Pleurisy
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Overview
Pleurisy, also known as pleuritis, is swelling of the thin lining around the chest cavity and lungs, also known as the pleura. This lining creates a smooth surface so the lungs glide easily in the chest while breathing. When the lining swells, the lungs rub painfully against the chest, causing swelling and chest pain.
In some cases, fluid can collect between the pleura. This is called pleural effusion. When there is no fluid, the condition is called dry pleurisy.
Symptoms
Usually the first sign of pleurisy is a sudden chest pain. The pain may be very mild or very severe. Sometimes the pain is only felt while breathing deeply or coughing. Other times, the pain may be felt all the time and get worse with deep breathing or coughing. Usually the pain is felt in the chest wall over the area that’s inflamed. You might also feel pain in the upper abdominal area, neck, back, and shoulders.
Because inhaling deeply hurts, a person with pleurisy tends to breathe quickly and shallowly. On the side where the pain is, the muscles of the chest move less than those on the other side. If fluid builds up between the layers of the pleura, the chest pain may go away. Large quantities of fluid can make expanding one or both lungs difficult.
Other symptoms may include:
- Fever
- Cough
- Shortness of breath
- Rapid breathing
Causes and Risk Factors
Irritation of the pleura can be caused by:
- Viruses
- Bacterial infections
- Cancer
- Inhaling asbestos or other toxic substances
- The use of certain medications
- Some types of autoimmune diseases, such as lupus or rheumatoid arthritis
Diagnosis
Diagnosis of pleurisy usually starts with a physical exam. Because the pain tied to pleurisy is distinct, it is often easy for the physician to diagnose. Using a stethoscope, the doctor may hear a squeaky, rubbing sound.
Chest X-rays and CT scans are often used to see an image of what is going on inside the lungs and chest. These tests help show if fluid is building up in the lungs. They will also show if the lungs are filling up with air as much as possible.
Other imaging tests may be used, such as an ultrasound or electrocardiogram, to rule out heart disease.
If fluid has begun to build up in the chest or lungs, the doctor may take a test sample of it. This will help determine the cause of the pleurisy and rule out the possibility of cancer.
A biopsy of a small sample of tissue may also be done to rule out the possibility of cancer. To do this, a needle will be used to remove a small tissue sample to be examined under a microscope.
A blood test to detect lupus or rheumatoid arthritis may also be performed.
Treatment
Treatment for pleurisy depends on what caused the condition. The experts at Cedars-Sinai’s Advanced Lung Disease Program can help you find the best treatment plan.
Antibiotics may be prescribed for infections caused by bacteria. If a virus causes the pleurisy, no treatment will be given. If the cause is lupus or an autoimmune disease, corticosteroids often quickly cure the pleurisy. These drugs suppress the immune system, which stops the swelling in the lining.
Nonsteroidal anti-inflammatory drugs, such as aspirin or ibuprofen, help relieve the chest pain. Codeine and other stronger pain relievers should not be used. These medicines can stop you from coughing. Coughing is important because it stops the lungs from collapsing and helps prevent pneumonia.
Holding a pillow against the part of the chest that hurts while coughing or breathing deeply can be helpful. Wrapping the chest in wide, elastic bandages can help relieve severe pain. Wrapping the chest also makes it harder to breathe and increases the risk of a collapsed lung or pneumonia.
© 2000-2022 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.
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Pleurisy is an inflammation of the pleura, a large, thin sheet of tissue that wraps around the outside of your lungs and lines the inside of your chest cavity. Between the layer of the pleura that wraps around your lungs and the layer that lines your chest cavity is a very thin space called
the pleural space. Normally this space is filled with a small amount of fluid that helps the two layers of the pleura glide smoothly past each other as your lungs breathe air in and out. Pleurisy occurs when the two layers of the pleura become red and inflamed, rubbing against each other every time your lungs expand to breathe in air. Infections like pneumonia are
the most common cause of pleurisy. The main symptom of pleurisy is a sharp or stabbing pain in your chest that gets worse when you breathe in deeply or cough or sneeze. The pain may stay in one place or it may spread to your shoulder or back. Sometimes it becomes a fairly constant dull ache. Depending on what's causing the pleurisy, you may have other symptoms, such as: Shortness of breath A cough Fever and chills Rapid,
shallow breathing Unexplained weight loss A sore throat followed by pain and swelling in your joints Your doctor will find out if you have pleurisy or another pleural disorder by taking a detailed medical history and doing a physical exam and several diagnostic tests, including: Chest X-ray to show air or fluid in the pleural space, and what's causing the condition (for example, pneumonia, a fractured rib, or a lung tumor) CT scan that
can show pockets of fluid, signs of pneumonia, a lung abscess or a tumor Ultrasound, which can show where fluid is located in your chestWhat is pleurisy?
Symptoms
Diagnosis
Magnetic resonance (MR) scan, which can show pleural effusions and tumors
Blood tests, which can show whether you have a bacterial or viral infection, pneumonia, rheumatic fever, a pulmonary embolism or lupus
Arterial blood gas tests, which show how well your lungs are taking in oxygen
Treatment
A procedure called thoracentesis is used to remove fluid from the pleural space. The doctor inserts a needle or a thin, hollow, plastic tube through the ribs in the back of your chest into your chest wall. A syringe is attached to draw fluid out of your chest.
To relieve symptoms, your doctor may recommend:
Acetaminophen or anti-inflammatory agents, such as ibuprofen, to control pain
Codeine-based cough syrups to control a cough
Lying on the painful side to make you more comfortable
Breathing deeply and coughing to clear mucus as the pain eases
Your doctor will look at the fluid under a microscope to determine what's causing the fluid buildup. If the fluid is infected, treatment involves antibiotics and draining the fluid. If the infection is tuberculosis or from a fungus, treatment involves long-term use of antibiotics or antifungal medicines. If the fluid is caused by tumors of the pleura, it may build up again quickly after it's drained. Sometimes antitumor medicines will prevent further fluid buildup. If they don't, the doctor may seal the pleural space.