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Pleurisy by Beth Walsh, MA

Definition

Pleurisy is an inflammation of the pleura, the double-layered membrane that surrounds each lung and the rib cage. The double-layered pleura protects and lubricates the surface of the lungs as they inflate and deflate within the rib cage. Healthy pleura have a thin, fluid-filled space between the two layers that lets them glide gently across each other. When they become inflamed, the diseased surfaces rub painfully together. This causes a characteristic sound called “friction rub.”

Rib Cage

Pleurisy cases are defined as having pleural effusion or as being dry. Pleural effusion, an accumulation of fluid in the pleural space, is more common, and is essentially a side effect of numerous diseases or trauma. Dry pleurisy refers to cases where there is no fluid build-up. Pleural effusion is less painful due to the fluid forcing some separation of the membranes. However, the fluid puts pressure on the lungs which can lead to respiratory distress and even lung collapse.

Pleurisy is a potentially serious condition that can have long-term effects. The sooner you seek medical care, the more favorable the outcome. Contact your doctor if you think you may have pleurisy.

Pleura of the Lungs

Causes

There are several causes for either acute or chronic pleurisy.

Viral infection (influenza, mumps)
Lung infections from bacteria (eg, tuberculosis ) or parasites (eg, amebiasis)
Systemic lupus
Asbestos
Pancreatitis
Rheumatoid arthritis
Cancer metastases
Liver and kidney disease (chronic)
Sickle cell disease
Inflammatory bowel disease
After a heart attack (eg, Dressler’s syndrome)
Heart failure
Pulmonary embolism
Chest injury
Drug reaction (nitrofurantoin, procainamide)

Risk Factors

The following factors increase your chance of developing pleurisy. If you have any of these risk factors, tell your doctor:

Infection, injury, or tumor
An underlying lung condition, such as pneumonia, tuberculosis, lung abscesses, or influenza

These are the most common causes, however, pleurisy can occur spontaneously.

Symptoms

If you experience any of these symptoms, do not assume it is due to pleurisy. These symptoms may be caused by other, less serious health conditions. If you experience any one of them, see your physician.

Sharp, stabbing pain towards the side and lower part of the chest especially when lying down, with relief by sitting up
Pain along the shoulders, neck, and abdomen
Aggravated pain during any movement of the chest, such as breathing and coughing
Dry coughing
Weakness
Headaches
Loss of appetite
Chills
Fever
Rapid pulse
Rapid and shallow breathing

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. The distinctive pain associated with pleurisy can be enough to diagnose the condition. The doctor will use a stethoscope to listen for abnormal chest sounds, such as a friction rub. The next step is determining the illness that caused the pleurisy. Tests may include the following:

Chest x-ray
Blood test
EKG
Computed tomography scan (CT scan)
Ultrasound scan
Fluid analysis after thoracentesis
- If a fluid analysis is not helpful, the physician may decide to perform a biopsy of the pleura with video-associated thoracic surgery (VATS)

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Pain Management

Analgesics and anti-inflammatory drugs, such as acetaminophen, ibuprofen, and indomethacin, are used to treat the pain. Some patients can reduce their pain by lying on the painful side, holding a pillow tightly, or wrapping chest with elastic bandages. The physician may prescribe codeine-based cough syrup to treat a painful cough.

Treating the Source of Infection

If pleurisy is the result of a bacterial infection, the physician can prescribe antibiotics. If it is the result of a viral infection, treatment is simply letting it run its course. If the cause is due to an autoimmune disease such as lupus , steroid treatment will quickly relieve pain.

If you are diagnosed with pleurisy, follow your doctor's instructions .

Prevention

To help reduce your chances of getting pleurisy, take the following steps:

Seek early medical attention for conditions that can cause pleurisy.
Consider getting vaccinated for pneumonia, especially if you are elderly, have a chronic illness, or weakened immunity.

RESOURCES:

American Lung Association http://www.lungusa.org
Mayo Clinic http://www.mayoclinic.com
National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov

CANADIAN RESOURCES:

The Canadian Lung Association http://www.lung.ca
Health Canada http://www.hc-sc.gc.ca/index-eng.php

References:

Kass SM, and Reamy BV: Pleurisy. Am Fam Physician . 2007;75:1357-64.
Pleurisy. Dr. Joseph F. Smith Medical Library website. Available at: http://www.chclibrary.org/micromed/00061080.html . Accessed August 1, 2005.
Pleurisy. The Merck Manual of Medical Information website. Available at: http://www.merck.com/mmhe/sec04/ch052/ch052b.html . Accessed August 1, 2005.

Last reviewed July 2010 by Marcin Chwistek, MD

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