. But now it turned out that the majority of these seals are.

adv.rbc.ru

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“On an x-ray or CT scan, the hardened areas really look like scars that have formed, that is, fibrosis. But in fact, this is some kind of post-inflammatory thickening, and in most patients it goes away, ”said Palman.

5-10% of those who have recovered from COVID-19 develop pulmonary fibrosis – some researchers consider this a form of premature aging of the lungs, a professor at the Department of Phthisiology and Pulmonology of the Medical Faculty of the Moscow State Medical University named after M. V. A.I. Evdokimova Sergey Babak.

“In a small number of cases, premature aging of the lung is activated after COVID-19, which is expressed in pulmonary fibrosis. But in young and healthy people, these processes are unlikely to be launched. And in older patients over 50, these risks increase. Plus, if they have concomitant lung diseases, such as COPD – chronic obstructive pulmonary disease – these processes can be accelerated, ”he said.

According to him, among the other most common consequences of coronavirus infection is post-covid syndrome, or long-covid. This condition can last 6-12 months.

“The disease is becoming chronic. People no longer transmit the virus, but it is inside them and affects all organs, including the lungs, ”the doctor added.

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Fibrosis after coronavirus – signs, causes, how to treat

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A quarter of patients with COVID-19 develop a course of the disease aggravated by pneumonia. Multifocal lung damage entails the likelihood of severe complications, such as fibrosis after coronavirus. The consequences of the inflammatory process, during which the lung tissue is replaced by connective tissue. In simple words, fibrosis is the appearance of scars and scars. If the lesions are small, the scarring does not affect lung function. If extensive, then gas exchange decreases, irreversible changes in lung function and respiratory failure occur.

CMRT specialist says

Publication date: October 29, 2021

Verification date: February 04, 2023

All facts have been verified by a physician.

Contents of the article

Pulmonary fibrosis – what is it, causes

Symptoms

Pulmonary fibrosis after coronavirus – symptoms are expressed by the following signs: loads

• increased breathing rate
• rapid fatigue
• skin color of fingers and nail plates becomes pale with a blue tint
• dry cough
• dizziness
• decrease in saturation – oxygen content in the blood

To confirm the diagnosis, a CT scan of the lungs is prescribed, on which the radiologist will see all the changes that have occurred. Fibrosis of the lungs, symptoms after covid on CT scans are expressed:

• areas of reduced transparency, the degree of haze of which indicates the severity of the lesion
• white areas indicate fluid in the lungs after coronavirus

According to the totality of signs, doctors determine the amount of drug treatment and further rehabilitation.

The likelihood of developing fibrosis after coronavirus

The tendency to fibrogenesis is affected

• genetic predisposition
• the presence of chronic diseases of the broncho-pulmonary system, autoimmune or other concomitant pathologies

Also at risk are patients with severe SARS-CoV-2 who were on mechanical ventilation.

How long do abnormal changes persist in the organs of the respiratory system

Post-like pathological changes persist in the lungs for a period of three to six to eight months. The duration is individual in each clinical case and depends on the state of the immune system, the presence of concomitant diseases, early or late treatment.

If even a slight manifestation of symptoms indicating the formation of pneumofibrosis appears, it is necessary to visit a doctor and undergo the recommended examination. The earlier treatment and pulmonary recovery is started, the lower the risk of complications.

Treatment of pulmonary fibrosis after pneumonia

The management of patients with past covid pneumonia involves a comprehensive diagnosis and treatment. Before the appointment, the doctor takes into account the results of the examination, selects the tactics of an individual course of therapy.

Along with drug treatment, physiotherapeutic procedures, special complexes of respiratory gymnastics, physiotherapy exercises are used.

How to avoid complications

The danger of pulmonary fibrosis after coronavirus is that with a large area of ​​fibrous growths, not only the lungs suffer.