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Pleurisy

What is the pleura?

The pleura is a thin membrane with two layers, with one layer lining the inside of the chest wall and the other covering the lungs.

The cavity between the two layers is known as the pleural cavity.  The pleural cavity contains a tiny amount of fluid, which helps the lungs and chest wall to move smoothly when breathing.

What is pleurisy?

Pleurisy is a condition whereby the pleura becomes inflamed.

Pleurisy, and other problems that affect the pleura, can cause a ‘pleuritic’ chest pain, generally a sharp stabbing pain.

Pleuritic chest pain can be experienced anywhere in the chest depending on the site of the inflamed pleura.  Breathing and coughing can exacerbate the pain as it causes the two parts of the inflamed pleura to rub over each other.

Pleurisy is very often associated with pleural effusions.  Pleural effusions can be an indicator of cancers such as mesothelioma or asbestos related lung cancer.

What causes pleurisy?

The most common cause of pleurisy is a viral infection, which can cause some inflammation in parts of the pleura.  With ‘viral pleurisy’ the patient is not usually very ill but they may also suffer from a cough, cold, fever or flu-like symptoms.  The pleuritic pain suffered can be quite severe, however, it typically only last a few days until the virus clears and the inflammation subsides.

Whist a viral infection is the most common cause of pleurisy there are other causes, to include;

  • Lung infections, such as pneumonia and tuberculosis
  • Mesothelioma – an asbestos related cancer
  • Diseases such as lupus, rheumatoid arthritis, cancer, liver diseases and pulmonary embolism
  • Chest injuries
  • Drug reactions

What are the symptoms?

The symptoms of pleurisy can include;

  • Severe fleeting, sharp pain in chest, often only on one side when breathing deeply, coughing, moving or sneezing
  • Severe chest pain that goes away when holding breath
  • Pleurisy can result in pain in different parts of the body such as the neck, shoulder and abdomen
  • Pain can cause rapid, shallow breathing

How is pleurisy diagnosed?

If any of the above symptoms are experienced, especially alongside a fever, the patient should report to their GP.  The GP will listen to their chest with a stethoscope, if the 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 inhalation and the beginning of exhalation.

The GP may order chest x-rays, although pleurisy without fluid will show as a normal x-ray.  In some instances a CT scan and ultrasound scan may be used to gain a better visual on the pleural space.

How is pleurisy treated?

Before pleurisy can be treated the underlying cause needs to be identified. GP’s may administer antibiotics, for an infection as well as prescribe anti-inflammatory drugs or pain medication.

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