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Pleurisy, or pleuritis, arises when the pleura—two thin, protective layers of tissue enveloping the lungs and lining the chest cavity—become inflamed, leading to sharp, stabbing pains in the chest known as pleuritic pain. This discomfort escalates with breathing, coughing, or sneezing, as these actions cause the inflamed pleural layers to rub against one another. Normally, these layers are lubricated by a small amount of fluid in the pleural space, allowing for smooth, frictionless movement during respiration. However, inflammation disrupts this smooth interaction, making each breath painfully reminiscent of coarse surfaces grating together.
Treatment for pleurisy is twofold, aiming to both alleviate the immediate discomfort caused by the condition and address its root cause to prevent ongoing irritation. This usually involves managing the pain through medication and tackling the underlying condition, such as an infection or other disease, that led to the pleural inflammation. By controlling the inflammation and ensuring the pleura can move smoothly once more, patients can find relief from the acute pains of pleurisy and return to normal breathing patterns.
Pleurisy may also develop along with other conditions, such as:
- Pleural effusion: This happens when fluid accumulates in the space between the layers of tissue, alleviating pleuritic pain by separating the layers and preventing rubbing.
- Atelectasis: Breathing difficulties and coughing may occur when significant fluid buildup in the pleural space exerts pressure, potentially leading to partial or complete collapse of the lung.
- Empyema: The formation of pus known as empyema, accompanied by fever, may develop when excess fluid in the pleural space becomes infected.
Symptoms
The primary indication of pleurisy is chest pain, known as pleuritic pain, characterized by a sharp, stabbing, or knife-like sensation originating from a particular location. This discomfort intensifies with upper body movements, deep breathing, or coughing and may occasionally radiate to the shoulder or back.
Other symptoms include:
- Shortness of breath
- Fatigue
- Fever
- Cough
It’s important to emphasize that certain causes of chest pain can entail serious risks. If you experience chest pain, it’s imperative to promptly seek medical attention at the nearest emergency room. Chest discomfort could potentially signify problems with the lungs, heart, or pleura, or it might indicate an underlying illness necessitating urgent medical intervention.
Causes
The most common causes of pleurisy are viral infections, bacterial infections, or other lung infections. These infections can lead to inflammation in the pleurae, resulting in chest pain.
Other potential causes include:
- Autoimmune conditions, such as lupus, rheumatoid arthritis, or familial Mediterranean fever (FMF)
- Lung or pleural illnesses such as lung cancer, mesothelioma, tuberculosis, or asbestosis
- Fungal infection
- Pulmonary embolism
- Trauma, chest surgery, or fractured ribs
- Recreational drugs and certain medications, including hydralazine, isoniazid, and procainamide
- Some hereditary illnesses, like sickle cell disease
- Inflammatory bowel disease
Risk factors
Pleurisy can affect anyone. However, certain factors may increase one’s risk of developing one, such as:
- Age: Being older than 65
- Infections: Having flu and pneumonia
- Certain medical conditions: This include autoimmune disorders, lupus, TB, and sickle cell disease
- Medications: Medications that causes inflammation in the body
Diagnosis
Tests that may be ordered include:
- Physical examination: The diagnosis of pleurisy involves doing a physical examination, listening to the lungs, and inquiring about one’s medical background. Healthcare providers usually ask about the specifics of the pain, such as its location, characteristics, and aggravating factors. Tests may be required to aid in the diagnosis.
- Blood tests: A blood sample is examined for indications of infection or autoimmune diseases. Pleurisy may be the initial symptom of certain conditions, such as lupus or rheumatoid arthritis.
- Electrocardiogram (ECG or EKG): If certain cardiac conditions are ruled out as the source of the chest pain, this test may be suggested. To assess the heart’s function, tiny electrodes are placed in the body during this test.
- Ultrasound: This is recommended if check if one has a pleural effusion. This imaging technique creates exact photographs of the internal architecture of the body by using high-frequency sound waves.
- Chest X-ray: While chest X-rays do not directly display pleurisy, they can offer insights into potential causes of the symptoms, such as fluid buildup around the lungs or infections like pneumonia. This can show if lungs are fully expanding or if there is fluid or air between the lungs and ribs.
- Computerized tomography (CT) scan: Images from this test can reveal the condition of the pleura and detect other potential causes of pain, such as lung blood clots. A CT scan takes X-ray images from various angles around the body and uses computer processing to create detailed cross-sectional images.
Other procedures that may be required include:
- Thoracentesis: Also known as fluid testing, this test can check for indications of infection or other potential pleurisy causes. During the procedure, numbing medication is injected between the ribs where fluid was detected on imaging. Then, a needle is inserted through the chest wall to remove the fluid for analysis. Ultrasound helps guide needle insertion. This procedure can improve breathing.
- Thoracoscopy: Also known as pleuroscopy, this procedure involves inserting a small camera through a small cut in the chest wall. This provide direct visual of the inside the chest to find issues or take a tissue sample for biopsy. This procedure is often done if TB or cancer is suspected.
Treatment
To alleviate symptoms associated with pleurisy, consider the following approaches:
- Infection-targeted medication: If the cause of your pleurisy is an infection, your healthcare provider might prescribe antibiotics or medications to combat fungal infections.
- Symptom management medication: For pain relief, your healthcare provider may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids.
- Fluid removal: To ease pain, your healthcare provider might perform a procedure to remove fluid from your lungs (known as thoracentesis).
- Rest: It’s crucial to find a comfortable resting position that minimizes your discomfort. Even as you begin to feel improvement, avoid exerting yourself too much.
- Avoid smoking: Smoking can exacerbate lung irritation. If you’re struggling to quit smoking on your own, seek assistance from your healthcare provider.
