What is pleurisy?

Pleurisy is an inflammation of the pleura, a large, thin sheet of tissue that wraps around the outside of your lungs and lines the inside of your chest cavity. Between the layer of the pleura that wraps around your lungs and the layer that lines your chest cavity is a very thin space called the pleural space. Normally this space is filled with a small amount of fluid that helps the two layers of the pleura glide smoothly past each other as your lungs breathe air in and out. Pleurisy occurs when the two layers of the pleura become red and inflamed, rubbing against each other every time your lungs expand to breathe in air. Infections like pneumonia are the most common cause of pleurisy.

Symptoms

The main symptom of pleurisy is a sharp or stabbing pain in your chest that gets worse when you breathe in deeply or cough or sneeze. The pain may stay in one place or it may spread to your shoulder or back. Sometimes it becomes a fairly constant dull ache. Depending on what's causing the pleurisy, you may have other symptoms, such as:

• Shortness of breath

• A cough

• Fever and chills

• Rapid, shallow breathing

• Unexplained weight loss

• A sore throat followed by pain and swelling in your joints

Diagnosis

Your doctor will find out if you have pleurisy or another pleural disorder by taking a detailed medical history and doing a physical exam and several diagnostic tests, including:

• Chest X-ray to show air or fluid in the pleural space, and what's causing the condition (for example, pneumonia, a fractured rib, or a lung tumor)

• CT scan that can show pockets of fluid, signs of pneumonia, a lung abscess or a tumor

• Ultrasound, which can show where fluid is located in your chest

• Magnetic resonance (MR) scan, which can show pleural effusions and tumors

• Blood tests, which can show whether you have a bacterial or viral infection, pneumonia, rheumatic fever, a pulmonary embolism or lupus

• Arterial blood gas tests, which show how well your lungs are taking in oxygen

Treatment

A procedure called thoracentesis is used to remove fluid from the pleural space. The doctor inserts a needle or a thin, hollow, plastic tube through the ribs in the back of your chest into your chest wall. A syringe is attached to draw fluid out of your chest.

To relieve symptoms, your doctor may recommend:

• Acetaminophen or anti-inflammatory agents, such as ibuprofen, to control pain

• Codeine-based cough syrups to control a cough

• Lying on the painful side to make you more comfortable

• Breathing deeply and coughing to clear mucus as the pain eases

Your doctor will look at the fluid under a microscope to determine what's causing the fluid buildup. If the fluid is infected, treatment involves antibiotics and draining the fluid. If the infection is tuberculosis or from a fungus, treatment involves long-term use of antibiotics or antifungal medicines. If the fluid is caused by tumors of the pleura, it may build up again quickly after it's drained. Sometimes antitumor medicines will prevent further fluid buildup. If they don't, the doctor may seal the pleural space.