Pleurisy

Date Updated: 01/03/2020

Overview

Pleurisy (PLOOR-ih-see) is a condition in which the pleura — two large, thin layers of tissue that separate your lungs from your chest wall — becomes inflamed. Also called pleuritis, pleurisy causes sharp chest pain (pleuritic pain) that worsens during breathing.

One pleural layer of tissue wraps around the outside of the lungs. The other pleural layer lines the inner chest wall. Between these two layers is a small space (pleural space) that's usually filled with a very small amount of liquid. Normally, these layers act like two pieces of smooth satin gliding past each other, allowing your lungs to expand and contract when you breathe.

If you have pleurisy, these tissues swell and become inflamed. As a result, the two layers of the pleural membrane rub against each other like two pieces of sandpaper, producing pain when you inhale and exhale. The pleuritic pain lessens or stops when you hold your breath.

Treatment of pleurisy involves pain control and treating the underlying condition.

Symptoms

Signs and symptoms of pleurisy might include:

Chest pain that worsens when you breathe, cough or sneeze
Shortness of breath — because you are trying to minimize breathing in and out
A cough — only in some cases
A fever — only in some cases

Pain caused by pleurisy might worsen with movement of your upper body and can radiate to your shoulders or back.

Pleurisy can be accompanied by pleural effusion, atelectasis or empyema:

Pleural effusion. In some cases of pleurisy, fluid builds up in the small space between the two layers of tissue. This is called pleural effusion. When there is a fair amount of fluid, pleuritic pain lessens or disappears because the two layers of pleura are no longer in contact and don't rub together.
Atelectasis. A large amount of fluid in the pleural space can create pressure, compressing your lung to the point that it partially or completely collapses (atelectasis). This makes breathing difficult and might cause coughing.
Empyema. The extra fluid can also become infected, resulting in an accumulation of pus. This is called an empyema. An empyema is often accompanied by fever.

When to see a doctor

Call your doctor right away if you experience unexplained, intense chest pain during breathing. You might have a problem with your lungs, heart or pleura or an underlying illness for which you need prompt medical care.

Causes

A variety of underlying conditions can cause pleurisy. Causes include:

Viral infection, such as the flu (influenza)
Bacterial infection, such as pneumonia
Fungal infection
Autoimmune disorder, such as rheumatoid arthritis or lupus
Lung cancer near the pleural surface
Pulmonary embolism
Tuberculosis (TB)
Rib fracture or trauma
Certain inherited diseases, such as sickle cell disease
Certain medications

Diagnosis

Your doctor will start by asking about your medical history and doing a physical exam, including examining your chest with a stethoscope.

To determine if you have pleurisy and identify the cause, your doctor might recommend:

Blood tests. A blood test might tell your doctor if you have an infection. Other blood tests also might detect an autoimmune disorder, such as rheumatoid arthritis or lupus, in which the initial sign can be pleurisy.
Chest X-ray. A chest X-ray can show if your lungs are fully inflating or if there is air or fluid between the lungs and ribs.
Computerized tomography (CT) scan. A CT scan combines a series of X-ray images taken from different angles around your body and uses computer processing to create cross-sectional images that look like slices of your chest. These detailed images can show the condition of the pleura and if there are other causes of pain, such as a blood clot in the lung.
Ultrasound. This imaging method uses high-frequency sound waves to produce precise images of structures within your body. Your doctor might use ultrasound to determine whether you have a pleural effusion.
Electrocardiogram (ECG or EKG). Your doctor might recommend this heart-monitoring test to rule out certain heart problems as a cause for your chest pain.

Diagnostic procedures

In some cases, your doctor might remove fluid and tissue from the pleural space for testing. Procedures might include:

Thoracentesis. In this procedure, your doctor injects a local anesthetic between your ribs to the area where fluid was seen on your imaging studies. Next your doctor inserts a needle through your chest wall between your ribs to remove fluid for lab analysis and to help you breathe better. Your doctor might insert the needle with the help of ultrasound guidance.
Thoracoscopy. If TB or cancer is a suspected cause of your condition, your doctor might perform a thoracoscopy — also called a pleuroscopy — in which a tiny camera (thoracoscope) is inserted through a small incision in your chest wall. This procedure allows for a direct view inside your chest to look for any abnormalities or to get a tissue sample (biopsy).

Treatment

Treatment for pleurisy focuses primarily on the underlying cause. For example, if bacterial pneumonia is the cause, an antibiotic will be prescribed to manage the infection. If the cause is viral, pleurisy may resolve on its own.

The pain and inflammation associated with pleurisy is usually treated with nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others). Occasionally, your doctor may prescribe steroid medication.

The outcome of pleurisy treatment depends on the seriousness of the underlying disease. If the condition that caused pleurisy is diagnosed and treated early, a full recovery is typical.

Lifestyle and home remedies

The following steps might help relieve symptoms related to pleurisy:

Take medication. Take medication as recommended by your doctor to relieve pain and inflammation.
Get plenty of rest. Find the position that causes you the least discomfort when you rest. Even when you start to feel better, be careful not to overdo it.
Don't smoke. Smoking can cause more irritation to your lungs. If you smoke and can't quit on your own, ask your doctor for help.

Preparing for an appointment

You're likely to start by seeing your family doctor. However, when you call to set up your appointment, you might be urged to seek immediate medical care if you are experiencing severe, unexplained chest pain.

You may want to bring a family member or friend along, if possible, to help you remember questions to ask and what your doctor said.

Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

You can prepare a list that includes:

Details of your symptoms, including where your chest pain starts and how far it spreads, as well as other signs and symptoms, such as fever, shortness of breath or weight loss.
Key medical information, including recent hospitalizations and any medical conditions you have. Also note whether family members — especially children — or close friends have recently been sick.
Medications you're taking, including prescription and over-the-counter drugs, vitamins, herbs or other supplements, and the dosages.
Key personal information, including recent travel abroad and major life changes. Your doctor might also be interested in your work history, including possible environmental exposure to asbestos.
Questions for your doctor.

Questions to ask your doctor

Questions may include:

What do you think is the underlying cause of my symptoms?
What kinds of diagnostic tests or procedures do I need, if any?
What treatment approach do you recommend?
How soon after I begin treatment can I expect to feel better?
Are there self-care steps I can take to improve my discomfort?
Do you recommend that I stay home from work or school? For how long?
Will it help if I stop smoking?
Am I at risk of long-term complications from this condition?
I have other health conditions. How can I best manage them together?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Be ready to answer questions your doctor might ask:

How would you describe your symptoms?
What, if anything, seems to improve or worsen your symptoms?
Have you been diagnosed with or treated for any other health conditions?
Have you recently traveled?
Have you been involved in any work, projects or hobbies over the years that might have exposed you to asbestos?
Do or did you smoke? If so, how much and for how long?
Have you recently noticed swollen and tender joints or rashes?

Your doctor will ask additional questions based on your responses, symptoms and needs. Preparing and anticipating questions will help you make the most of your time with the doctor.