Pleurisy

Pleurisy

Definition:

Pleurisy is an inflammation of the pleura, the lining of the lungs, with subsequent pain.

Alternative Names:

Pleuritis; Pleuritic chest pain

Causes, incidence, and risk factors:

Pleurisy may develop in the presence of lung inflammation (for example, pneumonia, tuberculosis), rheumatic diseases, chest trauma, certain cancers, and asbestos-related disease. The main symptom is pain over the chest wall at the site of the inflammation. In some circumstances, the pain may be felt in the shoulder.

The pain is increased by deep breathing, coughing, and chest movement. The normally smooth pleural surfaces, now roughened by inflammation, rub together with each breath, and may produce a rough, grating sound called a "friction rub". This can be heard with the stethoscope or an ear held against the chest.

Fluid often accumulates at the site of pleural inflammation. A localized collection of fluid separates the lung pleura from the chest wall pleura causing the chest pain to disappear even though the illness may be worsening.

Large accumulations of fluid compromise breathing and may cause coughing, shortness of breath with rapid breathing (tachypnea), cyanosis, and retractions.

Symptoms:

Recent or present respiratory illness with its symptoms
- Cough
- Fever
- Malaise
Localized chest pain on the chest wall
- Pain with each breath
- Worsened by coughing
- Worsened by deep breathing

Signs and tests:

Physical examination may show abnormal lung sounds:

A friction rub -- a rough scratchy sound that accompanies inspiration and expiration
Rales (may be present if there is an accompanying pneumonia)
Rhonchi (may be present with accompanying pneumonia or bronchitic process)
Decreased breath sounds (may be present if there is a collection of fluid around the lung

Tests:

CBC (may help differentiate bacterial versus viral infection)
X-ray of the chest
Ultrasound of the chest
Thoracentesis (a collection of fluid from the pleural cavity)

Treatment:

Treatment is directed at the underlying illness. Bacterial infections are treated with appropriate antibiotics. Tuberculosis requires special treatment. Viral infections normally run their course without medications. Pleural fluid may be removed by thoracentesis, and evaluated for signs of infection.

Expectations (prognosis):

Recovery depends on the nature of the underlying illness. Recovery from infections of all types is generally good with treatment. Recovery from pleurisy caused by malignant disease depends on the type and extent of the illness.

Complications:

Breathing difficulty
Complications associated with the precipitating illness
Complications associated with thoracentesis

Calling your health care provider:

Call your health care provider if you experience symptoms of pleurisy. If you have breathing difficulty or the skin turns bluish (cyanosis), you should be seen promptly, possibly in an emergency room.

Prevention:

Early treatment of bacterial respiratory infections can prevent pleuritis. No treatments are available for viral respiratory infections with the exception of several drugs for influenza type A.

Review Date: 1/27/2002
Reviewed By: David A. Kaufman, M.D., Pulmonary & Critical Care Medicine, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

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