What is Pleurisy?
Pleurisy, or pleuritis, is a condition where the pleura is inflamed. The pleura is a double layer of tissue that surround the lungs. The layer in close contact with the chest wall is called parietal pleura, while the layer in contact with the lungs is referred to as visceral pleura. Between the two layers is a thin film of fluid in a space called the pleural space. The fluid ensures that the two layers glide smoothly over each other when the lungs expand and contract during respiration. Excessive accumulation of this fluid in the pleural space is called pleural effusion.
Pleurisy may be:
- Wet pleurisy, when it is accompanied by pleural effusion
- Dry pleurisy, when pleural effusion is absent
The characteristic symptom of pleurisy is a sharp, stabbing pain in the chest, which worsens with deep breathing and coughing. It is diagnosed based on the presence of a scratchy sound while breathing referred to as the pleural rub, and diagnostic tests which include imaging studies, blood tests and examination of the pleural fluid. Pleurisy often subsides once the underlying cause is treated.
Pleurisy is often considered as a symptom of an underlying disease, rather than a disease itself. In some cases, the exact cause of pleurisy cannot be identified. Conditions that are commonly associated with pleurisy include:
- Infections of the pleura, which may spread from the lungs include:
- Viral infections
- Bacterial infections like pneumonia and tuberculosis
- Fungal infections
- Parasitic infections
- Infections just below the diaphragm like abscess
- Pulmonary embolism, a condition where a clot is present in the blood vessels of the lungs
- Autoimmune disorders, such as lupus and rheumatoid arthritis
- Lung cancer
- Chest trauma during accidents or surgery like coronary bypass or cardiac valve replacement surgery
- Lung diseases like asbestosis
- Other abdominal conditions like pancreatitis, inflammatory bowel disease
- Intake of medication like procainamide, nitrofurantoin, methotrexate, procarbazine, hydralazine and isoniazid
- Sharp and stabbing pain in a particular area of the chest, often in the lower part. The pain worsens during deep inspiration, sneezing or coughing, when the two layers of the pleura rub against each other. It may be relieved to some extent when the patient lies down on the affected side. In some cases like cancer, the pain may be dull
- Shallow breathing to reduce expansion of the lungs and pleura, and therefore pain
- Other symptoms depending on the presence of the underlying condition. These include fever and chills in cases of infections, productive cough in case of lung infections, and rashes and pain in joints in conditions like connective tissue disorders
Diagnosis of pleurisy is made based on history, physical examination and diagnostic tests.
- Medical history of the patient, where the patient complains of distinct chest pain. The patient may also give a history of an associated condition like lupus or tuberculosis.
- Physical examination, which includes a detailed chest examination. A scratching sound called pleural rub will be heard by the doctor with a stethoscope. The sound is most prominent at the end of inspiration.
- Blood tests which may indicate the presence of infection or other condition
- Radiological test, which includes x-ray, CT scan and MRI. These may help to diagnose conditions like pneumonia and abscess
- Testing of pleural fluid if present to determine the cause of inflammation
- Pleural biopsy if necessary
Pleurisy is treated once the underlying illness is managed. Treatment includes rest, painkillers and treatment of the underlying condition. Symptomatic treatment for pleurisy includes:
- Painkillers (NSAIDs) to manage pain and inflammation
- Cough suppressants, to suppress dry cough
- Adequate rest; patient is advised to lie down on the affected side
Pleural effusion if present should be drained if necessary.
- Pleural Disorders - (http://www.nhlbi.nih.gov/health/health-topics/topics/pleurisy)
- Buttaro TM, Trybulski J, Bailey PP, Sandberg-Cook J. Primary Care: A Collaborative Practice 4th edition
Latest Publications and Research on PleurisyIndwelling pleural catheters for non-malignant pleural effusions: report on a single centre's 10 years of experience. - Published by PubMed
Pleural fluid ADA activity in tuberculous pleurisy can be low in elderly, critically ill patients with multi-organ failure. - Published by PubMed
Cyclic AMP Regulates Key Features of Macrophages via PKA: Recruitment, Reprogramming and Efferocytosis. - Published by PubMed
Antinociceptive and anti-inflammatory effect of Poincianella pyramidalis (Tul.) L.P. Queiroz. - Published by PubMed
Diagnostic Value of Pleural Effusion Mononuclear Cells Count and Adenosine Deaminase for Tuberculous Pleurisy Patients in China: A Case-Control Study. - Published by PubMed