Pleurisy: an overview and more

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Pleurisy, also called pleurisy, refers to inflammation of the pleura, the lining of the lungs and chest cavity. The main symptom of pleurisy is a sharp pain in the chest, aggravated by deep breathing or coughing. Some potential causes of pleurisy are life-threatening, such as a heart attack or a blood clot in the lung. Other causes are related to an underlying medical condition, such as an infection, cancer, or an autoimmune disease such as lupus.

Illustration by Brianna Gilmartin, Get Drug Information

Pleura

The pleura is actually a membrane that contains two thin membranes: one covers the lungs (visceral pleura) and the other lines the inside of the chest cavity (parietal pleura).

The visceral and parietal pleura are separated by a very thin space called the pleural cavity , which generally contains three to four teaspoons of pleural fluid . This thin layer of fluid reduces friction on the lungs during inhalation and exhalation.

The parietal (nonvisceral) pleura is innervated by nerves. That is why pain occurs when irritation and inflammation occurs.

Symptoms of Pleurisy

A key symptom of pleurisy is a sharp, stabbing, or burning pain in the chest when breathing, coughing, sneezing, or laughing . Chest pain can be felt in the shoulder or neck (reflected pain).

In addition, breathing difficulties may occur. This is usually due to pain and excess fluid in the pleural space, which can compress or even destroy the lung (eg, atelectasis ).

In addition to pain and possible breathing problems, other possible symptoms of pleurisy (depending on the underlying cause) may include:

  • Cough
  • Fever and chills
  • Involuntary weight loss
  • Cyanosis (blue skin due to lack of oxygen)

Causes

There are many potential causes of pleurisy, to name just a few. Some are very serious, so immediate medical attention is needed for pleuritic (or any other) chest pain.

Infection

Infection with a virus, such as the flu (flu ), is a common cause of pleurisy. Other types of infections, such as bacterial, fungal, or parasite infections, can also cause pleurisy.

Sometimes, with bacterial causes of pleurisy, a collection of pus forms in the pleural cavity (for example, empyema ).

Heart and lung problems.

Various diseases of the heart and lungs, some of which are life-threatening, can cause pleurisy in a person or cause symptoms similar to pleurisy. These conditions include:

Autoimmune diseases

Several autoimmune diseases such as systemic lupus erythematosus (SLE or lupus) and rheumatoid arthritis can cause pleurisy.

Hemothorax

Pleurisy can also be caused by any disease that causes blood to pool in the pleural space, called a hemothorax . It can be a chest injury, chest or heart surgery, or lung or pleural cancer.

Cancer and other diseases

Cancers like lymphoma or mesothelioma can also cause pleurisy, as well as chronic kidney disease , inflammatory bowel disease, pancreatitis , or rare conditions like familial Mediterranean fever (FMF) .

Medicines

Some medications, such as procainamide (procainamide) and apresolin (hydralazine), can cause a lupus reaction, leading to pleurisy.

Diagnostics

Pleurisy is diagnosed with a careful history and physical examination, as well as laboratory tests and imaging studies.

History of the disease

During the history, your healthcare provider will ask you some questions about your symptoms. Answering these questions will help determine the cause of your pleurisy.

Here are some examples of possible questions:

  • Did your chest pain come on suddenly within minutes or has it progressed over several hours or weeks? Sudden chest pain indicates a potentially serious and life-threatening cause of pleurisy.
  • Does your pain stay in one place or does it radiate to your shoulder, neck, or back?
  • Do you have trouble breathing or any other accompanying symptoms (for example, fever, chills, nausea, sweating, cough, or weight loss)?

Physical exam

During a physical exam, your doctor will listen to your lungs with a stethoscope. The pleura is usually smooth, but with pleurisy it becomes rough, rubs against each other, and sometimes produces a squeaking sound called friction.

In addition to examining your lungs, your healthcare provider will monitor your vital signs to determine if you have a fever, low blood pressure, rapid heart rate or breathing rate, or low oxygen saturation. These findings can provide clues to your underlying diagnosis.

Then, depending on your doctor's suspicion, other organs, such as the heart, skin, or digestive tract, may be examined.

Visual tests

Most people with pleuritic chest pain have imaging.

These tests may include one or more of the following:

Blood test

Various blood tests may also be ordered to find out the cause of your pleurisy.

These are just a few examples of blood tests your healthcare provider may order:

Electrocardiogram (ECG)

Various abnormalities on the ECG can indicate an underlying heart problem, such as a heart attack or pericarditis.

Pleurocentesis

If excess fluid is found in the pleural space, a thoracentesis may be performed. In this procedure, a fine needle is inserted through the chest and into the pleural space to remove fluid. In addition to relieving symptoms (eg, Difficulty breathing), the fluid can be analyzed in a laboratory to determine a diagnosis (eg, Infection, cancer, etc.).

Biopsy

Less commonly, a pleural biopsy is done, in which a small sample of the inflamed pleura is removed. This is done to confirm certain diagnoses, such as tuberculosis or pleural cancer.

Watch out

The first step in the treatment of pleurisy is the urgent diagnosis and elimination of life-threatening causes, primarily pulmonary embolism, myocardial infarction, pericarditis, aortic dissection, pneumonia, and pneumothorax.

Once these conditions are excluded or eliminated in a timely manner, treatment for pleurisy includes two stages: pain relief and treatment of the underlying condition.

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used medications to relieve the pain of pleurisy. If a person does not respond well to NSAIDs or cannot tolerate or take them, a corticosteroid may be prescribed.

Once the pain is under control, the doctor will consider the underlying etiology. For example, for pleurisy associated with an infection, antibiotics (bacterial) or antifungal (fungi) may be prescribed.

Drainage of the infected fluid can also be done by thoracentesis . Sometimes when there is a lot of fluid or air, such as in pneumothorax, a chest tube can be inserted into the pleural space to effectively remove fluid (or air).

In fact, one or more procedures may be justified in cases of pleurisy, especially with recurrent or malignant (malignant) accumulation of pleural fluid. Some of these treatments include:

  • Pleurodesis : A procedure in which pleural fluid is drained and a chemical is then injected into the pleural space to help seal the space between the visceral and parietal membranes.
  • Indwelling Pleural Catheter (IPC): This is a small tube that is inserted into the pleural space to drain it again at home.
  • Pleurectomy : A type of surgery that removes a part of the affected pleura.

Get the word of drug information

Pleurisy is a serious medical condition that requires immediate medical attention. Try to remain calm and patient during the pleurisy test. Even if resolving your pain can be a bit complicated and tedious, once the cause is identified, you can begin to develop a treatment plan.

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