Topic Overview
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This topic provides
information about pleurisy, which usually results in chest pain. If you have
chest pain that concerns you and that your doctor does not know about, see the
topic
Chest Problems.
What is pleurisy?
Pleurisy is swelling (inflammation) of the thin layers of tissue (pleura)
covering the lungs and the chest wall.
The outer layer of the
pleura lines the inside of the chest wall, and the
inner layer covers the lungs. The tiny space between the two layers is called
the pleural cavity. This cavity normally contains a small amount of lubricating
fluid that allows the two layers to slide over each other when you
breathe.
When the pleura becomes inflamed, the layers rub
together, causing chest pain. This is known as pleuritic pain.
Pleurisy is sometimes called pleuritis.
What causes pleurisy?
In young, healthy people, an
infection of the
lower respiratory system by a
virus or bacteria may cause pleurisy. Pleurisy usually
lasts a few days to 2 weeks. In very rare cases, the virus or bacteria may
spread and cause pleurisy in others.
Other causes of pleurisy
include air leaking into the pleural cavity from a hole in
a lung (pneumothorax), injury to the chest
(such as a broken rib),
tuberculosis or other infections, or a tumor in the
pleura.
Other
conditions may also cause pleurisy. These include
rheumatoid arthritis,
lupus,
sickle cell crisis,
pulmonary embolism, or
pancreatitis. Pleurisy may also develop as a
complication of heart surgery.
What are the symptoms?
The symptoms of
pleurisy are chest pain and difficulty breathing. The chest pain usually starts
suddenly. People often describe it as a stabbing pain, and it usually gets worse
with breathing. The pain:
- May always be present, but it usually gets
worse when you breathe in. You may avoid breathing deeply to prevent the
pain.
- Usually is on only one side of the chest.
- May
extend to a shoulder or the belly.
- Is usually worse when you cough,
sneeze, or suddenly move.
- May ease when you hold your breath or
press on the painful area.
But this type of chest pain can be caused by conditions
that do not affect the pleura, such as chest muscle strain and
costochondritis.
If a viral infection is
causing your pleurisy, you may or may not have common viral symptoms, such as
fever, headache, and muscle aches.
The inflammation of the pleura
sometimes causes fluid to build up in the pleural cavity (pleural effusion). You may have less pain after this happens, because the fluid
prevents the two layers of the pleura from rubbing together. If there is a
large amount of fluid, it may prevent the lung from expanding when you breathe
in. This can make it hard to breathe. Other symptoms of pleural effusion
include fever, chest pain, and a dry cough.
Pleural effusion may occur without pleurisy in
other conditions, such as
heart failure or liver or kidney disease.
How is pleurisy diagnosed?
Many different
health problems can lead to pleurisy, so your doctor will look for what is causing
your inflammation. He or she will do a
physical exam and tests such as a
chest X-ray, blood tests, or a CT scan to look for the cause of your symptoms. The conditions that may
cause pleuritic chest pain include:
If your doctor thinks your pleurisy may be caused by an
autoimmune disease such as
lupus or
rheumatoid arthritis, he or she may do blood tests.
If you have pleural effusion, your doctor may use a needle to
remove some of the fluid from the pleura. This procedure is called
thoracentesis. The fluid is then studied, to help your doctor find
out the cause of the effusion.
See pictures of pleural effusion and thoracentesis.
How is pleurisy treated?
The treatment for
pleurisy depends on the cause. For example, if a bacterial infection is the
cause, you will probably need an
antibiotic. If a
pulmonary embolism is present, you may
get medicine to dissolve the clot or
to prevent future blood clots (anticoagulants).
For most cases of pain caused by pleurisy, your
doctor will suggest that you use aspirin, ibuprofen, or another
nonsteroidal anti-inflammatory drug (NSAID). Do not give aspirin to anyone younger than 20 because of the risk of Reye syndrome.
If you have severe pain, you may need prescription cough
or pain medicine. You may also be able to relieve pain by lying on the painful
side or pressing a pillow against it.
If you have pleural
effusion, you may need to have the fluid drained through a tube that the doctor inserts in
your chest.
In some cases of pleural effusion, you may need
pleurodesis. During this procedure, a medicine is put into your chest cavity,
which triggers an inflammatory reaction over the surface of the lung and inside
the chest cavity. This causes the surface of the lung to stick to the
surface of the chest cavity, which prevents more fluid from building
up or reduces the amount of fluid.