What is pleurisy?
Pleurisy, also called pleuritis, is an inflammation of the pleura, which is the moist, double-layered membrane that surrounds the lungs and lines the rib cage. The condition can make breathing extremely painful, and sometimes it is associated with excess fluid, which fills the area between the membrane's layers. This is called pleural effusion.
What are the causes?
Viral infection is probably the most common cause of pleurisy. Other diseases that can cause pleurisy are lung infections, such as pneumonia and tuberculosis, and other diseases such as systemic lupus erythematosus, rheumatoid arthritis, cancer, liver and kidney disease, heart failure and pulmonary embolism. Other causes include chest injuries and drug reactions. Pleurisy and pleural effusion are generally only as serious as the underlying diseases causing them.
What are the symptoms?
- You may experience severe, fleeting, sharp stabbing pain in your chest, often on one side only. The pain is increased when breathing deeply, coughing, moving, sneezing or even talking.
- Severe chest pain that goes away when you hold your breath
- When pleurisy occurs in certain locations of the lungs, the pain can be felt in other parts of the body such as the neck, shoulder or abdomen
- Rapid, shallow breathing in response to the pain
- Large accumulations of fluid compromise breathing and may cause coughing, shortness of breath with rapid breathing and cyanosis (skin turns bluish).
How is it diagnosed?
The distinctive pain caused by pleurisy is an important clue to this condition. In addition, your doctor will listen to your chest with a stethoscope as you breathe. If this examination reveals pleural friction rub, the superficial grating sound of the pleura's two layers sliding against each other, then the diagnosis is clear. A decrease in breath sounds and a change in their quality may allow your doctor to diagnose a pleural effusion.
Your doctor may also take X-rays of your chest, which will be normal if you have pleurisy but show fluid if there is pleural effusion. CT scans and ultrasound scans may also be used to better visualize the chest cavity. Your doctor may draw a sample of pleural fluid for analysis. He or she will first determine the exact location of the fluid. Then, after injecting your back or chest with a local anaesthetic, he will use a syringe to extract the fluid. He will send the sample for tests to determine the underlying cause of the fluid build-up.
What is the treatment?
Treatment is directed at the underlying illness. Bacterial infections are treated with appropriate antibiotics. Tuberculosis requires special treatment. Viral infections normally run their course without medications. Sometimes the cause of a pleural effusion may be cancer of the lung or a cancer in the lung that has spread from another site. Your doctor may prescribe anti-inflammatory drugs or pain medicines, such as aspirin, to remedy the inflammation. Sometimes, a codeine-based cough syrup will be prescribed to control a painful cough. If the amount of pleural fluid is causing difficulty in breathing, your doctor may drain it by thoracentesis, a procedure that requires hospitalisation.
How to prevent it?
Early treatment of bacterial respiratory infections can prevent pleuritis. No treatments are available for viral respiratory infections. Pleurisy usually is caused by an infection or a disease like lupus. While the condition probably cannot be prevented, it could indicate a more serious underlying problem that your doctor should be aware of right away.
What is the prognosis?
Recovery depends upon the nature of the underlying illness. Recovery from infections of all types is generally good with treatment. Recovery from pleurisy caused by malignancy depends on the type and extent of the disease.