Pleurisy affects the lining between the lungs and chest wall.
A variety of factors can cause this inflammation, including viral infections, autoimmune diseases, certain medications, lung cancer, chest wounds, and inflammation in other parts of the body such as pancreatitis.
Its severity ranges from mild to life-threatening.
Since many cases are mild and resolve themselves without treatment, it is hard to estimate how many people contract pleurisy worldwide.
Some famous people with experience of pleurisy are Benjamin Franklin, Mahatma Gandhi, Elvis Presley, Ringo Starr, and Judy Garland.
Here are some key points about pleurisy. More information is in the main article.
- Since the invention of antibiotics, pleurisy has become rarer.
- Pleurisy generally lasts from a few days to 2 weeks and often resolves itself.
- There are many potential causes of pleurisy, including pancreatitis, lung cancer, and chest wounds.
- The main symptom of pleurisy is a stabbing pain in the chest.
What is pleurisy?
The pleural space is located between the lungs and inner chest wall. It sits between two lubricated surfaces, called pleura.
The inner pleura lines the lungs and the outer lines the chest wall. Normally, there should be nothing in the pleural space.
In a healthy person, the pleura slide smoothly across each other during breathing. When they are inflamed, they rub against one another.
This rubbing is the cause of the chest pain associated with pleurisy, often called pleuritic pain.
Pleurisy used to be a common complication of bacterial pneumonia, but, due to the introduction of antibiotics, it is now less common. It is rarely contagious.
It can last from a few days up to 2 weeks, depending on the cause and severity of the inflammation.
The main symptom is a sharp, stabbing pain or constant, aching pain in the chest. The pain may present on one or both sides of the chest and can also affect the shoulders and back. The pain often worsens with the motion of breathing.
- shortness of breath, or rapid, shallow breathing
- unexplained weight loss
Tachycardia, or a rapid heart rate, is also common.
Pleurisy can occur as a complication of various medical conditions, but the most common cause is that a viral infection of the lungs has spread to the pleural cavity.
- bacterial infections, such as pneumonia and tuberculosis.
- a chest wound that punctures the pleural cavity.
- a pleural tumor.
- autoimmune disorders, like lupus and rheumatoid arthritis.
- sickle cell anemia.
- pulmonary embolism.
- a heart surgery complication.
- lung cancer or lymphoma.
- a fungal or parasitic infection.
- inflammatory bowel disease.
- familial Mediterranean fever.
- certain medications, such as procainamide, hydralazine, or isoniazid.
Infections can sometimes spread from person to person, but it is rare to contract pleurisy from another person. It is not contagious.
Pleurisy more often affects people aged over 65 years, those with existing medical conditions, or those who recently experienced a chest injury or heart surgery.
Pleurisy and smoking are not strongly connected, and cigarettes are rarely the direct cause.
However, an individual with pleurisy is advised not to smoke because smoking often causes coughing, and this can worsen the pain.
The physician will conduct a physical examination and ask about recent and general medical history.
They will search for the cause of the inflammation, and rule out other potential sources of the symptoms.
Sometimes, a patient may have a rib injury or an infection about which they are not aware.
Simple physical exams will be carried out. Sometimes a doctor can hear the pleural membranes rubbing together using a stethoscope. This sound is referred to as pleural friction rub.
Chest X-rays will most likely be ordered, and a blood sample taken to check for autoimmune disorders
In the case of pleural effusion, a build-up of fluid around the lung, the doctor might use a needle to take a fluid sample from the pleura for testing. This is called a thoracentesis.
Pleurisy can also be diagnosed through:
- imaging tests, such as a Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI) scan
- a biopsy, if cancer is suspected to be the cause
The treatment options for pleural pain include aspirin, ibuprofen, or non-steroidal anti-inflammatory drugs.
A doctor will normally aim to treat the root cause, such as a virus or other infections. Antibiotics will be prescribed if the pleurisy is a result of a bacterial infection.
In some cases, a patient may need to have fluid drained out of the pleural cavity via a tube inserted into the chest.
Pain can be treated with aspirin, ibuprofen, or non-steroidal anti-inflammatory drugs (NSAIDs). In some severe cases, prescription pain and cough medicines may be used, including codeine-based cough syrups.
If there is a pulmonary embolism, a blockage in the blood vessel that runs from the heart to the lungs, the patient may be placed on blood thinners.
If the cause is related to an autoimmune condition, such as lupus, then a rheumatologist will treat the disease with medication.
Treatment depends largely on the cause and the severity of the condition.
Historically, Native Americans have used the pleurisy root, also called butterfly weed, to treat pleurisy. There are some safety concerns regarding this particular plant. Physicians do not recommend its use, as there is no evidence that it is an effective cure.
Pleurisy is treatable, and the prognosis is good, but complications can arise if it is left untreated. The three most common complications are:
The excess fluid build-up in the pleural cavity may force the two pleural membranes apart and partly relieve the pain produced when they rub together.
However, the fluid can sometimes become infected.
Sometimes, the fluid might push against the lung making breathing even more difficult.
Pleuritic chest pain can accompany a pneumothorax after trauma to the chest wall. A collapsed lung or lungs can lead to air or gas build-up in the pleural cavity.
The most common symptom is a sudden pain in one side and shortness of breath.
Trauma to the chest wall can cause pleuritic chest pain and blood accumulation in the pleural space. If enough blood accumulates in this space, it can lead to shock from blood loss and hypoxia from overcrowding the lung space.
Early detection and swift management of the underlying condition make it possible to prevent pleurisy.
For example, an early diagnosis and treatment of an infection can prevent fluid from building up in the pleural cavity or minimize levels of inflammation.
Pleurisy can be difficult to diagnose, and it is easily confused with other diseases.
When being treated for any condition, getting plenty of rest and maintaining a healthful diet can help prevent complications such as pleurisy.