Pleurisy

Definition

Pleurisy is an inflammation of the lining of the lungs that causes pain when you take a breath or cough.

Causes, incidence, and risk factors

Pleurisy may develop when you have lung inflammation due to infections such as pneumonia or tuberculosis. It may also occur with rheumatic diseases, chest trauma, certain cancers, and asbestos-related disease.

When you have pleurisy, the normally smooth lining of the lung (the pleura) become rough. The rub together with each breath, and may produce a rough, grating sound called a "friction rub." This sound can be heard with the stethoscope, or when you place an ear against the patient's chest.

Symptoms

The main symptom of pleurisy is pain in the chest. Sometimes the pain may be felt in the shoulder.

Deep breathing, coughing, and chest movement makes the pain worse.

Pleurisy causes fluid to collect inside the lung area. This makes breathing difficult and may cause the following symptoms:

• Coughing 
• Shortness of breath
• Rapid breathing (tachypnea)
• Cyanosis

Signs and tests

The doctor will use a stethoscope to listen to the lungs for abnormal sounds.

• Friction rub is a rough scratchy sound
• Rales may be occur with pneumonia
• Rhonchi  may occur with pneumonia or bronchitis
• Decreased breath sounds may indicate fluid around the lung

• CBC (may help determine if the infection is caused by a bacteria or virus)
• X-ray of the chest
• Ultrasound of the chest
• Thoracentesis (a collection of fluid from the chest cavity)

Treatment

Treatment depends on what is causing the pleurisy. Bacterial infections are treated with antibiotics. Viral infections normally run their course without medications. Fluid in the lungs may be removed by thoracentesis and checked for signs of infection. The pain of pleurisy can often be controlled with acetominophen or anti-inflammatory drugs such as ibuprofen.

Expectations (prognosis)

Recovery depends on what is causing the pleurisy.

Complications

• Breathing difficulty
• Complications associated with the original illness
• Collapsed lung due to thoracentesis

Calling your health care provider

Call your health care provider if you have symptoms of pleurisy. If you have breathing difficulty or the skin turns blue, seek immediate medical care.

Prevention

Early treatment of bacterial respiratory infections can prevent pleurisy.

References

Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002:1005.

Murray J, Nadel J. Textbook of Respiratory Medicine. 3rd ed. Philadelphia, Pa: WB Saunders; 2000: 497-498. 

Illustrations

Respiratory system overview

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Pleuritis; Pleuritic chest pain ; pleuritic chest pain; pleuritis