Pleurisy

• The pleura is a two layered sac that holds the lungs and separates them from the chest wall, diaphragm, and heart.
• Pleurisy, also called pleuritis, 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 buildup to collect in the pleural sac.
• Pleurisy can go away on its own or worsen so that pleural 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.

There are many causes of pleurisy.

• Infectious disease caused by virus, bacteria, fungus, tuberculosis, or parasites
• Cancer such as mesothelioma, lung cancer, or cancer 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
• It may be drug induced and due to reaction to drugs such as methotrexate (Rheumatrex, Trexall) and penicillin
• Other causes of pleuritis
  • Uremia
  • Blood clot in lung called a pulmonary embolism
  • Radiation therapy
  • Sickle cell disease
  • Chemotherapy drugs
  • Asbestos
  • HIV

You can have many symptoms with pleurisy:

• Chest pain: This is the most common symptom of pleuritis. The pleuritic pain is generally a sharp, stabbing pain, but may also be a dull ache or a burning sensation. Pleuritic pain 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 (pulmonary embolism), fluid around the lung (pleural effusion), 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.

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 such as pericarditis, heart failure, and other pleural disorders such as pneumothorax (air leaking into the pleural space), pleural effusion (excess fluid around the lung in the pleural space), hemothorax (blood in the pleural cavity), and empyema (pus in the pleural space).

• 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 (called a pleurisy friction rub) 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 a chest X-ray.
• The doctor may order electrocardiogram (ECG).
• Medical professionals may perform some blood tests and send some of your blood to the lab for analysis to help rule out other causes of chest pain.

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 over-the-counter (OTC) 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.

When you have been diagnosed with pleurisy (pleuritis) and more serious causes of chest pain have been ruled out, you will probably get a prescription for pain medicine.

• Medical professionals may prescribe a nonsteroidal anti-inflammatory drug such as ibuprofen (Motrin), indomethacin (Indocin), or naproxen (Naprosyn). You may even receive stronger medicine, such as codeine, or other narcotic pain-reliever drugs, including hydrocodone (Vicodin) or oxycodone (Percocet).
• If you have a lot of pleural fluid in your chest, a medical professionals may need to perform a thoracentesis procedure to drain the fluid.

Pleural disease 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.

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. A pulmonary embolism is a blood clot from another part of the body that breaks off and travels to your lungs.

You should always consult 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.

Medical treatment for pleurisy can include thoracentesis (a hollow, plastic chest tube inserted to remove fluid or air from the pleural space) or pleurodesis (layers of the lung lining are fused together to eliminate the pleural space).

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.

Pleurisy prognosis depends on finding and treating the underlying cause. Most cases are treatable and resolve in days or weeks. Pleurisy caused by viral infections usually lasts about seven days and goes away. Pleuritis from other conditions, such as cancer, may continue indefinitely.