When you breathe, the thin tissues that line your lungs and chest
wall, called the pleura, rub together. This isn’t typically a problem because the
tissue is satiny and generates no friction. However, when this tissue is
inflamed or infected, it becomes irritated and swollen, causing significant
pain. This condition is known as pleurisy, or pleuritis.
Pleurisy has a grim fame. It caused the death of a number of
historical figures, including Catherine de Medici and Benjamin Franklin.
Pleurisy is no longer a common condition. Over the years,
antibiotics have been extremely successful in treating and preventing the
bacterial infections that historically were the main causes of pleurisy.
Nowadays, most cases of pleurisy are the result of a viral infection and deaths
from this illness are quite rare.
Viral infections are the most common cause of pleurisy. Viruses
can cause infections in the lungs, which can lead to pleurisy.
Other causes of pleurisy include:
- bacterial pneumonia
- chest wounds
- rib fractures
- blunt trauma to the chest wall
- chest or lung tumors
- blood clots in the arteries of your lung, or
- immune system disorders, such as systemic lupus
and rheumatoid arthritis
- sickle cell anemia, an inherited condition that
causes irregularly shaped, hard, and sticky red blood cells that interfere with
blood and oxygen flow
- pancreatitis, a condition in which the pancreas
- heart surgery complications
- lung cancer
- mesothelioma, which is a cancer caused by
- fungal or parasitic infections
Are the Symptoms of Pleurisy?
The chief symptom associated with pleurisy is a sharp, stabbing
pain when you breathe in or out. This pain might go away when you hold your
breath or put pressure on the painful area. However, it will definitely get
worse when you sneeze, cough, or move. Fever, chills, and loss of appetite are
possible symptoms, depending on the condition that’s causing the pleurisy.
Additional symptoms of pleurisy include:
- pain on one side of your chest
- pain in your shoulders and back
- shallow breathing to avoid feeling pain
- joint pain
- muscle aches
- shortness of breath
Pleurisy can be accompanied by a fluid buildup that puts pressure
on the lungs and causes them to stop working properly. This fluid accumulation
is called a pleural effusion.
This fluid may initially act like a cushion, causing the chest pain to
disappear. Eventually, an individual with a pleural effusion will experience
shortness of breath as the fluid increases. They may also experience fever,
chills, and a dry cough. These symptoms can indicate a fluid infection, also
called an empyema.
The first priority in diagnosing pleurisy is to figure out the
location and cause of the inflammation or swelling. Your doctor will want to do
a physical exam and record your medical history. Your doctor may prescribe one
or more of the following tests as well.
Chest X-rays will allow your doctor to see if there’s any
inflammation in the lungs. They may also order a decubitus chest X-ray, which is
an X-ray taken while you are lying on your side. This allows free fluid to form
a layer. A decubitus chest X-ray should confirm if there’s any fluid buildup.
Blood tests can help to determine if you have an infection and
the cause of your infection if you do have one. In addition, blood tests will
reveal whether you have an immune system disorder.
During thoracentesis, your doctor will insert a needle into the
area of your chest where imaging tests detect fluid. Then, they’ll remove the
fluid and analyze it for the presence of infections. Due to its invasive nature
and associated risks, this test is rarely done for the typical case of
To further research any abnormalities found on chest X-rays, your
doctor may want to take a series of detailed, cross-sectional images of your
chest using a CT scan. The images produced by the CT scan create a detailed
picture of the inside of your chest. This allows your doctor to get a closer
look at the irritated tissue.
In an ultrasound, high-frequency sound waves create an image of
the inner portion of your chest cavity. This will allow your doctor to see if
there’s any inflammation or fluid buildup.
A biopsy is useful if cancer is a possible cause of your pleurisy.
Your doctor will use sterile procedures and make small incisions in the skin of
your chest wall. An X-ray or CT scan can confirm the exact biopsy site. Your
doctor can use these imaging procedures to guide the lung biopsy needle between
your ribs and into your lung. Your doctor will take a small sample of lung
tissue and then remove the needle.
This tissue will then be sent to the laboratory to be analyzed
for infection and to look for abnormal cells consistent with cancer.
During a thoracoscopy, your doctor will make a small incision in
your chest wall and then insert a tiny camera attached to a tube into your
chest cavity. They’ll use the camera to locate the irritated area, and they’ll
then collect a tissue sample for analysis.
Is Pleurisy Treated?
Once your doctor identifies the source of inflammation or
infection, they’ll be able to determine the correct treatment. Getting adequate
rest to assist your body with the healing process is an important part of
getting well. In addition, lying on the side that has pain may provide just
enough pressure to make the pain go away.
Other methods of treatment include:
- antibiotics for bacterial infection
- over-the-counter medicines, including aspirin,
ibuprofen, or other non-steroidal anti-inflammatory drugs
- prescription pain and cough medication that may
- medications to break up any blood clots or large
collections of pus and mucus, which are then drained out via a tube
- bronchodilators via metered dose inhaler
devices, such as those used to treat asthma
Individuals with large amounts of fluid in their lungs (pleural
effusions) might have to stay in the hospital with a drain tube in the chest
until fluids drain adequately.
Pleurisy can have severe long-term implications, but seeking
medical treatment and adhering to your course of treatment can have wonderful
results. You and your doctor should identify any underlying causes of your
pleurisy to help you recover.