Pleurisy: Symptoms, Causes, Treatment

What are the symptoms of pleurisy?

Pleurisy, also known as pleuritis, is an inflammation of the pleura, the two thin layers of tissue that separate the lungs from the chest wall. The primary symptoms of pleurisy include:

Sharp Chest Pain: This pain is often the most prominent symptom and typically worsens with breathing, coughing, or sneezing. The pain may be localized to one side of the chest but can also radiate to the shoulders or back.
Shortness of Breath: Because deep breathing can intensify the pain, people with pleurisy may breathe more shallowly, leading to a sensation of shortness of breath.
Cough: A dry cough may occur as a result of irritation in the pleura.
Fever and Chills: If pleurisy is caused by an infection, it may be accompanied by fever, chills, and other flu-like symptoms.
Pleural Rub: A distinctive, scratchy sound may be heard through a stethoscope during breathing, caused by the inflamed pleural layers rubbing against each other.

If you suspect you have pleurisy or are experiencing any of these symptoms, it’s important to consult a healthcare professional for proper diagnosis and treatment.

What are the causes of pleurisy?

Pleurisy, or pleuritis, is inflammation of the pleura, which are the thin membranes surrounding the lungs and lining the chest cavity. This inflammation can lead to sharp chest pain, especially during breathing. There are several potential causes of pleurisy, including infections, autoimmune diseases, injuries, and other medical conditions. Here are the most common causes:

1. Infections

Viral infections: These are the most common cause of pleurisy. Viruses like the flu, Coxsackievirus, or Epstein-Barr virus can lead to pleural inflammation.
Bacterial infections: Pneumonia is a frequent bacterial cause, and pleurisy can occur as a complication of bacterial lung infections like tuberculosis (TB) or Streptococcus pneumoniae.
Fungal infections: Fungal diseases, though less common, can also cause pleurisy, especially in immunocompromised individuals.

2. Autoimmune Diseases

Lupus (Systemic lupus erythematosus): This autoimmune disorder can cause widespread inflammation, including in the pleura.
Rheumatoid arthritis: Inflammation related to rheumatoid arthritis can affect the pleura, leading to pleurisy.
Scleroderma: This condition, which involves hardening and tightening of connective tissues, can also cause pleural inflammation.

3. Pulmonary Embolism

A pulmonary embolism (a blood clot in the lungs) can cause pleurisy as a result of tissue damage or restricted blood flow to parts of the lung, leading to inflammation.

4. Trauma or Injury

Chest trauma: A rib fracture, injury from a car accident, or surgery on the chest can lead to pleurisy due to direct irritation or damage to the pleura.
Pneumothorax: This is a condition where air leaks into the space between the lung and chest wall, causing the lung to collapse. It can result in pleuritic pain and inflammation.

5. Cancer

Lung cancer: Tumors growing near the pleura can cause pleuritis.
Metastatic cancers: Cancers that spread to the pleura, such as breast cancer or lymphoma, may cause pleurisy.
Mesothelioma: This is a rare cancer of the pleura, usually linked to asbestos exposure.

6. Other Medical Conditions

Pleural effusion: Fluid buildup between the pleura, which can happen due to heart failure, liver disease, or kidney disease, may irritate the pleura and lead to pleurisy.
Pericarditis: Inflammation of the pericardium (the sac surrounding the heart) can sometimes occur alongside pleurisy, as both the heart and lungs share the chest cavity.
Pancreatitis: Inflammation of the pancreas can sometimes lead to pleurisy as an associated complication.
Inflammatory bowel disease: Conditions like Crohn’s disease or ulcerative colitis may be associated with pleuritis in some cases.

7. Medications

Some medications, like procainamide (used to treat heart rhythm problems) or isoniazid (used for tuberculosis), can cause pleurisy as a side effect in rare instances.

8. Environmental Factors

Asbestos exposure: This can lead to chronic pleural inflammation and diseases such as mesothelioma, which can present with pleurisy.

9. Idiopathic Causes

In some cases, the cause of pleurisy is unknown, referred to as idiopathic pleurisy. This may occur when the cause is minor or not easily detectable.

Summary of Causes:

Viral and bacterial infections (e.g., pneumonia, tuberculosis).
Autoimmune diseases like lupus or rheumatoid arthritis.
Pulmonary embolism (blood clot in the lungs).
Chest trauma or rib fractures.
Lung cancer or metastatic cancers.
Other conditions like pleural effusion, pericarditis, or pancreatitis.
Exposure to asbestos or certain medications.

Treatment for pleurisy typically involves addressing the underlying cause, such as antibiotics for infections or anti-inflammatory medications for autoimmune conditions.

How is the diagnosis of pleurisy made?

The diagnosis of pleurisy typically involves a combination of medical history, physical examination, and various diagnostic tests. Here’s an overview of the diagnostic process:

1. Medical History and Physical Examination:

Medical History: The healthcare provider will ask about symptoms, their onset, duration, and any factors that worsen or alleviate them. They may also inquire about recent illnesses, injuries, or medical conditions.
Physical Examination: The provider will listen to the lungs with a stethoscope for characteristic sounds, such as a “pleural rub,” which is a rough, scratchy sound produced by inflamed pleural layers rubbing against each other.

2. Diagnostic Tests:

Chest X-ray: A chest X-ray can help identify lung infections, tumors, or other abnormalities that might cause pleurisy. It can also show if there is fluid accumulation (pleural effusion) around the lungs.
Ultrasound: An ultrasound can help detect pleural effusion and guide the removal of fluid if needed.
CT Scan: A more detailed imaging technique, a CT scan can provide a clearer view of the lungs and pleura, helping to identify the underlying cause of the inflammation.
Blood Tests: Blood tests can help identify infections, autoimmune conditions, or other underlying issues. Specific tests may include a complete blood count (CBC), markers for inflammation (like C-reactive protein), and tests for autoimmune diseases.
Pleural Fluid Analysis: If there is fluid accumulation around the lungs, a procedure called thoracentesis may be performed to remove a sample of the fluid. The fluid is then analyzed for signs of infection, cancer cells, or other conditions.
Electrocardiogram (ECG): An ECG can help rule out heart-related causes of chest pain, as heart conditions can sometimes present with similar symptoms.

3. Other Tests:

Bronchoscopy: In some cases, a bronchoscopy may be performed to look inside the airways and collect samples if a lung infection or cancer is suspected.

The specific tests and examinations will depend on the patient’s symptoms and medical history. A thorough evaluation is crucial for identifying the underlying cause of pleurisy and determining the appropriate treatment.

What is the treatment for pleurisy?

The treatment for pleurisy depends on the underlying cause of the inflammation. The primary goals are to relieve symptoms and address the root cause. Here are common treatment approaches:

1. Pain Management:

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Medications like ibuprofen or naproxen are commonly used to reduce pain and inflammation.
Analgesics: If NSAIDs are not sufficient, stronger pain relievers may be prescribed.
Corticosteroids: In cases of severe inflammation, corticosteroids may be used to reduce inflammation. However, these are typically used for short durations due to potential side effects.

2. Treatment of the Underlying Cause:

Infections:
Antibiotics: If a bacterial infection is causing pleurisy, antibiotics are prescribed.
Antiviral Medications: For viral infections, antiviral medications may be used, although they are not always necessary as viral pleurisy often resolves on its own.
Antifungal Medications: For fungal infections, appropriate antifungal treatments are used.
Autoimmune Diseases: If pleurisy is related to an autoimmune condition like lupus or rheumatoid arthritis, treatment may include medications to suppress the immune system, such as corticosteroids or immunosuppressants.
Pulmonary Embolism: Treatment may include anticoagulants (blood thinners) to prevent further clotting.
Cancer: If pleurisy is due to cancer, treatment may involve chemotherapy, radiation therapy, or surgery.

3. Procedures:

Thoracentesis: If there is a significant accumulation of pleural fluid (pleural effusion), a procedure called thoracentesis may be performed to remove the fluid. This can relieve symptoms and allow for fluid analysis to determine the cause.
Chest Tube: In cases of large pleural effusions or pneumothorax, a chest tube may be inserted to drain fluid or air from the pleural space.

4. Supportive Care:

Rest: Adequate rest can help the body heal.
Breathing Exercises: In some cases, breathing exercises may be recommended to prevent complications like pneumonia.

The specific treatment plan will depend on the cause and severity of pleurisy, as well as the patient’s overall health. It’s essential to follow the healthcare provider’s recommendations and complete any prescribed treatments.