What is pleurisy?

Causes and Symptoms

The lungs sit within the chest wall just underneath the rib cage. The pleura is a very thin double lining covering the outer surface of the lungs and the undersurface of the ribs. During normal breathing, the lungs expand and relax, stretching their pleural membrane and moving it back and forth against the pleural membrane lining the rib cage. To minimize friction, a very small amount of fluid fills the space between them.

“Pleurisy” is a descriptive term that refers to chest pain with respiration. It occurs when the pleural membranes become irritated or inflamed. The pain is usually localized at the area of inflammation, but it can radiate toward the neck, shoulder, or abdomen. The pain may be mild discomfort or a severe stabbing or burning sensation. In addition to deep breathing, coughing or movements of the chest can exacerbate symptoms. Because of the pain, the patient may employ rapid, shallow breathing.

Patients with symptoms of a recent cold or respiratory infection likely have pleurisy caused by a virus; however, a more serious cause, such as pneumonia, may also be responsible. Tuberculosis is another infectious cause to be considered.

Patients with recent injuries to the chest or unusually strenuous activity may have pleurisy attributable to a muscle sprain or a fractured rib. Patients with sickle cell disease, advanced kidney failure, a recent heart attack, rheumatologic diseases such as lupus and rheumatoid arthritis, or asbestos exposure are also prone to pleurisy.

The most worrisome causes of pleurisy are pneumothorax (punctured lung), pulmonary
embolism (blood clot in the lung), or lung cancer. These causes are more likely to be associated with shortness of breath, although this symptom is not reliably present.

Treatment and Therapy

Treatment of pleurisy depends on the underlying cause. In most cases, a chest x-ray is indicated. In some cases, a collection of fluid in the pleural space will be visible. However, patients with pleurisy may often have a normal chest x-ray. In concerning cases, particularly those associated with shortness of breath and abnormally low oxygen levels, further radiologic studies, such as a computed tomography (CT) scan or magnetic resonance imaging (MRI), may be necessary.

Pleurisy caused by viral infections, trauma, rheumatologic diseases, and sickle cell disease is generally treated with pain medications, and the symptoms resolve within one to two weeks. Patients with kidney or heart disease may need drainage of the pleural fluid with a needle or tube placed into the pleural space through the back.

The more serious causes of pleurisy require specialized treatments based on the cause; typically, temporary oxygen supplementation is required, and sometimes hospitalization is necessary.

Bibliography

Fishman, Alfred, ed. Fishman’s Pulmonary Diseases and Disorders. 4th ed. New York: McGraw-Hill, 2008.

Marx, John A., et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia: Mosby/Elsevier, 2010.

"Pleurisy and Pleural Effusion." InteliHealth, April 19, 2011.

Porter, Robert S., et al., eds. The Merck Manual Home Health Handbook. Whitehouse Station, N.J.: Merck Research Laboratories, 2009.

Walsh, Beth. "Pleurisy." Health Library, September 1, 2011.

"What Are Pleurisy and Other Pleural Disorders?" National Heart, Lung, and Blood Institute, September 21, 2011.