Pleurisy

Overview

Pleurisy (PLOOR-ih-see) is a condition in which the pleura — two large, thin layers of tissue that separate your lungs from your chest wall — becomes inflamed. Also called pleuritis, pleurisy causes sharp chest pain (pleuritic pain) that worsens during breathing.

One pleural layer of tissue wraps around the outside of the lungs. The other pleural layer lines the inner chest wall. Between these two layers is a small space (pleural space) that's usually filled with a very small amount of liquid. These layers act like two pieces of smooth satin gliding past each other, allowing your lungs to expand and contract when you breathe.

If you have pleurisy, these tissues swell and become inflamed. As a result, the two layers of the pleural lining rub against each other like two pieces of sandpaper. This causes pain when you breathe in and out. The pleuritic pain lessens or stops when you hold your breath.

Treatment of pleurisy involves pain control and treating the cause.

Symptoms

Signs and symptoms of pleurisy might include:

• Chest pain that worsens when you breathe, cough or sneeze.
• Shortness of breath — often from trying to limit breathing in and out.
• Cough — only in some cases.
• Fever — only in some cases.

Pain caused by pleurisy might worsen with movement of your upper body and can spread to your shoulders or back.

Pleurisy can occur along with pleural effusion, atelectasis or empyema:

• Pleural effusion. In some cases of pleurisy, fluid builds up in the small space between the two layers of tissue. This is called pleural effusion. When there is a fair amount of fluid, pleuritic pain lessens or disappears because the two layers of pleura are no longer in contact and don't rub together.
• Atelectasis. A large amount of fluid in the pleural space can create pressure. This can compress your lung to the point that it partially or completely collapses (atelectasis). This makes breathing difficult and might cause coughing.
• Empyema. The extra fluid in the pleural space can also become infected, resulting in a buildup of pus. This is called an empyema. Fever often occurs along with an empyema.

When to see a doctor

Call your healthcare provider or seek emergency care right away if you experience unexplained, intense chest pain during breathing. You might have a problem with your lungs, heart or pleura or an underlying illness for which you need prompt medical care.

Causes

A variety of conditions can cause pleurisy. Causes include:

• Viral infection, such as the flu (influenza).
• Bacterial infection, such as pneumonia.
• Fungal infection.
• Autoimmune disorder, such as rheumatoid arthritis or lupus.
• Lung cancer near the pleural surface.
• Pulmonary embolism.
• Tuberculosis (TB).
• Rib fracture or trauma.
• Certain inherited diseases, such as sickle cell disease.
• Certain medications and recreational drugs.

Risk factors

The risk of pleurisy increases if you get certain infections, such as the flu or pneumonia. Some medical conditions, such as lupus, TB and sickle cell disease also can increase your risk. And taking certain medicines or certain recreational drugs raise the risk of pleurisy.

Diagnosis

Your healthcare provider will likely start by asking about your medical history and doing a physical exam that includes listening to your chest with a stethoscope.

To determine if you have pleurisy and identify the cause, your healthcare provider might recommend:

• Blood tests. A blood test might tell if you have an infection. Other blood tests might detect an autoimmune disorder, such as rheumatoid arthritis or lupus. In these conditions, pleurisy can be the first sign.
• Chest X-ray. A chest X-ray can show if your lungs are fully inflating or if there is air or fluid between the lungs and ribs.
• Computerized tomography (CT) scan. A CT scan combines a series of X-ray images taken from different angles around your body. It uses computer processing to create cross-sectional images that look like slices of your chest. These detailed images can show the condition of the pleura. They can also show if there are other causes of pain, such as a blood clot in the lung.
• Ultrasound. This imaging method uses high-frequency sound waves to produce precise images of structures within your body. An ultrasound might be used to determine whether you have a pleural effusion.
• Electrocardiogram (ECG or EKG). This heart-monitoring test might be recommended to rule out certain heart problems as a cause for your chest pain.

Diagnostic procedures

In some cases, your healthcare provider might remove fluid and tissue from the pleural space for testing. Procedures might include:

• Thoracentesis. In this procedure, a local numbing agent (anesthetic) is injected between your ribs to the area where fluid was seen on your imaging studies. Next a needle is inserted through your chest wall between your ribs to remove fluid for lab analysis. Removing fluid can also help you breathe better. The needle is usually inserted with the help of ultrasound guidance.
• Thoracoscopy. If TB or cancer is suspected, a thoracoscopy — also called a pleuroscopy — may be performed. During this procedure, a tiny camera (thoracoscope) is inserted through a small cut in your chest wall. This procedure allows for a direct view inside your chest to look for any problems or to get a tissue sample (biopsy).

Treatment

Treatment for pleurisy focuses primarily on the underlying cause. For example, if bacterial pneumonia is the cause, an antibiotic can be prescribed to manage the infection. If the cause is a viral infection, pleurisy may go away on its own.

The pain and inflammation associated with pleurisy is usually treated with nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others). Occasionally, your healthcare provider may prescribe steroid medication.

The outcome of pleurisy treatment depends on the seriousness of the underlying cause. Early diagnosis and treatment of the condition that caused pleurisy can help you feel better. Depending on the cause and the condition, you may make a full recovery.

Lifestyle and home remedies

These steps might help relieve symptoms related to pleurisy:

• Take medication. Take medication as recommended by your healthcare provider to relieve pain and inflammation.
• Get plenty of rest. Find the position that causes you the least discomfort when you rest. Even when you start to feel better, be careful not to overdo it.
• Don't smoke. Smoking can cause more irritation to your lungs. If you smoke and can't quit on your own, ask your healthcare provider for help.

Preparing for an appointment

You're likely to start by seeing your primary care provider. However, when you call to set up your appointment, you might be urged to seek immediate medical care if you're having severe, unexplained chest pain.

You may want to bring a family member or friend along, if possible, to help you remember questions to ask and what your healthcare provider said.

Here's some information to help you get ready for your appointment, and what to expect from your health care provider.

What you can do

Prepare a list that includes:

• Details of your symptoms, including where your chest pain starts and how far it spreads. Also list other signs and symptoms, such as fever, trouble catching your breath or weight loss.
• Key medical information, including recent hospitalizations and any medical conditions you have. Also note whether family members — especially children — or close friends have recently been sick.
• Medications you're taking, including prescription and nonprescription drugs, vitamins, herbs or other supplements, and the dosages.
• Key personal information, including recent travel and major life changes. Your health care provider might also be interested in your work history, including possible exposure to asbestos.
• Questions to ask your healthcare provider.

Questions to ask may include:

• What do you think is the underlying cause of my symptoms?
• What kinds of diagnostic tests or procedures do I need, if any?
• What treatment do you recommend?
• How soon after I begin treatment can I expect to feel better?
• Are there self-care steps I can take to improve my discomfort?
• Do you recommend that I stay home from work or school? For how long?
• Will it help if I stop smoking?
• Am I at risk of long-term complications from this condition?
• I have other health conditions. How can I best manage them together?

Don't hesitate to ask other questions during your appointment.

What to expect from your healthcare provider

Be ready to answer questions your healthcare provider might ask, such as:

• How would you describe your symptoms?
• What, if anything, seems to improve or worsen your symptoms?
• Have you been diagnosed with or treated for any other health conditions?
• Have you recently traveled?
• Have you been involved in any work, projects or hobbies over the years that might have exposed you to asbestos?
• Do or did you smoke? If so, how much and for how long?
• Have you recently noticed swollen and tender joints or rashes?

Your healthcare provider will ask additional questions based on your responses, symptoms and needs. Preparing and anticipating questions will help you make the most of your appointment time.