What is Pleurisy?
- The pleura is a two layered sac that holds the lungs and separates them from the chest wall, diaphragm, and heart.
- Pleurisy results from an inflammation of this sac.
- The pleura that lines the inside of the chest is called the parietal pleura. The pleura that covers the lungs is called the visceral pleura. If you are healthy, the pleura is separated by a thin layer of fluid. This lets the lungs expand and contract easily during breathing.
- The inflammation that occurs with pleurisy can cause pain with breathing and may even cause a large amount of fluid to collect in the pleural sac.
- Pleurisy can go away on its own or worsen so that fluid has to be drained from around the lungs.
- Some people develop scar tissue called adhesions after they have pleurisy. They then have chronic pain or shortness of breath.
What Causes Pleurisy?
There are many causes of pleurisy.
- Infectious disease caused by virus, bacteria, fungus, tuberculosis, or parasites
- Cancer such as mesothelioma or spread from other areas
- Collagen vascular disease such as lupus, rheumatoid arthritis, sarcoid disease, or scleroderma
- Trauma from bruised or broken ribs
- Gastrointestinal disease, for example pancreatitis, peritonitis, or a collection of pus under the diaphragm
- Reaction to drugs such as methotrexate (Rheumatrex, Trexall) and penicillin
- Other causes
How Do I Know If I Have Pleurisy Symptoms?
You can have many symptoms with pleurisy.
- Chest pain: This is the most common symptom. The pain is generally a sharp, stabbing pain, but may also be a dull ache or a burning sensation. It is usually worse when you take a deep breath, cough, or move around. The pain is usually better if you take shallow breaths or lie on the side that hurts. Chest pain is what usually causes people with pleurisy to seek medical attention.
- Cough: You may get a cough, depending on the cause of the pleurisy. Your cough may be dry or productive of sputum or blood.
- Shortness of breath: The shortness of breath associated with pleurisy may be due to the underlying cause, such as a blood clot in the lungs or pneumonia, or it may be due to the chest pain caused by breathing.
- Fever: You may also get a fever, depending on the cause of the pleurisy.
Lupus and Pleurisy
More than 50% of people with lupus have some sort of lung disease. Pleurisy (inflammation of the lining of the lung) is the most common lung problem. This can lead to chest pain and shortness of breath ,and can be confused with blood clots in the lung (pulmonary embolism) or pneumonia.
How Do Doctors Diagnose Pleurisy?
The doctor will ask you many questions about the pain, such as where it is located, how long it has been there, and how you've tried to make it better. The doctor will also ask about your personal habits, especially smoking, including the use of tobacco and street drugs such as marijuana and cocaine. Do not hide any information from the doctor. Anything you say will be just between the two of you, and you won't get in trouble with the law.
The doctor will perform a complete physical examination and may do a number of tests to exclude other conditions.
- A doctor or nurse will check your blood pressure, heart rate, respiratory rate, temperature, and the oxygen saturation of your blood.
- The doctor will look at your skin for rashes or bruises. Infections of the skin such as shingles can cause chest pain, as can bruises.
- The doctor may press on your chest. If you have pain that the doctor can duplicate, especially in front where the ribs come together on the breast bone, you may have costochondritis, which is an inflammation of the cartilage of the chest.
- The doctor will listen closely with a stethoscope to your lungs. By listening, the doctor can sometimes tell whether you have other diseases of the lungs, such as asthma, emphysema, pneumonia, or a collapsed lung (pneumothorax). Some people with pleurisy develop a rubbing sound that is heard over the area that hurts. The doctor will also listen to your heart's rate and rhythm and determine whether you have any murmurs or extra heart sounds that may indicate a defect in or injury to the heart.
- You may need an x-ray of your chest.
- The doctor may order electrocardiogram (ECG).
- Some of your blood may be sent to the lab for analysis to help rule out other causes of chest pain.
Can Pleurisy Symptoms Be Treated at Home?
Some chest pain is dangerous. Sometimes even an experienced doctor can't tell you the exact cause of your pain. Pleurisy is frequently diagnosed only when other more serious causes have been ruled out.
- Use an anti-inflammatory medicine, such as ibuprofen (Motrin) or aspirin, to reduce the pain and inflammation.
- You may have less pain if you lie on the side that hurts.
- Avoid exerting yourself or doing anything that would cause you to breathe hard.
- Call your doctor or go to your hospital's emergency department if you can't breathe deeply or cough because of severe pain.
What Drugs Treat Pluerisy?
When you have been diagnosed with pleurisy and more serious causes of chest pain have been ruled out, you will probably get a prescription for pain medicine.
- You may be prescribed an anti-inflammatory drug such as ibuprofen (Motrin), indomethacin (Indocin), or naproxen (Naprosyn). You may even receive stronger medicine, such as codeine, hydrocodone (Vicodin), or oxycodone (Percocet).
- If you have a lot of fluid in your chest, it may need to be drained.
Pleurisy can cause intense discomfort. If your pain is not well controlled, you may develop pneumonia because you can't breathe and cough appropriately. Increasing shortness of breath, coughing up more phlegm, intense shaking chills (called rigors), and high fevers should prompt reevaluation by a doctor. If the pain gets worse in spite of prescribed medication or if your symptoms do not improve after a week, you should get reevaluated by a doctor or other health care professional.
When Should I Call the Doctor?
Talk with your doctor about any chest pain that worries you. Many causes of chest pain are dangerous and even life-threatening.
- If you have high fever, shaking chills, and a cough that produces thick green or yellow sputum, you may have pneumonia. Talk to your doctor, who may want you to have a chest x-ray.
- Your risk of having another disease along with pleurisy increases with your age and the presence of other serious medical conditions such as heart disease, emphysema, chronic bronchitis, diabetes, and collagen vascular diseases.
- If you have a swollen leg or arm along with pleurisy, you may have a deep venous thrombosis and pulmonary embolus. This is a blood clot in a vein that has broken off and traveled to your lungs.
You should almost always see a doctor for new chest pain, especially if you are very short of breath, have a high fever, or feel lightheaded or if the pain keeps you from moving around comfortably.
If you are in severe distress, call 911 immediately for ambulance transport to the nearest hospital's emergency department.
How Can I Prevent from Getting Pleurisy?
Most pleurisy is caused by infection and is unavoidable. You can avoid severe pleuritic chest pain by early diagnosis and treatment with anti-inflammatory drugs.
What Is the Outlook for a Person with Pleurisy?
Pleurisy caused by viral infections usually lasts about seven days and goes away. Pleurisy from other conditions, such as a cancer, may continue indefinitely.
Reviewed on 9/11/2017
Boka, K, MD. "Pleural Effusion." Medscape. Updated: Jul 21, 2017.