Pleurisy (Pleuritis)

What Is Pleurisy?

Pleurisy is a type of chest pain. It affects a part of your body called the pleura.

The pleura is a thin layer of tissue that wraps your lungs. They fit snugly within your chest, which is lined with another thin layer of pleura.

These layers keep your bare lungs from rubbing against the wall of your chest cavity every time you breathe in. There’s a bit of fluid within the narrow space between the two layers of pleura to keep everything moving smoothly.

When you’re healthy, you never notice your pleura at work. But if your pleura has a problem, you’ll feel it.

When the pleurae are swollen and inflamed, they rub against each other in a very painful way each time your lungs expand. When you inhale deeply, cough, sneeze, or laugh, you’ll probably feel a sharp, stabbing pain in the area that’s affected.

Most of the time, pleurisy happens because of an infection. If your doctor treats your infection, that can make it -- and the pain -- go away.

Pleurisy Causes

Bacterial infections such as pneumonia often cause pleurisy. It can also be caused by a virus such as the flu or by a fungus.

Other things that can cause pleurisy are:

• Lung cancer
• Other types of cancer that affect your lungs or pleura
• A blood clot in your lung
• An autoimmune disease, such as lupus or rheumatoid arthritis
• A chest injury
• Sickle-cell anemia
• Mesothelioma

Pleurisy Symptoms

Chest pain from pleurisy has signs that can make it easy for your doctor to know that you have it. You’re likely to notice these things:

• A sharp, stabbing pain that causes you to take small, shallow breaths because it’s worse when you try to breathe deeply
• Pain that spreads to your shoulder or back
• A cough
• Fever and chills

Pleurisy Diagnosis

Your doctor will ask you to describe the type of pain you feel when you breathe or cough, and they’ll ask whether it gets better or worse as the day goes on. They’ll listen to your lungs with a stethoscope to see if they’re making any strange noises. (Doctors often can hear the pleurae rubbing against each other.)

You may also need to have tests, such as:

• Imaging. If your doctor wants to rule out other problems, they may send you for an X-ray, a CT scan, or an ultrasound. These images can show if it’s pleurisy that’s causing your pain.
• Blood tests. These may show if an infection is the culprit. It may also reveal if you have an autoimmune disease like lupus or another problem.
• EKG. An electrocardiogram of your heart might show that your chest pain is caused by a heart problem, not pleurisy.
• Thoracentesis. A technician looks at a sample of your pleural fluid under a microscope for problems like infections or cancer.
• Thoracoscopy. Your doctor uses a thin, flexible tube called a thoracoscope to look inside your chest cavity.

Pleurisy Treatment

In order to treat your pleurisy the right way, your doctor needs to know what’s causing it:

• If it’s bacteria, antibiotics can make you better.
• If it’s a fungus, they’ll probably give you an antifungal drug.
• If it’s a virus, you’ll get better on your own in a few days or weeks.

Some people with pleurisy have too much fluid built up between their two layers of pleura. Your doctor may need to remove some of the fluid. They may insert a thin needle into the space between your pleura to do this.

Painkillers and steroid medications can help while you’re getting better.

If coughing hurts too much, your doctor might prescribe medication (codeine) that can make you cough less.

You might feel better if you lie on the side that’s causing you pain. As the pain starts to go away, try to breathe more deeply and cough up any phlegm you have.

Pleurisy Complications

Complications of pleurisy can be serious. They include:

• Lungs that are blocked or can’t expand the way they should (atelectasis)
• Pus in your pleural cavity (empyema)
• A sudden drop in blood flow (shock)
• A dangerous reaction to infection (sepsis)

Inflammation can also make fluid build up in your pleural cavity. This is called pleural effusion. You might have less pain, but it can be hard for you to breathe. Your doctor might give you medications like diuretics, or you might have a procedure to drain the fluid.

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