Definition, Causes and Epidemiology of Pleurisy (Pleuritis, Pleurodynia)

Introduction and Definition

• The pleura are a two-layered sac that holds the lungs and separates them from the chest

wall, diaphragm, and heart.

• The pleura that line the inside of the chest is called the parietal pleura and that covering

the lungs are called the visceral pleura.

• If you are healthy, the pleura are separated by a thin layer of fluid.

• This lets the lungs expand and contract easily during breathing.

• Pleurisy results from an inflammation of this sac.

• The inflammation that occurs with pleurisy can cause pain with breathing and may even

cause a large amount of fluid to collect in the pleural sac.

• Pleurisy can go away on its own or worsen so that fluid has to be drained from around the

lungs.

• Some people develop scar tissue called adhesions after they have pleurisy. They then

have chronic pain or shortness of breath.

Types of Pleurisy

• There are two types of pleurisy, dry and wet pleurisy.

• In dry pleurisy, the more common condition, the inflamed pleurae rub directly against

each other.

• In wet pleurisy, fluid oozes from the inflamed tissue into the space between the lungs and

the chest wall. This fluid may compress the lungs, making breathing difficult.

• Both types of pleurisy often occur as complications of respiratory tract infections, such as

pneumonia, viral infections, and tuberculosis, and are more likely to develop in persons

who are highly susceptible to such infections.

Causes of Pleurisy

There are many causes of pleurisy, these include:

• Infectious disease caused by virus, bacteria, fungus, tuberculosis, or parasites

• Cancer such as mesothelioma or spread from other areas

• Collagen vascular disease such as lupus erythematosus, rheumatoid arthritis, sarcoid

disease, or scleroderma

• Trauma from bruised or broken ribs

• Gastrointestinal disease, for example, pancreatitis, peritonitis, or a collection of pus under

the diaphragm

• Reaction to drugs such as methotrexate and penicillin

Other Causes

• Uremia

• Blood clot in lung

• Radiation therapy

• Sickle cell disease

• Chemotherapy drugs

• Asbestos

• HIV

Clinical Features of Pleurisy

Chest Pain

• This is the most common symptom.

• The pain is generally a sharp, stabbing pain, but may also be a dull ache or a burning

sensation.

• It is usually worse when you take a deep breath, cough, or move around.

• The pain is usually better if you take shallow breaths or lie on the side that hurts.

• Chest pain is what usually causes people with pleurisy to seek medical attention.

Cough

• Patient may get a cough, depending on the cause of pleurisy.

• Cough maybe dry or productive of sputum or blood.

Shortness of Breath

• The shortness of breath associated with pleurisy may be due to the underlying cause, such

as a blood clot in the lungs or pneumonia, or it may be due to the chest pain caused by

breathing.

Fever

• Patient may also get a fever, depending on the cause of pleurisy.

Signs of Pleurisy

• Low-pitched grating sound (pleural rub) that occurs with each breath in a case of dry

pleurisy.

• The skin near the affected area is often found to be tender.

• Usually findings reflect the underlying cause e.g. emphysema, pneumonia,

Pneumothorax, a collapsed lung etc.

Management of Pleurisy

• Refer patients with pleurisy to the higher level (hospital) for diagnosis and treatment but

make sure a patient is given pre referral treatment.

Diagnosis

• Pleurisy is frequently diagnosed only when other more serious causes have been ruled out

• Diagnostic pleural tap

• A tuberculin test may be done to learn whether tuberculosis is a factor

• Chest X-ray to detect the presence of pleural fluid

• Electrocardiogram (ECG)

Treatment

• Treat the underlying infection or disease, often with antibiotics.

• The symptoms of pleurisy can be relieved somewhat by resting.

• Strapping the chest firmly with an adhesive elastic bandage is sometimes recommended.

However, it may prevent deep breathing and coughing up of mucus, both of which are

necessary to clear the respiratory tract.

• Anti-inflammatory medications and even cortisone drugs are very effective in relieving

the inflammation and pain, particularly in dry pleurisy.

• Anti-inflammatory drugs, such as ibuprofen or aspirin, to reduce the pain and

inflammation.

• Patient may have less pain if lie on the side that hurts.

• Patient should avoid exerting herself/himself or doing anything that would cause him/her

to breathe hard.

• If there is huge pleural effusion, it may need to be drained.

Prevention

• Most pleurisy is caused by infection and is unavoidable. You can avoid severely pleuritic

chest pain by early diagnosis and treatment with anti-inflammatory drugs.

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