Pleurisy, also known as pleuritis, is a condition where the linings of the lungs and chest become inflamed.
The pleural cavity - the area between the lungs and inner chest wall - sits between two lubricated surfaces, called pleura. The inner pleura lines the lungs and the outer lines the chest wall.
A variety of factors can cause the pleura to become inflamed, this is called pleurisy.
In this article, we will cover the causes, treatment, and diagnosis of pleurisy.
Fast facts on pleurisy
Here are some key points about pleurisy. More detail and supporting information is in the main article.
- Since the invention of antibiotics, pleurisy has become much rarer
- Pleurisy generally lasts from a few days to 2 weeks
- Elvis Presley had recurring pleurisy
- 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?
Pleurisy is an inflammation of the pleural membranes.
When healthy, the pleura slide smoothly across each other as we breathe. 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. However, since the advent of antibiotics, rates have dropped substantially. Pleurisy is rarely contagious.
The condition can last from a few days up to 2 weeks, but this depends on what caused the pleurisy and how severe the inflammation is.
Because pleurisy is often a mild condition that resolves itself without treatment, it is hard to estimate how many people contract pleurisy worldwide.
Some famous people have had pleurisy, including Benjamin Franklin (died of it), Mahatma Gandhi, Elvis Presley (had recurring pleurisy), Ringo Starr (at age 13), and Judy Garland.
Causes of pleurisy
Pleurisy is a complication of several different medical conditions, but the most common cause is a viral infection of the lungs spreading to the pleural cavity.
Other causes of pleurisy include:
- 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
- Infections can sometimes spread from person to person, but it is rare to "catch" pleurisy
Risk factors for pleurisy
Because pleurisy can be the result of a number of different situations, anyone is at risk of contracting pleurisy. However, someone who is over 65, sickly, or has suffered a chest injury or heart surgery has a higher chance of getting pleurisy.
Pleurisy and smoking are not strongly connected; cigarettes are very rarely the direct cause. However, an individual with pleurisy is not advised to smoke because the coughing that smoking produces can worsen the pain.
Symptoms of pleurisy
The main symptom of pleurisy is a sharp, stabbing pain in the chest. This pain can affect the shoulders and back, too; the pain is often only on one side of the chest.
An individual with pleurisy might sneeze, cough, and have rapid, shallow breathing due to the pain caused by deep breathing. Tachycardia (a rapid heart rate) is also common.
Patients often describe a constant aching pain that may vary in dullness with the cause of the inflammation. If pleurisy is caused by a viral infection, there may also be fever, chills, headaches, joint pain, and muscle aches.
Difficulty breathing and a sore throat can also occur.
Diagnosis of pleurisy
Chest X-rays are often part of the diagnosis process.
When diagnosing pleurisy, doctors often search for the cause of the inflammation and rule out other potential sources of the symptoms. For instance, a patient may have a rib injury or an infection which they are not aware of.
Simple physical exams will be carried out. Sometimes it is possible for a doctor to hear the pleural membranes rubbing together using a stethoscope; the sound is referred to as pleural friction rub.
Chest x-rays will most likely be ordered, and a blood sample might be taken to check for autoimmune disorders.
If there is pleural effusion (a build-up of fluid around the lung), a doctor might use a needle to take a fluid sample from the pleura in a procedure called a thoracentesis.
Pleurisy can also be diagnosed by:
- CT scan
- MRI scan
- Biopsy (if cancer is suspected)
- Arterial blood gas sampling (to test lung capacity)
Treatments for pleurisy
When treating pleurisy, doctors generally attempt to treat the root cause, such as a virus or other infection. Antibiotics will be prescribed if the pleurisy is a result of a bacterial infection.
In some pleural effusion cases, a patient may need to have the fluid drained out of the pleural cavity via a tube inserted into the chest.
To treat the pain caused by pleurisy, doctors may recommend aspirin, ibuprofen, or NSAIDs (non-steroidal anti-inflammatory drugs). In some severe cases, prescription pain and cough medicines may be used, including codeine-based cough syrups.
Those found to have pulmonary embolisms - a blockage in the blood vessel that runs from the heart to the lungs - may need to take anti-blood clotting medicine to prevent future complications.
Sometimes, pleurisy might be treated by placing fibrinolytic drugs into the chest, these break up blood clots, which can then be drained through a tube. If the fluids still do not drain, a surgical procedure might be necessary.
Ultimately, pleurisy treatment depends on the severity of the condition.
Historically, Native Americans used the pleurisy root, also called butterfly weed, to treat pleurisy. There are some safety concerns regarding this particular plant, and physicians do not recommend its use; there is no evidence that it works as an effective cure for pleurisy.
Although pleurisy is treatable and the prognosis is good, there can be complications if it is left untreated. The three most common complications are as follows:
Pleural effusion - excess fluid build-up in the pleural cavity. The fluid may force the two pleural membranes apart and partly relieve the pain produced when they rub together. In some cases, the fluid can become infected and turn into an abscess. Additionally, the fluid might sometimes push against the lung to such an extent that it collapses, making breathing even more difficult.
Pneumothorax - collapsed lung or lungs leading 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.
Hemothorax - blood collecting within the pleural cavity. This can cause shock or prevent sufficient blood from reaching the organs.
Pleurisy can be prevented only by the early detection and management of the causal disease. For example, an early diagnosis and treatment of an infection can prevent fluid from building up in the pleural cavity.
In other cases, management of a more serious disease can reduce the amount of inflammation or fluid build-up one may experience.
Pleurisy, which can stem from many different conditions, is often difficult to diagnose or easily confused with other diseases. When being treated for any condition, it is important to get plenty of rest and maintain a healthy diet so as to avoid developing complications such as pleurisy.