When you breathe, the tissues that line your lungs and chest wall, called the pleura, rub together. Normally this is not a problem, since the tissue is satiny and generates no friction. However, when this tissue is inflamed or infected, it becomes irritated and swollen. Its texture then becomes gritty, causing extreme pain. This condition is called pleurisy. It is also sometimes referred to as as “pleuritis.”
Pleurisy has a grim fame of sorts, for it caused the death of a number of historical figures, including Catherine de Medici and Benjamin Franklin.
Luckily, pleurisy is no longer a common condition. Over the years, antibiotics have been extremely successful in treating and preventing the bacterial infections that historically were the main causes of pleurisy. Nowadays, most cases of pleurisy are the result of a viral infection.
Viral infections are the most common cause of pleurisy. Viruses can cause infections it the lung, which in turn can lead to pleurisy.
Other causes of pleurisy include:
- bacterial pneumonia
- chest wounds
- rib fractures
- blunt trauma to the chest wall
- chest or lung tumors
- blood clots in arteries of the lung (pulmonary emboli)
- immune system disorders, such as systemic lupus and rheumatoid arthritis
- sickle cell anemia, an inherited condition that causes irregularly shaped, hard, and sticky red blood cells (the cells that carry oxygen to the body’s tissues); this can interfere with blood and oxygen flow
- pancreatitis, an inflamed pancreas (an organ that aids in digestion and blood sugar regulation)
- heart surgery complications
- lung cancer , lymphoma or mesothelioma (cancer caused by asbestos exposure)
- fungal or parasitic infections
The chief symptom associated with pleurisy is a sharp, cutting pain when you breathe in or out. This pain might go away when you hold your breath or put pressure on the painful area. However, it will definitely get worse when you sneeze, cough, or move. Fever, chills, and loss of appetite are possible symptoms, depending on what condition is causing pleurisy.
Additional symptoms of pleurisy include:
- pain on one side of the chest
- pain in the shoulders and back
- breathing shallowly to avoid feeling pain
- joint pain
- muscle aches
- problems breathing
Pleurisy can be accompanied by a fluid buildup that puts pressure on the lungs and causes them to stop working properly. This fluid accumulation is called a pleural effusion. This fluid may initially act like a cushion, causing the chest pain to disappear. However, eventually an individual with a pleural effusion will experience shortness of breath as the fluid increases. He or she may also experience fever, chills, and a dry cough. These are symptoms can indicate a fluid infection, also called empyema.
The first priority in diagnosing pleurisy is to discover where the inflammation or swelling is occurring and to figure out what is causing it. Your doctor will want to do a physical examination and record your medical history. Other methods of diagnosis include:
Chest X-rays will allow a doctor to see if there is any inflammation in the lungs. In addition, your doctor may order a decubitus chest X-ray (X-ray taken while an individual is laying down on his or her side). This allows free fluid to layer out and will confirm any fluid buildup.
Blood tests can help to determine both if you have an infection and, if so, what is causing the infection. In addition, blood tests will reveal whether or not you have an immune system disorder.
During thoracentesis, your doctor will insert a needle into the area of your chest where fluid was detected by imaging tests. The fluid is then removed and analyzed for the presence of infections.
Computed Tomography (CT) Scan
To further research any abnormalities found on chest X-rays, your doctor may want to take a series of detailed, cross sectional images of your chest by conducting a CT scan. The images created by the CT scan are then used to create a detailed picture of the chest, so doctors can get a closer look at the irritated tissue.
In an ultrasound, high-frequency sound waves are used create an image of the inner portion of your chest cavity. This will allow doctors to see if there is any inflammation or fluid buildup.
Biopsies are typically used if cancer is being considered as a possible cause of pleurisy. Sterile procedures are used and the doctor will make small cuts (incisions) in the skin of the chest wall. The exact biopsy site can be confirmed by an X-Ray or CT scan and these imaging procedures can be used to guide the lung biopsy needle between the ribs and into the lung. A small sample of lung tissue is biopsied and the needle is removed.
This tissue will then be sent to the laboratory to be analyzed for infection and to look for abnormal cells consistent with cancer.
During a thoracoscopy, your doctor will make a small incision in your chest wall and will then insert a tiny camera attached to a tube into your chest cavity. He or she will use the camera to locate the irritated area, and will then collect a tissue sample for analysis.
Once your doctor identifies the source of inflammation or infection, he or she will be able to determine the correct course of treatment. Getting adequate rest to assist your body with the healing process is an important part of getting well. In addition, lying on your painful side may provide just enough pressure to make the pain go away.
Other methods of treatment include:
- antibiotics (in the case of bacterial infection)
- over-the-counter medicines, including aspirin, ibuprofen or other nonsteroidal anti-inflammatory drugs
- prescription pain and cough medication (sometimes codeine-based cough syrups)
- using medications to break up any blood clots or large collections of pus and mucus, which is then drained out via a tube
Individuals with large amounts of fluid in their lungs (pleural effusions) might have to stay in the hospital with a drain tube in the chest until fluids have adequately drained.
Written by: Shannon Johnson
Medically reviewed by Brenda B. Spriggs, MD, MPH, FACP