Definition of Pleurisy

Pleurisy: Inflammation of the pleura, the linings surrounding the lungs. There are two layers of pleura; one covering the lung and the other covering the inner wall of the chest. These two layers are lubricated by pleural fluid. Pleurisy is frequently associated with a pleural effusion (the accumulation of extra fluid in the space between the two layers of pleura). Pleurisy causes a stabbing pain in the chest aggravated by breathing, chest tenderness, cough, and shortness of breath. Pleurisy can be caused by many conditions including infections, collagen vascular diseases (such as lupus and rheumatoid arthritis), cancers (such as metastatic lung cancer or breast cancer), tumors of the pleura, heart failure, lung embolism (blood clot in a vessel to the lungs), obstruction of lymph channels, trauma (rib fractures or injury from instruments in the chest from an operation or car accident), certain drugs (such as Hydralazine, Procan, and Dilantin), abdominal processes (such as pancreatitis, cirrhosis of the liver) and lung infarction (lung tissue death due to lack of oxygen from poor blood supply).

The chest pain of pleurisy is very distinctive. It is usually sharp and aggravated by breathing. The doctor can often hear the friction that is generated by the rubbing of the two inflamed layers of pleura with each breath. With large amounts of pleural fluid accumulation, there can be decreased breath sounds and the chest is dull sounding when the doctor drums on it (dullness upon percussion). A chest x-ray in the upright position and while lying on the side helps diagnose small amounts of fluid. Ultrasound is also a very sensitive method of detecting the presence of fluid. A CT scan can be very helpful in detecting trapped pockets of fluid as well as in determining the nature of the tissues surrounding the area.

Removal of pleural fluid with a needle and syringe (aspiration) is key in diagnosing the cause of pleurisy. Removal of the fluid from the chest cavity (a procedure called thoracentesis) can also relieve the pain and shortness of breath due to pleurisy. If the fluid is infected, treatment involves antibiotics and drainage of the fluid. If there is pus inside the pleural space, a chest drainage tube is inserted. In severe cases, in which there are large amounts of pus and scar tissue (adhesions), there is a need for decortication (opening the pleural space and removing portions of one or two ribs in order to clear scar tissue and remove pus and debris). In cases of pleurisy caused by cancer, the fluid often reaccumulates so a procedure called pleurodesis may be done in which an irritant (such as Bleomycin, Tetracycline, or Talc powder) is instilled inside the space between the pleura in order to create inflammation. This inflammation, in turn, will tack the two pleura together. This procedure thereby obliterates the space between the pleura and prevents the reaccumulation of fluid.