Pleurisy

Overview

Pleurisy is inflammation of the pleura, the two thin layers of tissue that line the lungs and the inside of the chest wall. Normally these layers glide smoothly over each other as you breathe, lubricated by a small amount of fluid. When they become inflamed, they rub against each other, producing a characteristic sharp, stabbing chest pain that worsens with breathing, coughing, or sneezing.

Pleurisy is a sign that something is irritating the lung lining rather than a disease in itself, and it has many possible causes, the most common being a viral infection. While many cases settle as the underlying cause is treated, chest pain and breathlessness always deserve careful evaluation because some causes are serious. Sometimes fluid builds up between the layers, called a pleural effusion.

Symptoms

The main symptom of pleurisy is chest pain with these features:

• Sharp, stabbing chest pain that worsens when breathing in, coughing, or sneezing
• Pain that may ease when holding the breath or pressing on the area
• Pain that can spread to the shoulder or back
• Shallow breathing to avoid the pain
• Sometimes shortness of breath, cough, or fever, depending on the cause

Because chest pain and breathlessness can also be caused by serious conditions such as a heart problem or a blood clot in the lung, sudden severe chest pain, significant breathlessness, or coughing up blood should be treated as an emergency.

Causes

Pleurisy results from inflammation of the lung lining, which can have many causes:

• Viral infections: The most common cause, including infections such as the flu.
• Pneumonia and other lung infections: Bacterial or other infections of the lung.
• Blood clot in the lung (pulmonary embolism): A serious cause that needs urgent treatment.
• Autoimmune conditions: Such as lupus or rheumatoid arthritis.
• Chest injury: Rib fractures or trauma.
• Other causes: Including certain medications and, less commonly, other lung conditions.

Finding the underlying cause is central to treating pleurisy effectively and safely.

Risk Factors

• Recent viral or other respiratory infection
• Pneumonia or other lung conditions
• Autoimmune diseases such as lupus or rheumatoid arthritis
• Conditions that raise the risk of blood clots
• Recent chest injury or surgery

Diagnosis

Diagnosis focuses on confirming pleurisy and finding its cause:

• History and examination: Describing the pain and listening to the chest, where a doctor may hear a rubbing sound.
• Chest X-ray: To look for pneumonia, fluid, or other lung problems.
• Blood tests: To check for infection or inflammation.
• Further imaging: A CT scan or ultrasound to look for fluid, clots, or other causes.
• Heart tests: An ECG and other tests may be done to rule out heart-related chest pain.

Treatment

Treatment targets both the symptoms and the underlying cause:

• Treating the cause: Antibiotics for a bacterial infection, clot-dissolving or blood-thinning treatment for a pulmonary embolism, or treatment of an autoimmune condition.
• Pain relief: Anti-inflammatory or other pain medicines to ease the chest pain.
• Rest and breathing comfort: Finding positions that ease breathing while recovering.
• Draining fluid: If a large pleural effusion develops, fluid may be drained with a needle or tube.

Viral pleurisy often improves on its own with supportive care, but any serious underlying cause must be treated promptly.

Prevention

Pleurisy itself cannot always be prevented, but you can reduce some risks:

• Stay up to date with recommended vaccinations, such as flu and pneumonia vaccines where advised
• Treat respiratory infections promptly and follow medical advice
• Manage autoimmune conditions with your doctor
• Seek care for chest injuries and follow guidance to prevent blood clots after surgery or long periods of immobility

When to See a Doctor

See a doctor for sharp chest pain that worsens with breathing, especially with fever, cough, or breathlessness. Seek emergency care immediately if you have:

• Sudden, severe, or crushing chest pain
• Significant or worsening shortness of breath
• Coughing up blood
• Fainting, a fast heartbeat, or bluish lips

These can signal a serious condition such as a heart attack or a blood clot in the lung. When in doubt about chest pain, call emergency services.

Related Topics

Frequently Asked Questions

References

1. Mayo Clinic. Pleurisy.
2. MedlinePlus, U.S. National Library of Medicine. Pleurisy.
3. National Heart, Lung, and Blood Institute (NHLBI). Pleural Disorders.
4. National Health Service (NHS). Pleurisy.