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Pleurisy

Alternate Names

  • pleuritis
  • The lining of the chest cavity (pleura)

Definition

Pleurisy is inflammation of the thin tissue lining around the lungs.

What is going on in the body?

A thin lining, known as the pleura, exists around the lungs. It allows for smooth, comfortable movement between the chest wall and the lungs as a person breathes. The pleura becomes rough and stiff when it becomes inflamed. Because the lung expands and contracts while breathing, this inflammation makes breathing painful.

Risks

What are the causes and risks of the condition?

There are many causes of pleurisy. These may include pneumonia, tuberculosis, lung tumors, and lung cancer. A blood clot in the lung, called a pulmonary embolus, can result in pleurisy. Other causes include viral infections of the pleura and connective tissue diseases such as systemic lupus erythematosus.

Prevention

What can be done to prevent the condition?

Pleurisy is best prevented by avoiding the disease processes that lead to it, insofar as possible. Preventing pneumonia is very important. This can be aided by a one-time pneumonia vaccine, with a booster as recommended by the healthcare professional. Many cases of the flu can be prevented with an annual influenza vaccine (flu shot). Proper treatment of illnesses known to cause pleurisy is also important. Anyone who smokes tobacco should quit, using any of a variety of available methods.

Diagnosed

How is the condition diagnosed?

Pleurisy is diagnosed by history and physical exam. The classic complaint is severe knifelike chest pain that gets worse with each breath. Chest x-rays are often used to uncover causes of pleurisy. Blood tests are also used to diagnose pleurisy in some people.

Long Term Effects

What are the long-term effects of the condition?

Single episodes of pleurisy, such as those caused by pneumonia, have no long term effects. Occasionally, people will suffer from scarring of the pleura. This results in abnormal breathing and constant pain. Adhesions can occur where the pleura attaches to the chest wall. If this problem is severe enough to affect lung function, surgery may be required.

Other Risks

What are the risks to others?

Pleurisy caused by viral or bacterial upper respiratory infections can be contagious. Tuberculosis is highly contagious.

Treatments

What are the treatments for the condition?

Treatment is aimed at reducing the inflammation of the pleura. This is usually accomplished with anti-inflammatory medications such as ibuprofen (i.e., Motrin, Advil). Pain control is important. If the pain is not controlled, full deep breaths will not be possible. This can result in further complications, such as atelectasis and pneumonia. Often narcotic pain medication is necessary to control the pain of pleurisy.

Side Effects

What are the side effects of the treatments?

All medications have side effects. The most common side effect from anti-inflammatory medication is stomach upset.

After Treatment

What happens after treatment for the condition?

If there is no serious underlying disease, a person will return to a normal state of health following treatment. Diseases such as tuberculosis need to monitored on a long-term basis. Pleurisy can be a short-lived complication of these illnesses. Once the pleurisy is gone, the underlying disease may continue.

Monitor

How is the condition monitored?

Routine monitoring of the diseases that cause plerisy is important. Episodes of pleurisy may be monitored with chest x-rays and pulmonary function tests if indicated. These tests measure the functioning of the lungs and how much airflow is occuring as a person breathes. A return to normal lung function is the goal of treatment.

Sources

Harrison's. Principles of Internal Medicine. 1987.

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