When you breathe, the thin tissues that line your lungs and chest wall, called the pleura, rub together. This isn’t typically a problem because the tissue is satiny and generates no friction. However, when this tissue is inflamed or infected, it becomes irritated and swollen, causing significant pain. This condition is known as pleurisy, or pleuritis.
Pleurisy has a grim fame. It caused the death of a number of historical figures, including Catherine de Medici and Benjamin Franklin.
Pleurisy is no longer a common condition. Over the years, antibiotics have been extremely successful in treating and preventing the bacterial infections that historically were the main causes of pleurisy. Nowadays, most cases of pleurisy are the result of a viral infection and deaths from this illness are quite rare.
Viral infections are the most common cause of pleurisy. Viruses can cause infections in the lungs, which can lead to pleurisy.
Other causes of pleurisy include:
- bacterial pneumonia
- chest wounds
- rib fractures
- blunt trauma to the chest wall
- chest or lung tumors
- blood clots in the arteries of your lung, or pulmonary emboli
- immune system disorders, such as systemic lupus and rheumatoid arthritis
- sickle cell anemia, an inherited condition that causes irregularly shaped, hard, and sticky red blood cells that interfere with blood and oxygen flow
- pancreatitis, a condition in which the pancreas is inflamed
- heart surgery complications
- lung cancer
- mesothelioma, which is a cancer caused by asbestos exposure
- fungal or parasitic infections
The chief symptom associated with pleurisy is a sharp, stabbing pain when you breathe in or out. This pain might go away when you hold your breath or put pressure on the painful area. However, it will definitely get worse when you sneeze, cough, or move. Fever, chills, and loss of appetite are possible symptoms, depending on the condition that’s causing the pleurisy.
Additional symptoms of pleurisy include:
- pain on one side of your chest
- pain in your shoulders and back
- shallow breathing to avoid feeling pain
- joint pain
- muscle aches
- shortness of breath
Pleurisy can be accompanied by a fluid buildup that puts pressure on the lungs and causes them to stop working properly. This fluid accumulation is called a pleural effusion. This fluid may initially act like a cushion, causing the chest pain to disappear. Eventually, an individual with a pleural effusion will experience shortness of breath as the fluid increases. They may also experience fever, chills, and a dry cough. These symptoms can indicate a fluid infection, also called an empyema.
The first priority in diagnosing pleurisy is to figure out the location and cause of the inflammation or swelling. Your doctor will want to do a physical exam and record your medical history. Your doctor may prescribe one or more of the following tests as well.
Chest X-rays will allow your doctor to see if there’s any inflammation in the lungs. They may also order a decubitus chest X-ray, which is an X-ray taken while you are lying on your side. This allows free fluid to form a layer. A decubitus chest X-ray should confirm if there’s any fluid buildup.
Blood tests can help to determine if you have an infection and the cause of your infection if you do have one. In addition, blood tests will reveal whether you have an immune system disorder.
During thoracentesis, your doctor will insert a needle into the area of your chest where imaging tests detect fluid. Then, they’ll remove the fluid and analyze it for the presence of infections. Due to its invasive nature and associated risks, this test is rarely done for the typical case of pleurisy.
To further research any abnormalities found on chest X-rays, your doctor may want to take a series of detailed, cross-sectional images of your chest using a CT scan. The images produced by the CT scan create a detailed picture of the inside of your chest. This allows your doctor to get a closer look at the irritated tissue.
In an ultrasound, high-frequency sound waves create an image of the inner portion of your chest cavity. This will allow your doctor to see if there’s any inflammation or fluid buildup.
A biopsy is useful if cancer is a possible cause of your pleurisy. Your doctor will use sterile procedures and make small incisions in the skin of your chest wall. An X-ray or CT scan can confirm the exact biopsy site. Your doctor can use these imaging procedures to guide the lung biopsy needle between your ribs and into your lung. Your doctor will take a small sample of lung tissue and then remove the needle.
This tissue will then be sent to the laboratory to be analyzed for infection and to look for abnormal cells consistent with cancer.
During a thoracoscopy, your doctor will make a small incision in your chest wall and then insert a tiny camera attached to a tube into your chest cavity. They’ll use the camera to locate the irritated area, and they’ll then collect a tissue sample for analysis.
Once your doctor identifies the source of inflammation or infection, they’ll be able to determine the correct treatment. Getting adequate rest to assist your body with the healing process is an important part of getting well. In addition, lying on the side that has pain may provide just enough pressure to make the pain go away.
Other methods of treatment include:
- antibiotics for bacterial infection
- over-the-counter medicines, including aspirin, ibuprofen, or other non-steroidal anti-inflammatory drugs
- prescription pain and cough medication that may contain codeine
- medications to break up any blood clots or large collections of pus and mucus, which are then drained out via a tube
- bronchodilators via metered dose inhaler devices, such as those used to treat asthma
Individuals with large amounts of fluid in their lungs (pleural effusions) might have to stay in the hospital with a drain tube in the chest until fluids drain adequately.
Pleurisy can have severe long-term implications, but seeking medical treatment and adhering to your course of treatment can have wonderful results. You and your doctor should identify any underlying causes of your pleurisy to help you recover.