Pleurisy

Alternative names
Pleuritis; Pleuritic chest pain

Definition
Pleurisy is an inflammation of the pleura, the lining of the lungs, with subsequent pain.

Causes, incidence, and risk factors

Pleurisy may develop in the presence of lung inflammation (Pneumonia, Tuberculosis), rheumatic diseases, chest trauma, certain cancers, and asbestos-related disease. The main symptom is pain over the chest wall at the site of the inflammation. In some circumstances, the pain may be felt in the shoulder.

The pain is increased by deep breathing, coughing, and chest movement. The normally smooth pleural surfaces - now roughened by inflammation - rub together with each breath, and may produce a rough, grating sound called a “friction rub”. This can be heard with the stethoscope or an ear held against the patient’s chest.

Fluid often accumulates at the site of pleural inflammation. A localized collection of fluid separates the lung pleura from the chest wall pleura, causing the Chest pain to disappear even though the illness may be worsening.

Large accumulations of fluid compromise breathing and may cause coughing, Shortness of breath with Rapid breathing (tachypnea), cyanosis, and retractions.

Symptoms

     
  • Recent or present respiratory illness with its symptoms       o Cough       o Fever       o Malaise  
  • Localized Chest pain on the chest wall       o Pain with each breath       o Worsened by coughing       o Worsened by deep breathing

Signs and tests
Physical examination may show abnormal lung sounds:

     
  • Friction rub - a rough scratchy sound that accompanies breathing  
  • Rales (may be present with accompanying pneumonia)  
  • Rhonchi (may be present with Pneumonia or Bronchitis)  
  • Decreased breath sounds (may be present with a collection of fluid around the lung)

Tests:

     
  • CBC (may help differentiate bacterial versus viral infection)  
  • X-ray of the chest  
  • Ultrasound of the chest  
  • Thoracentesis (a collection of fluid from the pleural cavity)

Treatment
Treatment is directed at the underlying illness. Bacterial infections are treated with appropriate antibiotics. Tuberculosis requires special treatment. Viral infections normally run their course without medications. Pleural fluid may be removed by thoracentesis, and evaluated for signs of infection. The pain of pleurisy can often be controlled with acetominophen or anti-inflammatory agents, such as ibuprofen

Expectations (prognosis)
Recovery depends on the nature of the underlying illness. Recovery from infections of all types is expected with treatment. Recovery from pleurisy caused by malignant disease depends on the type and extent of the illness.

Complications

     
  • Breathing difficulty  
  • Complications associated with the original illness  
  • Complications associated with thoracentesis (collapsed lung)

Calling your health care provider
Call your health care provider if you experience symptoms of pleurisy. If you have breathing difficulty or the skin turns bluish, seek medical care promptly, possibly in an emergency room.

Prevention
Early treatment of bacterial respiratory infections can prevent pleuritis. No treatments are available for viral respiratory infections with the exception of several drugs for influenza type A.

Johns Hopkins patient information

Last revised: December 6, 2012
by Simon D. Mitin, M.D.

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