=Definition.=—Chronic inflammation of the pleural layers. There are two
forms, exudative and dry or plastic pleurisies.
=Chronic Pleurisy with Effusion.=—This may follow an acute
serofibrinous type. Some cases develop very slowly. In most cases in
children, the fluid changes to pus early in the disease. The fluid may
remain for months without changing to a purulent character. In such
cases the character and physical signs do not differ from those in
acute serofibrinous pleurisy.
=Chronic Dry Pleurisy.=—These cases originate in two ways:
=First=, this may succeed pleural effusion when the fluid portion of
the exudate is absorbed and the pleural layers are opposed. They are
separated only by fibrinous elements that become organized into firm
connective tissue. This process goes on at the base, principally,
which, if it follows the acute form, produces but slight flattening,
but if it succeeds the chronic form or empyema, the extent of
retraction and flattening will be marked. Calcification may occur in
these firm, fibrous membranes and occasionally little pouches of fluid
are found between the false bands.
=Second=, a large number of cases are dry from the onset. This
condition may follow directly =acute plastic pleurisy=. It may be of
=tuberculous= origin or it may set in without any acute symptoms. No
matter how slight the plastic exudate may be, it invariably tends
to become organized, thus producing adhesion of the layers. This is
undoubtedly the result when the pleurisy is primary or secondary.
The adhesions are generally circumscribed. When the adhesions are of
tuberculous origin they may be locally confined to one pleura or they
may be bilateral. In these cases both the parietal and costal layers
are thickened, and embodied in the thickened pleura are found firm
fibrin masses and small tubercles.
Occasionally, vasomotor symptoms arise in chronic pleurisy, especially
in cases of tuberculous origin, and are probably due to the involvement
of the first thoracic ganglion. These almost invariably mean that
there is a displacement of the first, second, or third rib. Unilateral
flushing or sweating of the face or dilatation of the pupil are
frequently noticeable.
=Symptoms.=—Definite symptoms are rarely present. In some cases the
physical signs are quite pronounced, while, on the other hand, they
may be entirely negative. In mild cases there may be slight immobility
of the affected side with feeble breath sounds. In other cases there
may be very full chest expansion while the breath sounds are feeble.
In a large number of instances the physical signs are quite distinct.
There is displacement of the viscera, retraction of the chest walls,
curvature of the spinal column and dropping of the shoulders. There are
feeble breathing and creaking, leathery friction sounds. Dullness is
found at the base.
=Treatment.=—The treatment of chronic pleurisy is largely that of
acute pleurisy. Gymnastic and methodical breathing exercises should be
employed in helping to correct the thoracic walls. Care must be taken
not to injure the chest and pleura if adhesions have formed. Surgical
work may be necessary in some cases.
The vasomotor symptoms that are sometimes manifested in chronic
pleurisy and are claimed to be due to involvement of the first thoracic
ganglion, are an interesting feature to the osteopath. Such cases would
probably present to the osteopath a marked lesion of the upper dorsal
vertebræ or the second or third rib. These vasomotor symptoms are also
found in pleurisy associated with tuberculosis of the apex of the lung.
The osteopath frequently treats these cases and he should be cautious
about over-treating or straining the chest wall. The adhesions are
persistent and often there is more or less pain, so care must be
exercised when attempting to structurally readjust. Do not expect to
completely relieve every case, but nevertheless there are few cases but
that can be benefited. Occasionally the pain alone is due simply to
pleurodynia.