Pleurisy

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at May 30, 2016
StartDiseasesPleurisy

Pleurisy which is also known as pleuritis and pleuritic chest pain is an inflammation of the pleura, the double-layered membrane that lines the rib cage and surrounds the lungs. Inflammation of the pleura causes difficulty in breathing, chest pain, and sometimes edema or excess fluid.

Contents

Definition & Facts

Inflammations of the pleura can make breathing painful. This lining exists in the body to protect the exterior of the lungs as they inflate and deflate. In healthy individuals, the space between the layers (pleural cavity) is filled with lubricating fluid which allows the two layers to slide easily against each other. When these membranes are inflamed, every breath or cough causes the sensitive surfaces to rub together with painful results.

Pleurisy is sometimes associated with a related condition called pleural effusion, in which excess fluid develops and fills the spaces between the two layers of the pleura. While this fluid build-up may lessen the irritation of the inflamed membranes, the extra fluid exerts pressure on the lungs, which restricts breathing. In some cases the lungs can be compressed to the point where they partially or completely collapse.

A large amount of fluid may cause significant shortness of breath, and in severe cases, the fluid itself can become infected. People should always see a doctor if chest pain appears, particularly if accompanied by shortness of breath and dizziness.

Symptoms & Complaints

Signs and symptoms may involve chest pain experienced while breathing and which worsens upon sneezing or coughing. The tendency to try to limit and control breathing in order to reduce the discomfort can lead to shortness of breath and light-headedness. The pain involved may also be felt in the back or shoulders, or move to various parts of the torso. Sometimes, pleural effusion can appear without inflammation and without pain.

In some cases a persistent cough or fever may develop. Because these symptoms can be similar to those resulting from influenza, pneumonia, or other severe respiratory afflictions, it's important to see a doctor for a proper diagnosis. Some patients diagnosed with pleurisy thought they were experiencing heart attacks.

Swollen limbs that appear along with other symptoms may indicate deep vein thrombosis or even pulmonary embolism, which is a potentially serious condition where a blood clot has broken loose and traveled into the lungs. Should an infection develop within the pleura, this is called empyema and may involve fever and other symptoms of infections.

Causes

Pleurisy is often a complication of other conditions. Viral infections of the lungs, such as tuberculosis and pneumonia, are the most common causes, but it may also develop as a result of medical conditions such as systemic lupus, rheumatoid arthritis, fungal infections that reach the respiratory system, infection of the pancreas, lung cancer, liver diseases, and blood clots in the lungs.

Chest injuries or surgical procedures on the heart, as well as negative reactions to medications or drugs can also be a cause. Pleurisy effusion can be caused by heart failure, kidney disease, or liver disease. One's risk of developing complications from pleurisy increases with age and a history of conditions such as heart disease, diabetes, emphysema, bronchitis, and vascular disease.

Diagnosis & Tests

Diagnosis beings with review of the patient's medical history and a basic physical examination, such as using a stethoscope to monitor breathing. Further testing will likely involve chest X-rays to give interior views of the lung when inflated or deflated. CT (computerized tomography) scans may be used to check for abnormalities such as blood clots and inflammation. Ultrasound imaging can detect effusion, while EKG (electrocardiogram) tests might be required to rule out heart problems.

In addition, the physician might remove fluid for testing (thoracentesis), or perform a biopsy on pleural tissue extracted from the lungs to check for infections or cancer cells. These are invasive procedures usually requiring anesthesia.

Treatment & Therapy 

Treatment usually consists of controlling pain and addressing the cause. After the underlying cause of the disease has been identified, treatment can begin by correcting the root problem. Pleurisy caused by viral infections will likely heal on its own as the body's immune system fights the infection. If a bacterial infection is determined to be the source of the pleuritis, antibiotics may be prescribed. Symptoms of infections may be treated with nonsteroidal anti-inflammatory (NSAID) drugs such as acetaminophen and ibuprofen which are also pain relievers.

Steroids may also be prescribed, as may prednisone, a corticosteroid with side effects such as depression and high blood sugar. Special codeine-based cough medicines may be prescribed to help reduce pain due to coughing. Those who have severe inflammation or other serious medical conditions may be required to stay in a hospital where they can be monitored until these problems are stabilized.

In cases of pleural effusion, the doctor will treat the underlying cause of the excess fluid. If this is severe, it may involved hospitalization so that the fluid can be drained through a tube inserted into the lungs. Alternative medicine approaches to deal with symptoms and promote recovery may include herbal supplements, hydrotherapy, controlled diet, acupuncture, or aromatherapy.

Prevention & Prophylaxis

While pleurisy has several possible causes and no single factor can prevent it from occurring, if the underlying cause is caught early it can be treated with no permanent damage to the lungs. Diagnosing the problem could also lead to discovery of more serious conditions such as cancer, lupus, or blood clots.

For those who have the condition, sleeping and lying on the side rather than back is generally reported as easing the pain involved. Preventing the condition lies with general health guidelines such as healthy diet, adequate sleep, and regular cardiovascular exercise, along with proactive measures against respiratory issues. These include avoiding known irritants, particularly tobacco and asbestos. Pleurisy is a commonly occurring result of asbestos exposure.

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