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Pleurisy (or pleuritis) occurs when the double membrane (pleura) that lines the chest cavity and surrounds each of your lungs becomes inflamed.
One layer of the pleura, which is just a few cells thick, overlies each lung. The other layer lines the inner chest wall. When you breathe in, the large muscle separating the chest cavity from the abdominal cavity (diaphragm) contracts and your chest wall expands, causing your lungs to expand. The two layers of pleura rub against each other with almost no friction, allowing your lungs to expand and contract without any resistance from the lining of the chest wall.
When inflamed, the two layers of the membrane in the affected side of your chest rub against each other, producing pain when you inhale and/or exhale. Between breaths, you feel almost no pain. At times, pleurisy causes an accumulation of fluid in the chest cavity (pleural effusion).
Causes & Development
Pleurisy occurs as a complication of many things. The underlying medical conditions that can cause pleurisy are numerous and include:Sometimes a cause cannot be found (ideopathic pleurisy).
Signs & Symptoms
Pleurisy typically causes sharp chest pain, almost always during the act of breathing. There may also be dry cough, fever and chills, pain when moving, or fast, shallow breathing -- shortness of breath. The patient will typically be able to point to the exact location of the pain. In some people, the pain spreads to the neck, shoulder, or abdomen.
When an accumulation of fluids is associated with pleurisy, the pain usually disappears because the fluid serves as a lubricant. However, if enough fluid accumulates, it puts pressure on your lungs and interferes with their normal function, causing shortness of breath. If the fluid becomes infected, the signs and symptoms of dry cough, fever and chills may appear.
Diagnosis & Tests
A doctor may make a diagnosis based on your signs and symptoms. Upon examining you and listening to your chest, your doctor may hear a "friction rub" that sometimes sounds like the crunching sound of walking on very dry snow.
You may also undergo the following diagnostic procedures:- Imaging. A chest X-ray may show an area of inflammation in your lungs that indicates pneumonia. Your doctor will want to investigate an unexplained abnormality seen on an X-ray with additional imaging, usually beginning with a computerized tomography (CT) scan. In a CT procedure, a computer translates information from X-rays into images of thin sections (slices) of your chest. CT scans produce more detailed images of your internal organs than do conventional X-ray studies. Sometimes doctors want a special type of chest X-ray in which you lie on your side where the pleurisy is to see if there's any fluid that doesn't appear on a standard chest X-ray. This type of X-ray is called a decubitus chest X-ray.
- Blood test. A blood test may tell your doctor whether your lungs are infected and what type of infection you have. Other blood tests may also detect an autoimmune disorder such as rheumatoid arthritis or lupus in which the initial sign is pleurisy.
- Thoracentesis. To remove fluid for laboratory analysis, your doctor may suggest a procedure called thoracentesis. In this procedure, your doctor first injects a local anesthetic, then inserts a needle through your chest wall between your ribs to remove fluid. In addition, a sample of tissue (pleural biopsy) for microscopic analysis may be obtained if your doctor is concerned that the fluid collection may be caused by tuberculosis or cancer. If only a small amount of fluid is present, your doctor may insert the needle with the help of ultrasound over the site of the fluid.
- Video-assisted thoracic surgery (VATS). Another way of obtaining a sample of pleural tissue is by a surgical procedure called video-assisted thoracic surgery. In VATS, a tube is inserted to collapse a lung to about one-quarter its normal size. This creates a space through which your doctor can insert a pen-sized instrument through your chest wall to take a tissue sample under video guidance.
Treatment & Prevention
The most important goal in relieving pleurisy or pleural effusions is treatment of the underlying condition that's causing your signs and symptoms. For example, if the cause of pleurisy is a bacterial infection of the lung (pneumonia), an antibiotic may control the infection. But, for pleurisy due to a viral infection, antibiotics won't be effective.
Over-the-counter or prescription nonsteroidal anti-inflammatory drugs (NSAIDs) may help relieve some of the signs and symptoms of pleurisy. Prescription codeine may help control a cough as well as the pain. If there is a large buildup of fluid, the patient may need to stay in the hospital to have the fluid drained over a period of several days through a tube inserted into the chest.
Even though the cause may not be known, the problem can still be treated.
The sharp, fleeting pain in your chest that pleurisy causes is made worse by coughing, sneezing, moving and deep breathing. You may find relief from pain when you hold your breath or when you apply pressure over the painful area.
Prognosis
The outcome of treatment may depend on the seriousness of the underlying disease. Most cases of pleuritis of unknown cause heal with time.
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Signs, symptoms & indicators of Pleurisy: | | | | | Symptoms - Respiratory |  Chest pain when breathing | The hallmark of pleurisy is severe chest pain that starts suddenly. Often strong or stabbing when taking a deep breath or coughing, the pain usually subsides or disappears between breaths, and it is usually felt on one side of the stomach area or lower chest. |
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Recommendations and treatments for Pleurisy:
KEY | | Strong or generally accepted link |  | | Likely to help |
GLOSSARY
Abdomen (Abdominal)
That part of the body between the chest and the hips that contains the stomach, intestines, liver, bladder, pancreas and other organs.
Acute
An illness or symptom of sudden onset, which generally has a short duration.
Anesthetic
Agent causing loss of sensation by neurological dysfunction or a pharmacological depression of nerve function.
Anti-inflammatory (Antiinflammatory)
Reducing inflammation by acting on body mechanisms, without directly acting on the cause of inflammation, e.g., glucocorticoids, aspirin.
Arterial (Arteries, Artery)
Blood that leaves the heart. When it leaves the right ventricle, it is venous blood; and when it leaves the left ventricle, through the aorta, it is fresh and oxygenated. After it has passed out to the capillaries and started to return, it is venous blood.
Autoimmune Disease (Autoimmune, Autoimmunity)
One of a large group of diseases in which the immune system turns against the body's own cells, tissues and organs, leading to chronic and often deadly conditions. Examples include multiple sclerosis, rheumatoid arthritis, systemic lupus, Bright's disease and diabetes.
Bacteria (Bacterial, Bacterium)
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Biopsy
Removal of a sample of tissue from a living being for diagnosis. A pathologist later uses a microscope to look for certain features, such as cancer cells, in the sample. A fine-needle aspiration biopsy involves inserting a thin needle to remove a small amount of tissue, sometimes using CT or ultrasound to guide the needle. A core biopsy involves obtaining a sample of tissue with a thick needle or by inserting a thin, lighted tube (laparoscope) into a small incision in the abdomen. Another biopsy method is to remove tissue during an operation.
Cancer
Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Diaphragm
The thin muscle under the lungs and heart that separates the chest from the stomach/abdomen.
Embolism
Obstruction of a vessel by an abnormal body, usually a detached blood clot.
Hepatitis
Inflammation of the liver usually resulting in jaundice (yellowing of the skin), loss of appetite, stomach discomfort, abnormal liver function, clay-colored stools, and dark urine. May be caused by a bacterial or viral infection, parasitic infestation, alcohol, drugs, toxins or transfusion of incompatible blood. Can be life-threatening. Severe hepatitis may lead to cirrhosis and chronic liver dysfunction.
Lung (Lungs, Pulmonary)
Organ of the body, located in the chest cavity which is designed to bring oxygen from the air into the blood stream, while also expelling carbon dioxide and other waste gases out of the body. Pulmonary: Related to the lungs.
NSAID (NSAIDs)
Non-steroidal anti-inflammatory drug.
Over-The-Counter (OTC, Over The Counter)
A drug or medication that can legally be bought without a doctor's prescription being required.
Pancreatitis
Inflammation of the pancreas. Symptoms begin as those of acute pancreatitis: a gradual or sudden severe pain in the center part of the upper abdomen goes through to the back, perhaps becoming worse when eating and building to a persistent pain; nausea and vomiting; fever; jaundice (yellowing of the skin); shock; weight loss; symptoms of diabetes mellitus. Chronic pancreatitis occurs when the symptoms of acute pancreatitis continue to recur.
Pleurisy
An inflammation of the serous membranes that both surround the lungs and line the inside of the chest cavity; the two membranes supply fluid lubrication between the expanding and contracting lungs and the body. Most pleurisy (and usually the milder form) follows or accompanies bronchitis or late winter chest colds. It may be dry pleurisy (with few secretions and sharp sticking pain that prevents any but moderate inhalation), or acute or effusive pleurisy (with fever, coughing, and built up serous fluids -- usually dismissed as bronchitis). Some types are part of serious cardio-pulmonary disorders and/or chronic disease.
Pneumonia (Pneumonitis)
Inflammation, usually infectious, of the lungs. Unless the result of only moderate chemical or smoke irritation, it is a potentially life-threatening condition. There are so many defenses against an infection this deep in the body that the very presence of pneumonia signals a pathogen of great virulence or impaired or exhausted immunity, or all three. Pneumonitis: Inflammation of the lungs, from whatever cause. It may be concurrent with pneumonia or pleurisy.
Rheumatoid Arthritis
A long-term, destructive connective tissue disease that results from the body rejecting its own tissue cells (autoimmune reaction).
Stomach
A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.
Tuberculosis
Also known as TB, Consumption or "The White Plague", tuberculosis is an infectious disease caused by a bacterium called Mycobacterium tuberculosis, usually affecting the lungs but possibly also the brain, kidneys and bones. Patients may at first be symptom-free or experience a flu-like illness. In the secondary stage, there might be a slight fever, night sweats, weight loss, fatigue and various other symptoms, depending on the part of the body affected. Tuberculosis of the lung is usually associated with a dry cough that eventually leads to a productive cough with blood-stained sputum. There might also be chest pain and shortness of breath.
Ultrasound
Ultrasound testing uses sound waves projected into the body to produce an image of internal organs, structures, tumors, etc. In this procedure, a gel is applied to the patient's skin, and a small device that emits ultrasonic pulses is slowly passed over the area. The sonic image produced is viewed on a monitor.
X-rays (X-ray)
High-energy radiation used to take pictures of areas inside the body.
Last updated: May 26, 2008
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