What are the main symptoms of pleurisy. How is pleurisy diagnosed. What treatments are available for pleurisy. When should you seek medical attention for pleurisy symptoms. What are the potential complications of untreated pleurisy.

Understanding Pleurisy: An Overview of the Condition

Pleurisy, also known as pleuritis, is a medical condition characterized by inflammation of the pleura – the thin, double-layered membrane that surrounds the lungs and lines the chest cavity. This inflammation can cause significant discomfort and respiratory issues, particularly when breathing deeply or coughing.

The pleura normally creates a smooth surface that allows the lungs to glide easily within the chest during respiration. However, when inflammation occurs, this smooth movement is disrupted, leading to pain and other symptoms.

Types of Pleurisy

There are two main types of pleurisy:

• Dry pleurisy: This occurs when there is no fluid buildup between the pleural layers.
• Wet pleurisy (pleural effusion): In this case, fluid accumulates between the pleural layers, potentially alleviating some pain but causing other complications.

Recognizing the Symptoms of Pleurisy

Pleurisy can manifest through various symptoms, with chest pain being the most prominent. Understanding these symptoms is crucial for early detection and treatment.

Primary Symptoms

The hallmark symptom of pleurisy is sharp chest pain that worsens when breathing deeply, coughing, or moving. This pain may:

• Be felt in the chest wall over the inflamed area
• Spread to the shoulders, upper abdomen, neck, and back
• Vary in intensity from mild to severe
• Be constant or only occur during certain activities

Additional Symptoms

Other symptoms that may accompany pleurisy include:

• Shortness of breath
• Rapid, shallow breathing
• Cough
• Fever

Why does pleurisy cause shallow breathing? Due to the pain associated with deep inhalation, individuals with pleurisy often adopt a pattern of quick, shallow breaths to minimize discomfort. This can lead to reduced chest wall movement on the affected side.

Causes and Risk Factors for Pleurisy

Pleurisy can be triggered by various factors, ranging from infections to underlying medical conditions. Understanding these causes can help in prevention and early intervention.

Common Causes

The most frequent causes of pleurisy include:

• Viral infections (e.g., influenza, COVID-19)
• Bacterial infections (e.g., pneumonia, tuberculosis)
• Autoimmune diseases (e.g., lupus, rheumatoid arthritis)
• Pulmonary embolism
• Chest injuries or trauma
• Certain medications
• Cancer (particularly lung cancer or metastatic cancer)

Risk Factors

Several factors can increase an individual’s risk of developing pleurisy:

• Age (more common in older adults)
• Smoking
• Exposure to asbestos or other toxic substances
• Weakened immune system
• History of certain medical conditions (e.g., lung disease, heart disease)

Can lifestyle changes reduce the risk of pleurisy? While not all cases of pleurisy are preventable, maintaining a healthy lifestyle, avoiding smoking, and managing underlying health conditions can help reduce the risk of developing this condition.

Diagnosing Pleurisy: Medical Approaches and Techniques

Accurate diagnosis of pleurisy is crucial for appropriate treatment. Healthcare providers employ various methods to confirm the presence of pleurisy and identify its underlying cause.

Physical Examination

The initial step in diagnosing pleurisy typically involves a thorough physical examination. During this assessment, the healthcare provider may:

• Listen to the patient’s chest with a stethoscope to detect a characteristic rubbing or squeaking sound (pleural friction rub)
• Assess breathing patterns and chest wall movement
• Evaluate the severity and location of pain

Imaging Studies

Various imaging techniques can be employed to visualize the pleura and lungs:

• Chest X-ray: This can reveal signs of inflammation, fluid accumulation, or underlying lung conditions.
• CT scan: Provides more detailed images of the chest, helping to identify small effusions or other abnormalities.
• Ultrasound: Useful for detecting and measuring pleural effusions.

Laboratory Tests

Blood tests and other laboratory analyses may be conducted to:

• Check for signs of infection or inflammation
• Identify potential autoimmune conditions
• Assess overall health status

Specialized Procedures

In some cases, additional procedures may be necessary:

• Thoracentesis: Removal of pleural fluid for analysis
• Pleural biopsy: Collection of a small tissue sample for examination
• Bronchoscopy: Examination of the airways to rule out other conditions

How long does it take to diagnose pleurisy? The time required for diagnosis can vary depending on the complexity of the case. While some cases may be diagnosed quickly through physical examination and basic tests, others might require more extensive investigation, potentially taking several days to reach a definitive diagnosis.

Treatment Options for Pleurisy: From Home Remedies to Medical Interventions

The treatment of pleurisy aims to address the underlying cause, alleviate symptoms, and prevent complications. The approach can range from simple home remedies to more complex medical interventions, depending on the severity and cause of the condition.

Home Remedies and Self-Care

For mild cases of pleurisy, particularly those caused by viral infections, home remedies and self-care measures can be effective:

• Rest: Adequate rest allows the body to heal and reduces strain on the respiratory system.
• Pain management: Over-the-counter pain relievers such as ibuprofen or naproxen can help alleviate pain and reduce inflammation.
• Positional relief: Finding a comfortable position, often lying on the affected side, can help minimize pain.
• Deep breathing exercises: Gentle breathing exercises can help prevent complications like atelectasis (collapsed lung tissue).

Medical Treatments

When home remedies are insufficient or the underlying cause requires specific treatment, medical interventions may include:

• Antibiotics: Prescribed for bacterial infections such as pneumonia.
• Antiviral medications: Used in cases of viral pleurisy, particularly in high-risk individuals.
• Anti-inflammatory drugs: Stronger prescription medications may be used to reduce inflammation and pain.
• Corticosteroids: In cases of severe inflammation or certain autoimmune conditions.
• Diuretics: To help remove excess fluid in cases of pleural effusion.

Treating Underlying Conditions

Effective management of pleurisy often involves addressing the root cause:

• Cancer treatment: If pleurisy is caused by lung cancer or metastatic cancer.
• Management of autoimmune diseases: For conditions like lupus or rheumatoid arthritis.
• Anticoagulation therapy: In cases of pulmonary embolism.

Invasive Procedures

In some cases, more invasive procedures may be necessary:

• Thoracentesis: To drain large amounts of pleural fluid.
• Pleurodesis: A procedure to prevent fluid reaccumulation in recurrent cases.
• Pleural drain: Insertion of a chest tube for continuous drainage in severe cases.

How long does it take for pleurisy to resolve with treatment? The duration of recovery can vary significantly depending on the underlying cause and the individual’s overall health. Mild cases may improve within a few days to weeks with appropriate treatment, while more severe or complicated cases can take several weeks to months to fully resolve.

When to Seek Medical Attention: Recognizing Serious Symptoms

While mild cases of pleurisy may resolve on their own or with minimal intervention, certain symptoms warrant immediate medical attention. Recognizing these signs is crucial for preventing potentially serious complications.

Urgent Medical Care

Seek urgent medical care if you experience:

• Severe chest pain that doesn’t improve with over-the-counter pain medications
• Difficulty breathing or shortness of breath that worsens over time
• High fever (above 39°C or 102.2°F) accompanied by chills
• Coughing up blood or blood-tinged sputum
• Chest pain that spreads to the arms, back, neck, or jaw

Emergency Situations

Call emergency services or go to the nearest emergency department if you experience:

• Sudden, severe chest pain lasting more than 15 minutes
• Chest pain accompanied by dizziness, sweating, or nausea
• Signs of a possible heart attack or pulmonary embolism
• Severe difficulty breathing or rapid, shallow breathing

Why is prompt medical attention important for severe pleurisy symptoms? Severe symptoms may indicate a more serious underlying condition, such as a pulmonary embolism or pneumothorax (collapsed lung). Early intervention in these cases can be life-saving and prevent long-term complications.

Potential Complications of Untreated Pleurisy

While many cases of pleurisy resolve without significant issues, untreated or severe cases can lead to complications. Understanding these potential outcomes underscores the importance of proper management and timely medical intervention.

Common Complications

Untreated pleurisy may result in:

• Pleural effusion: Accumulation of fluid between the pleural layers, which can compress the lung and impair breathing.
• Empyema: A collection of pus in the pleural space, often requiring drainage and antibiotic treatment.
• Atelectasis: Collapse of lung tissue, which can lead to reduced oxygen exchange and increased risk of infection.
• Pneumothorax: Air accumulation in the pleural space, causing lung collapse.

Long-term Effects

Chronic or recurrent pleurisy may lead to:

• Pleural thickening: Scarring of the pleura, which can restrict lung expansion.
• Chronic pain: Persistent chest discomfort even after the initial inflammation has resolved.
• Reduced lung function: Decreased lung capacity and impaired respiratory function.

Systemic Complications

In some cases, untreated pleurisy can have broader health implications:

• Sepsis: If the underlying cause is a severe infection that spreads to the bloodstream.
• Respiratory failure: In cases of severe lung compression or infection.
• Malnutrition and muscle wasting: Due to prolonged illness and reduced physical activity.

Can pleurisy recur after treatment? Yes, pleurisy can recur, especially if the underlying cause is not fully addressed or if there are predisposing factors. Recurrent pleurisy may indicate a chronic condition that requires ongoing management and monitoring.

Living with Pleurisy: Lifestyle Adjustments and Long-term Management

While acute pleurisy often resolves with appropriate treatment, some individuals may experience chronic or recurrent symptoms. Adopting certain lifestyle changes and long-term management strategies can help improve quality of life and reduce the risk of complications.

Lifestyle Modifications

Consider implementing the following changes:

• Quit smoking: Smoking can exacerbate respiratory issues and increase the risk of infections.
• Maintain a healthy diet: A balanced diet supports overall health and immune function.
• Regular exercise: Gentle, low-impact exercises can improve lung function and overall fitness.
• Stress management: Chronic stress can weaken the immune system, making you more susceptible to infections.

Ongoing Medical Care

For individuals with chronic pleurisy or underlying conditions:

• Regular check-ups: Monitor your condition and adjust treatment as needed.
• Adherence to medication: Follow prescribed treatment plans for underlying conditions.
• Pulmonary rehabilitation: May be beneficial for improving lung function and managing symptoms.
• Vaccinations: Stay up-to-date on vaccinations, particularly for pneumonia and influenza.

Coping Strategies

Living with chronic pleurisy can be challenging. Consider these coping strategies:

• Join support groups: Connect with others who have similar experiences.
• Practice relaxation techniques: Methods like deep breathing exercises or meditation can help manage pain and anxiety.
• Educate yourself: Understanding your condition can empower you to make informed decisions about your health.
• Communicate with healthcare providers: Keep your medical team informed about any changes in your symptoms or concerns.

How can you prepare for potential flare-ups of pleurisy? Develop an action plan with your healthcare provider that outlines steps to take during a flare-up. This may include having necessary medications on hand, knowing when to seek medical attention, and implementing specific self-care measures to manage symptoms.

By understanding pleurisy, recognizing its symptoms, and implementing appropriate management strategies, individuals can effectively navigate this condition and maintain their overall health and well-being. Regular communication with healthcare providers and a proactive approach to lifestyle modifications can significantly improve outcomes and quality of life for those affected by pleurisy.

Pleurisy – NHS

Pleurisy is inflammation around the lungs, which causes sharp chest pain. It’s easy to treat and usually gets better in a few days, but can sometimes be a sign of something more serious, like pneumonia.

Check if it’s pleurisy

The main symptom of pleurisy is sharp chest pain when you breathe in.

The pain may be worse when you cough, sneeze or move around.

It may also spread to your shoulders and back.

Urgent advice: Ask for an urgent GP appointment or get help from NHS 111 if:

• you have sharp chest pain that comes and goes, or only happens when breathing or coughing
• you have sharp chest pain that has not got better after a few days
• you’ve coughed up a few small spots, flecks or streaks of blood, or noticed blood in your phlegm or on a handkerchief
• you’re feeling short of breath regularly

You can call 111 or get help from 111 online.

Immediate action required: Call 999 or go to A&E if:

• you have sudden chest pain that lasts for 15 minutes or more
• you have sudden chest pain that spreads to your arms, back, neck or jaw
• you have difficulty breathing
• you’re coughing up more than just a few spots or streaks of blood
• you’re coughing up blood and finding it hard to breathe, have a very fast heartbeat, or have pain in your chest or upper back

These symptoms could be a sign of a more serious problem, such as a heart attack or a blood clot in the lungs (pulmonary embolism).

What happens at your appointment

If you have symptoms of pleurisy, a GP will examine you and listen to your chest.

The GP may refer you to a specialist if they’re not sure what’s causing your symptoms.

You may need to have tests, such as:

• blood tests
• a chest X-ray
• an ultrasound scan
• a CT scan

Treatment for pleurisy

Pleurisy will usually get better on its own in a few days without treatment from a GP.

If your symptoms are being caused by a bacterial infection, such as pneumonia, you may need antibiotics.

You can ease the chest pain by:

• taking painkillers such as paracetamol or ibuprofen
• resting in different positions until you find a comfortable one – lying on the painful side can help

You may need to have treatment in hospital if your symptoms are severe or being caused by something more serious, such as a pulmonary embolism or tuberculosis.

Page last reviewed: 18 May 2023
Next review due: 18 May 2026

Pleurisy | Cedars-Sinai

ABOUT

DIAGNOSIS

TREATMENT

Overview

Pleurisy, also known as pleuritis, is swelling of the thin lining around the chest cavity and lungs, also known as the pleura. This lining creates a smooth surface so the lungs glide easily in the chest while breathing. When the lining swells, the lungs rub painfully against the chest, causing swelling and chest pain.

In some cases, fluid can collect between the pleura. This is called pleural effusion. When there is no fluid, the condition is called dry pleurisy.

Symptoms

Usually the first sign of pleurisy is a sudden chest pain. The pain may be very mild or very severe. Sometimes the pain is only felt while breathing deeply or coughing. Other times, the pain may be felt all the time and get worse with deep breathing or coughing. Usually the pain is felt in the chest wall over the area that’s inflamed. You might also feel pain in the upper abdominal area, neck, back, and shoulders.

Because inhaling deeply hurts, a person with pleurisy tends to breathe quickly and shallowly. On the side where the pain is, the muscles of the chest move less than those on the other side. If fluid builds up between the layers of the pleura, the chest pain may go away. Large quantities of fluid can make expanding one or both lungs difficult.

Other symptoms may include:

• Fever
• Cough
• Shortness of breath
• Rapid breathing

Causes and Risk Factors

Irritation of the pleura can be caused by:

• Viruses
• Bacterial infections
• Cancer
• Inhaling asbestos or other toxic substances
• The use of certain medications
• Some types of autoimmune diseases, such as lupus or rheumatoid arthritis

Diagnosis

Diagnosis of pleurisy usually starts with a physical exam. Because the pain tied to pleurisy is distinct, it is often easy for the physician to diagnose. Using a stethoscope, the doctor may hear a squeaky, rubbing sound.

Chest X-rays and CT scans are often used to see an image of what is going on inside the lungs and chest. These tests help show if fluid is building up in the lungs. They will also show if the lungs are filling up with air as much as possible.

Other imaging tests may be used, such as an ultrasound or electrocardiogram, to rule out heart disease.

If fluid has begun to build up in the chest or lungs, the doctor may take a test sample of it. This will help determine the cause of the pleurisy and rule out the possibility of cancer.

A biopsy of a small sample of tissue may also be done to rule out the possibility of cancer. To do this, a needle will be used to remove a small tissue sample to be examined under a microscope.

A blood test to detect lupus or rheumatoid arthritis may also be performed.

Treatment

Treatment for pleurisy depends on what caused the condition. The experts at Cedars-Sinai’s Advanced Lung Disease Program can help you find the best treatment plan.

Antibiotics may be prescribed for infections caused by bacteria. If a virus causes the pleurisy, no treatment will be given. If the cause is lupus or an autoimmune disease, corticosteroids often quickly cure the pleurisy. These drugs suppress the immune system, which stops the swelling in the lining.

Nonsteroidal anti-inflammatory drugs, such as aspirin or ibuprofen, help relieve the chest pain. Codeine and other stronger pain relievers should not be used. These medicines can stop you from coughing. Coughing is important because it stops the lungs from collapsing and helps prevent pneumonia.

Holding a pillow against the part of the chest that hurts while coughing or breathing deeply can be helpful. Wrapping the chest in wide, elastic bandages can help relieve severe pain. Wrapping the chest also makes it harder to breathe and increases the risk of a collapsed lung or pneumonia.

© 2000-2022 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

Pleurisy – health articles

Human lungs are located in the chest cavity. Outside they are covered with pleura. The pleura is a serous membrane that lines the inner layer of the chest cavity and envelops both lungs. The pleura is made up of mesothelial cells.

Pleurisy – an inflammatory disease of the pleura, which is characterized by the deposition of fibrin on their surface (fibrinous or dry pleurisy), or the accumulation of fluid in the pleural cavity (exudative pleurisy).

This disease is very common. This is the most commonly diagnosed pathology of the lungs. In the general structure of the incidence of the population, pleurisy accounts for 5-15%.

Causes

Pleurisy is a disease that in most cases develops on the basis of some existing pathology. The most common cause of the development of an inflammatory reaction in the pleural cavity are various infections. Often pleurisy occurs against the background of systemic diseases, tumors, injuries.

Some authors refer to pleurisy and cases of pleural effusion without a clear presence of an inflammatory response. This situation is not entirely correct, since pleurisy is an ailment that involves an obligatory inflammatory component.

The following causes of pleurisy are distinguished:

• infection of the pleura;
• tuberculosis;
• allergic inflammatory reaction;
• autoimmune and systemic diseases;
• exposure to chemicals;
• chest injury;
• exposure to ionizing radiation;
• exposure to pancreatic enzymes;
• primary and metastatic tumors of the pleura.

Symptoms

The clinic of dry pleurisy is characterized by stabbing pains in the chest, aggravated by coughing, breathing and movement. The patient is forced to take a position, lying on a sore side, to limit the mobility of the chest. Breathing is superficial, sparing, the affected half of the chest noticeably lags behind during respiratory movements. Body temperature sometimes rises to subfebrile values, the course of pleurisy may be accompanied by chills, night sweats, and weakness.

Diaphragmatic dry pleurisy has a specific clinic: pain in the hypochondrium, chest and abdominal cavity, flatulence, hiccups, tension in the abdominal muscles.

The onset of exudative pleurisy is accompanied by a dull pain in the affected side, reflex arising painful dry cough, lagging of the corresponding half of the chest in breathing, pleural friction noise. As the exudate accumulates, the pain is replaced by a feeling of heaviness in the side, increasing shortness of breath. Exudative pleurisy is characterized by general symptoms: weakness, febrile body temperature, loss of appetite, sweating.

Diagnosis

An external examination performed by a physician is very important for diagnosing pleurisy and determining its nature. During auscultation (listening to the lungs in different phases of breathing with a stethoscope), pleural friction noise can be detected, which is specific for fibrinous pleurisy, with exudative pleurisy during percussion (tapping a certain area to identify characteristic sound phenomena), there is a dullness of percussion sound above the effusion zone. Thus, it is possible to determine the spread of exudate in the pleural cavity.

In the general and biochemical blood tests, nonspecific inflammatory changes are noted: ESR acceleration, increase in the number of leukocytes; the appearance or increase in the concentration of inflammatory proteins.

Instrumental methods (ultrasound, radiography) play a significant role in the diagnosis of pleurisy, as they allow you to see the area of ​​the lesion and determine the nature of the inflammatory process.

Treatment

Treatment is determined by the form of pleurisy. Treatment of an infectious type of inflammation of the pleura involves the use of antibiotics and other antimicrobial agents, diuretics, painkillers. In the case of exudative inflammation, physiotherapy and exercise therapy can be used, but only after the effusion has resolved. If pulmonary tuberculosis is the cause of inflammation of the pleura, anti-tuberculosis drugs are prescribed.

Treatment involves the use of symptomatic remedies. If there are pleural fibrinous overlays (dry pleurisy), the patient should be provided with complete rest. In case of cough, antitussives are prescribed. Treatment often includes the setting of cans, mustard plasters, the use of anti-inflammatory drugs, and breathing exercises.

If a large volume of fluid has accumulated, a pleural puncture may be required.

Nutrition for pleurisy should be complete and meet physiological needs. It is required to include more foods rich in vitamins in the diet. The diet for pleurisy involves limiting the intake of carbohydrates and salt. It is also required to reduce the amount of liquid you drink to 500-600 ml. As for non-infectious pleurisy, its treatment involves the elimination of the underlying disease.