Pleurisy

What is pleurisy?

Pleurisy is an inflammation of the lining of a lung (pleura) usually caused by a lung infection. It is accompanied by sharp chest pain that is worse when breathing in (inspiration) because the two inflamed membranes rub across each other. There are two types of pleurisy: inflammatory and infectious. Pleurisy is frequently caused by a bacterial infection (pneumonia or tuberculosis) or by a viral infection (pleurodynia). It can also be caused by a blood clot in the lungs (pulmonary embolism), chest injury, or lung cancer. As a symptom, pleurisy can accompany a number of other medical conditions including rheumatoid arthritis, lupus erythematosus, and lung infarction.

Inflammation in the lining of the lung and the adjacent chest wall can cause an increased production of pleural fluid. This fluid can accumulate between the two pleural layers that line the lungs (pleural effusion), preventing the inflamed layers from rubbing against each other. So, although it interferes with normal respiration, the presence of pleural effusion may actually decrease the amount of pain caused by the pleurisy.

How is it diagnosed?

The diagnosis of pleurisy is made almost exclusively by the reported symptoms of the individual. The more important aspect of diagnosis is to discover the underlying disease process causing the pleurisy.

History: Symptoms include a sharp, stabbing chest pain that may travel to the tip of the shoulder on the involved side. Pain is usually worse with coughing or when breathing in (inspiration).

Physical exam reveals rapid, shallow breathing. Often, the individual is bent over towards the side of the pain. Auscultation (listening to breath sounds with a stethoscope) may reveal a friction rub over the area of pain, and decreased breath sounds in the affected area due to pain with a deep inspiration. Auscultation may also reveal evidence of the underlying pulmonary condition that has contributed to the pleurisy.

Tests: Initial tests include a chest x-ray to check for pleural effusion and to rule out pulmonary disease. Further diagnostic testing may be ordered to identify the underlying cause for the pleurisy.

How is pleurisy treated?

Primary treatment for pleurisy may include painkillers (analgesics), nonsteroidal anti-inflammatory agents, and cough suppressants. Antibiotics may be necessary if the cause is a bacterial infection, or a large pleural effusion may need to be drained (thoracentesis). Additional treatment is aimed at eliminating the underlying medical condition.

Medications

Motrin (Ibuprofen), Naprosyn (Naproxen)

What might complicate it?

Pleural effusion is the most common complication. Other complications might include inflammation of the membranous sac enclosing the heart (pericarditis), pus in the pleural cavity (empyema), or collapse (atelectasis) in areas of the lung that are not being well aerated due to pain.

Predicted outcome

The predicted outcome for pleurisy can be either a quick, full recovery, or a condition that is drawn out for weeks. Most of the time, with treatment, pleurisy is annoying rather than disabling. The outcome depends on the discovery and treatment of the underlying cause.

Alternatives

Conditions with similar symptoms include pneumonia, pleural effusion, empyema, mesothelioma, tuberculosis, lupus erythematosus, or pulmonary embolism.

Appropriate specialists

Pulmonologist.

Last updated 6 August 2015