Pleurisy is inflammation of the thin tissue lining around the lungs.
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.
Pain with breathing is the most common symptom of pleurisy. The pain in the chest is often described as "knifelike". Others describe the pain as an ache or a catch in the chest with breathing. The pain is intensified with each breath. The affected person often breathes very shallowly to reduce the pain of pleurisy. Shallow breathing for a prolonged period can result in collapse of parts of the lung, known as atelectasis. Simply moving the upper body sometimes worsens the pain of pleurisy. A person will often adopt a very still posture to avoid additional pain.
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.
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.
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.
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.
Pleurisy caused by viral or bacterial upper respiratory infections can be contagious. Tuberculosis is highly contagious.
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.
All medications have side effects. The most common side effect from anti-inflammatory medication is stomach upset.
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.
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.
Harrison's. Principles of Internal Medicine. 1987.