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: