What Is Pleurisy?

Pleurisy, also called pleuritis, is an inflammation of the pleura, which is the moist, double-layered membrane that surrounds the lungs and lines the rib cage. The condition can make breathing extremely painful. Sometimes it is associated with another condition called pleural effusion, where excess fluid fills the area between the membrane's layers.

The double-layered pleura protects and lubricates the surface of the lungs as they inflate and deflate within the rib cage. Normally, a thin, fluid-filled gap -- the pleural space -- allows the two layers of the pleural membrane to slide gently past each other. But when these layers become inflamed, with every breath, sneeze, or cough their roughened surfaces rub painfully together like two pieces of sandpaper.

In some cases of pleurisy, excess fluid seeps into the pleural space, resulting in pleural effusion. This fluid buildup usually has a lubricating effect, relieving the pain associated with pleurisy as it reduces friction between the membrane's layers. But at the same time, the added fluid puts pressure on the lungs, reducing their ability to move freely. A large amount of fluid may cause shortness of breath. In some cases of pleural effusion, this excess liquid can become infected.

What Causes Pleursy?

Viral infection is probably the most common cause of pleurisy. Other causes include the following:

• Lung infections, such as pneumonia and tuberculosis
• Other diseases such as systemic lupus erythematosus (lupus), rheumatoid arthritis, cancer, liver and pulmonary embolism
• Chest injuries
• Drug reactions

Pleurisy and pleural effusion are generally only as serious as the underlying disease causing it. If you have either of these conditions, you may already be undergoing treatment for the underlying disease; if not, seek medical attention immediately.

A pleural effusion can occur without pleurisy Kidney disease, heart failure, and liver disease can cause pleural effusion without inflammation or pain.

Symptoms

What Are the Symptoms of Pleurisy?

Symptoms of pleurisy include the following:

• Severe, fleeting, sharp, pain in your chest, often on one side only, when breathing deeply, coughing, moving, sneezing or even talking.
• Severe chest pain that goes away when you hold your breath.
• When pleurisy occurs in certain locations of the lungs, the pain can be felt in other parts of the body such as the neck, shoulder or abdomen.
• Rapid, shallow breathing in response to the pain.

Call your doctor if you have even a slight fever with these other symptoms. Fever could be a sign of a lung infection.

What Are the Symptoms of Pleural Effusion?

The symptoms of pleural effusion include:

• Shortness of breath
• A dry cough

Call Your Doctor If:

• You are experiencing pleurisy symptoms, particularly if you have not been diagnosed for an underlying disease that could be causing this lung condition; pleurisy and pleural effusion can be symptoms of such serious diseases as pneumonia and lung cancer.

• You experience symptoms accompanied by fever, no matter how slight. You may have a type of infection that requires treatment with antibiotics.

How Do I Know If I Have Pleurisy?

Oftentimes, the distinctive pain caused by pleurisy is an important clue to your doctor. In addition, your doctor will listen to your chest with a stethoscope as you breathe. If this examination reveals pleural friction rub -- the abrasive sound of the pleura's two layers sliding against each other -- the diagnosis is clear.

Pleural friction rub produces a scraping, raspy sound that occurs at the end of your inhalation and the beginning of your exhalation. It comes from the area directly over the pleural inflammation. A decrease in breath sounds and a change in their quality may allow your doctor to diagnose a pleural effusion.

Your doctor may also take X-rays of your chest. These X-rays will be normal if you have only pleurisy without fluid, but will show fluid of a pleural effusion. CT scans and ultrasound scans may also be used to better visualize the chest cavity.

If there is fluid present, your doctor may draw a sample of pleural fluid for analysis. Your doctor will determine the exact location of the fluid. Then, after injecting your back or chest with a local anesthetic, your doctor will use a syringe to extract the fluid in a procedure called thoracentesis. This may be done with guidance from an ultrasound test. The doctor will run tests on the sample to determine the underlying cause of the fluid buildup.

Occasionally, your doctor may request a biopsy of the pleura to better analyze the tissue and determine the cause of the pleurisy. A sample of pleural tissue can be obtained several ways:

• With a biopsy needle
• By making a small incision in the chest wall
• By using a thoracoscope (a video-assisted instrument for viewing the chest cavity and collecting samples)

What Are the Treatments for Pleursy?

Once the underlying cause of your pleurisy is identified, your doctor will take steps to treat it. Your doctor may administer antibiotics for an infection. In addition to this, your doctor may prescribe anti-inflammatory drugs or pain medicines, such as aspirin, to remedy the inflammation. Sometimes, a codeine-based cough syrup will be prescribed to control a painful cough.

In the case of pleural effusion, your doctor will direct treatment towards the underlying cause of the fluid. If the pleural fluid is infected or the amount is excessive, the doctor may drain it through a tube inserted in your chest, a procedure that requires hospitalization.

How Can I Prevent Pleursy?

While the condition probably can't be prevented, it could indicate a larger underlying problem like infection or lupus that your doctor should know about right away.