Pleurisy

Overview

What is pleurisy?

The pleura is the thin membrane that lines the outside of the lungs and the inside of the chest cavity. Pleurisy is an inflammation (swelling or irritation) of these two layers of tissue.

The pleural space is a thin area between the chest lining and the membrane that lines the lungs. Fluid lubricates the layers of the pleura so they slide smoothly alongside each other when you breathe. When the membranes become inflamed, they rub painfully against each other instead.

Pleurisy can cause sharp or stabbing chest pain and shortness of breath. It is also called pleuritis.

Who is affected by pleurisy?

Pleurisy can affect people with certain underlying medical conditions, such as infections or autoimmune diseases. Pleurisy occurs in people of all ages, but it develops most often in people over age 65. These people are more likely to develop chest infections.

People of Mediterranean descent have a higher risk for pleurisy due to a hereditary condition called familial Mediterranean fever. With familial Mediterranean fever, a genetic mutation (change) causes inflammation in the chest and abdomen.

Symptoms and Causes

What causes pleurisy?

Doctors do not always know what causes pleurisy. Infections usually cause the disorder. These infections can be viral (caused by a virus), such as influenza, or bacterial (caused by bacteria), such as pneumonia. While infections can cause pleurisy, pleurisy itself is not contagious.

Other conditions that can cause pleurisy include:

What are the symptoms of pleurisy?

Most people with pleurisy experience sharp or stabbing chest pain, also known as pleuritic pain. This pain often worsens when you cough or breathe in deeply. Sometimes the pain can spread to the shoulder or back.

Pain similar to pleuritic pain can also be a symptom of emergency medical conditions such as a heart attack or pulmonary embolism (blood clot in the lung). If you experience sharp chest pain, it is important to seek immediate medical attention to rule out these life-threatening conditions.

Other signs and symptoms of pleurisy can include:

  • Cough.
  • Fatigue (extreme tiredness).
  • Fever.
  • Shortness of breath.
  • Unexplained weight loss.

Can you get pleurisy more than once?

Yes. You do not become immune to pleurisy by having it and recovering. Also, some of the conditions that can cause pleurisy are chronic—you have them for a long time—so you may continue to be susceptible to inflammation of the pleura.

Diagnosis and Tests

How is pleurisy diagnosed?

Doctors use a medical history and several tests to evaluate for pleurisy. These tests include:

  • Biopsy: In some cases, a doctor will take a small sample of lung tissue to determine whether cancer or tuberculosis is present.
  • Blood test: Doctors use blood tests to look for signs of infection or autoimmune disorders such as lupus or rheumatoid arthritis.
  • Electrocardiogram (EKG or ECG): This test uses small electrodes placed on the chest to measure the heart’s electrical activity. It helps doctors rule out problems or defects of the heart.
  • Imaging tests: Imaging tests such as X-rays, CT scans and ultrasounds allow your doctor to see abnormalities in the pleural space, including air, gas or a blood clot.
  • Physical exam: Listening to your lungs with a stethoscope allows your doctor to hear a rubbing sound in your lungs that may be a sign of pleurisy.
  • Fluid extraction (thoracentesis): A doctor inserts a small needle into the pleural space and removes fluid to look for signs of infection or other causes of pleurisy.

Management and Treatment

What are the treatments for pleurisy?

Pleurisy treatment depends on the underlying condition causing it. In some cases, pleurisy goes away on its own without treatment.

Your treatment options might include:

  • Draining the pleural space: Doctors remove air, blood, or fluid from the pleural space. Depending on how much of the substance needs to be drained, doctors use a needle and syringe (thoracentesis) or a chest tube to suction fluid out of the area.
  • Medication: Your doctor might prescribe an antibiotic, an antifungal or an antiparasitic to treat an infection. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can relieve the pain associated with pleurisy. Corticosteroids can reduce inflammation, but they can produce many side effects. Your doctor may prescribe bronchodilators to make it easier for you to breathe.
  • Radiation treatment or chemotherapy: In some cases, doctors use cancer treatments to shrink tumors that cause pleurisy.

What are the complications associated with pleurisy?

Some people with pleurisy experience complications. They include:

  • Hemothorax: Blood builds up in the pleural space.
  • Pleural effusion: Too much fluid collects in the pleural space. Pleural effusion can cause difficulty in breathing.
  • Severe illness from not treating the infection or condition that caused pleurisy in the first place.

Prevention

How can you prevent pleurisy?

You can’t prevent pleurisy, but you can reduce your risk by promptly treating conditions that may cause it. You should also quit smoking tobacco, using electronic cigarettes, and smoking marijuana. If you don’t smoke, don’t start.

Who is at risk of developing pleurisy?

People of Mediterranean descent have a higher risk for pleurisy due to a hereditary condition called familial Mediterranean fever. People with other underlying conditions that can lead to pleurisy are also at higher risk for the disorder. These conditions include:

  • Asbestosis (lung disease caused by inhaling asbestos).
  • Autoimmune disorders such as lupus and rheumatoid arthritis.
  • Cancers of the respiratory system such as lung cancer, asthma, and COPD.
  • Chest surgery or trauma.
  • Inflammatory bowel disease.
  • Taking certain medications, including hydralazine, isoniazid, and procainamide.

Outlook / Prognosis

What is the prognosis (outlook) for people with pleurisy?

Doctors successfully treat most cases of pleurisy. Most people who receive prompt diagnosis and treatment for the condition causing pleurisy recover fully. People treated with antibiotics for an infection causing pleurisy usually feel better in about a week. Very rarely, people who are not treated may have life-threatening complications. The outlook also depends on the underlying condition that caused the pleurisy.

Living With

When should I see a healthcare provider about pleurisy?

Contact your healthcare provider if you experience unexplained severe chest pain or other symptoms of pleurisy.

What questions should I ask my doctor?

If you have pleurisy, you may want to ask your doctor:

  • Why did I develop pleurisy?
  • Should I consider genetic testing?
  • If medicine caused pleurisy, should I stop or change my medicine?
  • Am I at higher risk for other lung conditions?
  • What can I do at home to relieve pain?
  • What signs of complications should I look out for?
  • Am I more likely to get pleurisy again after having it once?

Last reviewed by a Cleveland Clinic medical professional on 11/07/2019.

References

  • American Academy of Family Physicians. Accessed 11/8/2019.Pleurisy (Pleuritis). (https://familydoctor.org/condition/pleurisy-pleuritis/)
  • American Family Physician. Accessed 11/8/2019.Pleurisy. (https://www.aafp.org/afp/2007/0501/p1357.html)
  • National Heart, Lung, and Blood Institute. Accessed 11/8/2019.Pleurisy and other Pleural Disorders. (https://www.nhlbi.nih.gov/health-topics/pleurisy-and-other-pleural-disorders)

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