Conditions Basics What is pleurisy? Pleurisy is swelling (inflammation) of the thin layers of tissue (pleura) covering the lungs and the chest wall.
The outer layer of the pleura (Figure 1) lines the inside of the chest wall, and the inner layer covers the lungs. The tiny space between the two layers is called the pleural cavity. This cavity normally contains a small amount of lubricating fluid that allows the two layers to slide over each other when you breathe.
When the pleura becomes inflamed, the layers rub together, causing chest pain. This is known as pleuritic pain.
Pleurisy is sometimes called pleuritis.
What causes it? In young, healthy people, an infection of the lower respiratory system (Figure 2) by a virus or bacteria may cause pleurisy. Pleurisy usually lasts a few days to 2 weeks. In very rare cases, the virus or bacteria may spread and cause pleurisy in others.
Other causes of pleurisy include air leaking into the pleural cavity from a hole in a lung (pneumothorax), injury to the chest (such as a broken rib), tuberculosis or other infections, or a tumour in the pleura.
Other conditions may also cause pleurisy. These include rheumatoid arthritis lupus sickle cell crisis pulmonary embolism pancreatitis
What are the symptoms? The symptoms of pleurisy are chest pain and difficulty breathing. The chest pain usually starts suddenly. People often describe it as a stabbing pain, and it usually gets worse with breathing. The pain:
May always be present, but it usually gets worse when you breathe in. You may avoid breathing deeply to prevent the pain. Usually is on only one side of the chest. May extend to a shoulder or the belly. Is usually worse when you cough, sneeze, or suddenly move. May ease when you hold your breath or press on the painful area. But this type of chest pain can be caused by conditions that do not affect the pleura, such as chest muscle strain and costochondritis
If a viral infection is causing your pleurisy, you may or may not have common viral symptoms, such as fever, headache, and muscle aches.
The inflammation of the pleura sometimes causes fluid to build up in the pleural cavity (pleural effusion (Figure 3) ). You may have less pain after this happens, because the fluid prevents the two layers of the pleura from rubbing together. If there is a large amount of fluid, it may prevent the lung from expanding when you breathe in. This can make it hard to breathe. Other symptoms of pleural effusion include fever, chest pain, and a dry cough.
Pleural effusion may occur without pleurisy in other conditions, such as heart failure or liver or kidney disease.
How is it diagnosed? Many different health problems can lead to pleurisy, so your doctor will look for what is causing your inflammation. The doctor will do a physical exam and tests, such as a chest X-ray, blood tests, or a CT scan, to look for the cause of your symptoms. The conditions that may cause pleuritic chest pain include:
Viral infections. Chest muscle strain. Rib fracture. Blood clots in the blood vessels of the lung (pulmonary embolism). Inflammation around the heart (pericarditis). Pneumonia. Tuberculosis. Fluid in the pleura (pleural effusion). If your doctor thinks your pleurisy may be caused by an autoimmune disease
If you have pleural effusion, your doctor may use a needle to remove some of the fluid from the pleura. This procedure is called thoracentesis (Figure 4) . The fluid is then studied, to help your doctor find out the cause of the effusion.
How is pleurisy treated? The treatment for pleurisy depends on the cause. For example, if a bacterial infection is the cause, you will probably need an antibiotic. If a pulmonary embolism
For most cases of pain caused by pleurisy, your doctor will suggest that you use aspirin, ibuprofen, or another non-steroidal anti-inflammatory drug (NSAID)
If you have pleural effusion, you may need to have the fluid drained through a tube that the doctor inserts in your chest.
In some cases of pleural effusion, you may need pleurodesis. During this procedure, a medicine is put into your chest cavity, which triggers an inflammatory reaction over the surface of the lung and inside the chest cavity. This causes the surface of the lung to stick to the surface of the chest cavity, which prevents more fluid from building up or reduces the amount of fluid.
Figure 1 - Pleura of the lungs The pleura includes two thin layers of tissue that protect and cushion the lungs. The inner layer (visceral pleura) wraps around the lungs and is stuck so tightly to the lungs that it cannot be peeled off. The outer layer (parietal pleura) lines the inside of the chest wall. The very thin space between the layers is called the pleural space. A liquid, called pleural fluid, is in the pleural space. The fluid lubricates the pleural space so that the two layers of pleural tissue can slide against each other.
Current as of: July 31, 2024
Author: Ignite Healthwise, LLC StaffClinical Review Board
Figure 2 - Respiratory system The upper respiratory tract (upper airway) consists of the nose, mouth, sinuses, pharynx (upper section of the throat), and larynx (voice box). The lower respiratory tract consists of the trachea (windpipe), bronchial tubes, and lungs. The bronchial tubes carry air into the lungs and branch into smaller and smaller bronchioles. These end in alveoli (air sacs).
The main function of the respiratory system is to supply the blood with oxygen so the blood can deliver oxygen to all parts of the body. The respiratory system does this through breathing.
Current as of: July 31, 2024
Author: Ignite Healthwise, LLC StaffClinical Review Board
Figure 3 - Pleural effusion Pleural effusion is a buildup of fluid in the space between tissues lining the lungs and the chest wall. This area is called the pleural space. Because of the fluid buildup, the lungs may not be able to expand completely. This can make it hard to breathe.
Current as of: July 31, 2024
Author: Ignite Healthwise, LLC StaffClinical Review Board
Figure 4 - Placement of a thoracentesis needle In thoracentesis, the doctor removes fluid from the space between the lungs and the chest wall (the pleural space). The doctor inserts a needle (and sometimes a plastic catheter) between two ribs and through the chest wall to remove and examine the fluid.
Current as of: July 31, 2024
Author: Ignite Healthwise, LLC StaffClinical Review Board
