Published on Oct 12, 2019 - 4 min read
Pleurisy is the inflammation of the membrane that lines the inner side of the chest cavity. It can cause sharp chest pains and difficulty in breathing. For more information, read the article.
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.
Inflammation of the pleural layer of the lungs limits lubrication at the area between the two pleural layers. This results in pleurisy. It is usually caused by viral, bacterial, and fungal infections. The other causes may be autoimmune disorders such as rheumatoid arthritis, lupus, lung cancer, genetic disorders, and pulmonary embolism.
Pleurisy causes stabbing pain when the affected person breathes. It usually lasts for an interval of a few days to two weeks. But the duration of pleurisy is also determined by the underlying cause of the disease.
Usually, patients suffering from pleurisy find comfort in sleeping by lying on the affected side of the lungs. However, to avoid complications such as lung collapse, pneumonia, etc., patients are advised to change sides frequently while sleeping. To avoid the pain that occurs during coughing during sleep, patients can hold their pillows against their chests.
To treat chest pain that is caused by pleurisy, doctors use non-steroidal anti-inflammatory drugs (NSAIDs). The most commonly used painkiller is Ibuprofen. But, Paracetamol and Codeine are also used. It is important that patients should be educated about the hazards of self-medication. Self-medicating could be dangerous with any drugs and especially for pleurisy, and it is not advisable. Proper consultation with a doctor should be done before administering any drugs.
The class of antibiotics named macrolides are used in the treatment of pleurisy. The drugs under this class include Azithromycin, Clarithromycin, etc. However, medicines are not the only mode of treating pleurisy. Also, self-medicating with these drugs might lead to conditions like antibiotic resistance.
The typical symptom in pleurisy is a sharp stabbing type of chest pain. It sometimes radiates towards the shoulder also. Due to the similarity of the pain between myocardial infarction and pleurisy, pleurisy might feel like a heart attack.
Yes, pleurisy feels like a pulled chest muscle. The pain is usually sharp, sudden, and the severity of the pain increases when the person is breathing. Many patients explain this pain as if their chest muscle is being pulled when they are breathing.
The symptoms of pleurisy presented by different patients depend mainly on the cause of pleurisy. Pleurisy can also present with fever, and when pleurisy presents with a fever, then the cause is due to infections by a virus, bacteria, or fungus. Fever is often present along with chills.
One of the primary imaging modalities is a chest x-ray. It is performed when a person suffers from chest pain and is suspected of pleurisy. An x-ray may be normal when the person does not have any other problem other than pleurisy. But, when there are conditions like pleural effusion or pneumonia along with pleurisy, it can be visualized from an x-ray film.
Pleurisy is not contagious by itself. The most common cause of pleurisy is bacterial pneumonia. This condition has become less common over the years due to the usage of antibiotics. However, close relatives of patients and health care providers have to take necessary preventive measures in order to prevent themselves from pleurisy.
Pleurisy causes chest pain that is associated with breathing difficulty. Patients who are suffering from pleurisy experience fatigue in a range of mild to moderate levels. Pain caused by each episode of breathing can make patients tired very soon over time. The severity of the underlying cause of pleurisy will also determine the degree of fatigue in the patients.
In acute or severe cases of pleurisy, the patient might have severe difficulty in breathing, severe chest pain that is stabbing in nature. It might make the person appear blue due to inadequate oxygen supply to the body. This leaves anxiety in the patient. In turn, there will be activation of the sympathetic nervous system of the body. This process will lead to an increase in heart rate.
There are two pleural layers in the human body, namely, the parietal and visceral pleura. When a person suffers from pleurisy, both the layers of pleura get inflamed severely. This causes the layers of the pleura to rub against each other. It causes severe pain every time the person inhales and exhales. This is the reason why pleurisy is so painful.
The affected person feels weak and tired with pleurisy. The chest pain is usually one-sided. The pain is aggravated by breathing and violent movements of the body. If the condition progresses, the person starts to feel increasingly unwell if it is left untreated.
The most common initial presentation of a patient suffering from pleurisy is the acute onset of chest pain. The pain is usually one-sided, and it radiates to the shoulder. It starts with the mild difficulty in breathing and progresses soon as severe dyspnea. However, in patients with underlying causes of pleurisy such as pneumonia or tumors, pleurisy might be acute.
There are three steps involved in getting rid of pleurisy faster. It includes the proper intake of the prescribed medications for pain and inflammation of pleurisy. Adequate rest is mandatory. Patients are advised to take rest in positions with the least discomfort. The last and important advice to patients with pleurisy is to quit smoking immediately as smoking might aggravate the disease.
Pleurisy presents with pain that is explained as sharp and stabbing in nature. The pain is located in the left medial region of the chest, and it might also radiate towards the shoulder region. The nature of the pain will not be constant, and different patients report different symptoms.
Pleurisy is caused when the parietal and visceral pleural layers are severely inflamed due to any disease condition. The pain starts when the two layers start rubbing against each other every time the person inhales and exhales. If you are facing any discomfort, you should contact your doctor immediately.
When you are affected by pleurisy, you might experience one-sided chest pain, cough, sneezes, and shortness of breath. You might also take shallow breaths since deep breathing episodes might aggravate your chest pain. However, when you experience these symptoms, it can not only be pleurisy. It can be any other health issues. To achieve a proper diagnosis, immediate consultation with a doctor is needed.
Pleurisy can not be completely treated at home. However, at initial stages, patients might opt for deep breathing exercises. Over-the-counter medicines can be used to alleviate symptoms until the person reaches the hospital. When there is a severe difficulty of breathing or if the person is well-known with comorbid conditions, immediate hospitalization is mandatory.
Proper intake of prescribed medicines, rest, and most importantly, avoiding smoking helps patients with pleurisy improve their health. Avoiding physical exercises and practicing deep breathing exercises can improve the symptoms.
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