Pleurisy: Causes, Symptoms, Diagnosis, Treatment, and Prevention
What is pleurisy?
A pleurisy is characterized by inflammation of the pleura, the thin layer of tissue covering the chest and lungs. During breathing, the pleura normally produce a small amount of fluid that allows them to move smoothly over one another. Pleuritic pain occurs when the pleura rub against each other painfully when they become inflamed, causing sharp chest pain that worsens as you breathe, cough, or sneeze.
Some of the causes of pleurisy include viral or bacterial infections, autoimmune diseases, lung cancer, blood clots, chest injuries, and certain medications. Complications of pleurisy include fluid buildup (pleural effusion), air leaks (pneumothorax), and scarring (pleural thickening).
What are the symptoms of pleurisy?
The main symptom of pleurisy is pleuritic pain, which is sharp, stabbing, or knife-like, and usually affects one side of the chest or shoulder. Aside from the pain in the back and abdomen, it can make it harder to breathe deeply or cough, as well as worsen when lying down, moving, or applying pressure to your chest.
Other symptoms of pleurisy may include:
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Shortness of breath
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Fever and chills
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Cough
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Fatigue
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Loss of appetite
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Weight loss
The symptoms of pleurisy may vary depending on the underlying cause and the severity of the inflammation. Some people may have mild or no symptoms, while others may have severe or life-threatening symptoms.
How is pleurisy diagnosed?
As part of the diagnosis, a doctor will ask about a patient's medical history, symptoms, and exposure to infection or other risk factors. As part of the physical examination, the doctor will listen to the lungs with a stethoscope for abnormal sounds that indicate inflammation or fluid in the pleura, such as crackles or friction rubs.
The doctor may also order some tests to confirm the diagnosis and identify the cause of pleurisy, such as:
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Chest X-ray: to check for any signs of inflammation, fluid, air, or tumors in the lungs or pleura.
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Blood tests: to measure the levels of white blood cells, which may indicate infection or inflammation, and other markers of inflammation, such as erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP).
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Sputum culture: to identify any bacteria or fungi that may be causing an infection in the lungs or pleura.
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Pleural fluid analysis: to examine the fluid that is drained from the pleural space by a procedure called thoracentesis, which involves inserting a needle through the chest wall. The fluid can be tested for its appearance, color, protein, glucose, pH, cell count, and culture, which can help determine the cause and type of pleurisy.
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CT scan or MRI: to provide more detailed images of the lungs and pleura, and to detect any abnormalities that may not be visible on a chest X-ray, such as small blood clots, tumors, or abscesses.
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Ultrasound: to use sound waves to create images of the lungs and pleura, and to guide the needle during thoracentesis or biopsy.
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Biopsy: to take a small sample of tissue from the pleura or lung for microscopic examination, which can help diagnose cancer or other diseases.
How is pleurisy treated?
The treatment of pleurisy depends on the cause and severity of the condition. The main goals of treatment are to relieve the pain, reduce the inflammation, and treat the underlying cause.
Some of the treatment options for pleurisy include:
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For pain and inflammation relief, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, or codeine may be used. A bacterial infection may be treated with antibiotics, whereas a viral or fungal infection may be treated with antivirals or antifungals. A bacterial infection may be treated with antibiotics. For autoimmune diseases or severe inflammation, corticosteroids may be used. Other medications may be used to treat specific causes, such as blood thinners for blood clots, or chemotherapy or radiation for cancer.
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A thoracentesis, chest tube insertion, or pleurodesis are procedures used to remove excess fluid, air, or blood from the pleural space. When performing a thoracentesis, a needle is used to drain the fluid, while when inserting a chest tube, a tube is placed through the chest wall to allow continuous drainage. The purpose of pleurodesis is to seal the pleura together and prevent fluid accumulation. Injecting talc or doxycycline into the pleura is to seal the pleura together.
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Pneumonectomy, decortication, or pleurectomy are surgical procedures that remove part or all of the pleura or lung. A pleurectomy is the removal of the inflamed or scarred pleura, while a decortication is the removal of the thickened or fibrous layer of pleura that covers the lung. When pleurisy or cancer is present, a pneumonectomy is performed on the entire lung.
How can pleurisy be prevented?
Some of the ways to prevent pleurisy include:
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Avoiding smoking and exposure to secondhand smoke, which can damage the lungs and increase the risk of infections and cancer.
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Getting vaccinated against infections that can cause pleurisy, such as influenza, pneumococcal pneumonia, or tuberculosis.
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Practicing good hygiene and washing the hands frequently, especially during cold and flu season, to prevent the spread of germs that can cause respiratory infections.
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Seeking medical attention promptly if experiencing any symptoms of pleurisy, such as chest pain, shortness of breath, or fever, to prevent complications and receive appropriate treatment.
