Published on Oct 12, 2019 - 4 min read
Pleurisy or pleuritis is the inflammation of the pleura, which is the thin tissues that line the chest cavity and the lungs. Pleurisy results in sharp chest pain, called pleuritic pain, which worsens on breathing. Various underlying conditions can cause pleurisy, and the treatment aims to control pain and to treat the underlying condition.
Normally when you breathe, the pleura rub together, but as it is satiny, there is no friction. But, when the tissue is inflamed or infected, it causes significant pain while breathing. This condition has killed historical figures like Catherine de Medici and Benjamin Franklin. Earlier, bacterial infections were the main cause of pleurisy, which was easy to treat and prevent with antibiotics. But in the modern world, viral infections majorly cause this condition.
Pleura separates your lungs from your chest wall, as one layer is present around the outside of the lungs and the other lines the inside of the chest wall. The space between these layers is called pleural space, which is usually filled with little fluid. These layers help your lungs to contract and expand when you breathe without any friction.
When this pleura becomes irritated and inflamed, it results in pleurisy. As the tissues in the pleura rub against each other during breathing, patients experience pain on inhaling and exhaling. The pain goes away on holding your breath, as the lungs no longer expand.
Some of the causes that result in inflammation of the pleura are:
Trauma to the chest wall.
Autoimmune disorders like rheumatoid arthritis and lupus.
Sickle cell anemia.
The symptoms commonly associated with pleurisy are:
A sharp or stabbing pain on breathing.
The pain goes away if you hold your breath or apply pressure on the area that is paining.
Pain worsens on sneezing or coughing.
Unintentional weight loss.
Pain can radiate to the back or shoulder.
Sometimes, along with pleurisy, fluid can get accumulated outside the lungs, which puts pressure on the lungs and prevents them from functioning properly (pleural effusion). As the fluid increases, the person will find it hard to breathe.
As the fluid gets accumulated between the pleura, you might not experience pain anymore. This fluid can also get infected and result in fever and chills, and this condition is called empyema.
After doing a physical exam and taking a complete medical history, your doctor will try to find the location and cause of the inflammation. He or she might order the following tests:
X-ray - Chest X-rays will show if there is any inflammation in the lungs. Your doctor might also take an X-ray with you lying on your side, as it allows free fluid to form a layer. This X-ray helps diagnose pleural effusion.
Blood tests - To detect any infection and to determine the cause. It might also help detect any autoimmune condition.
CT scan - To detect any other pathology in the chest and lungs, your doctor might order a CT scan. This helps produce detailed cross-sectional images of your chest.
Ultrasound - An ultrasound uses high-frequency sound waves to produce images of the organs inside your chest cavity. It lets the doctor determine if there is inflammation or fluid buildup inside.
Pleural biopsy - To determine the cause of pleurisy, sometime, a sample of the pleura is taken. Here, through a small incision in the skin of your chest wall, a needle is used to remove a small sample of the pleura. The tissue is then checked for infection, cancer, or tuberculosis.
Thoracentesis - A needle is inserted into the area of your chest where there is fluid buildup. Then the fluid is removed and sent to the lab to check for the presence of infections. As it is an invasive test, it is rarely done.
Thoracoscopy or Pleuroscopy - A flexible tube with a camera is inserted through a small incision in your chest wall. The camera is then used to detect any inflammation and to take a tissue sample.
The treatment depends on the cause. Once the cause is identified, your doctor will suggest appropriate treatment. You have to rest and give your body time to recover and heal. Some of the treatment options include:
Bacterial infection can be treated with antibiotics.
Medicines like Aspirin, Ibuprofen, and other NSAIDs (nonsteroidal anti-inflammatory drugs) for pain.
Cough syrup containing Codeine.
For pulmonary emboli, medicines that break up clots.
To treat asthma, inhaled bronchodilators can be used.
For pleural effusion, the fluid must be drained out properly.
The complications associated with pleurisy are:
Pleural effusion - Collection of more fluid between the pleura can put pressure on the lungs, which can prevent it from functioning properly.
Empyema - The fluid can get infected, which makes pus cells getting collected, resulting in empyema.
Pneumothorax - Pneumothorax is collapsed lungs. It causes sudden pain in one side and dyspnea.
Hemothorax - Accumulation of blood in the pleural space is called hemothorax. It can result in severe blood loss, hypoxia, and shock.
It is not always possible to prevent pleurisy. The only way to prevent complications is by early diagnosis and treatment.
As it causes chest pain and breathing difficulty, it is often mistaken for conditions like a heart attack. If you have been diagnosed with this condition, take proper rest and eat healthily to prevent complications. For more information, consult a pulmonologist online.
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