Pleurisy (Pleuritis)

How pleurisy causes pain

The visceral pleura covers the lung, and the parietal pleura lines the chest wall, with a thin layer of fluid between them. The parietal pleura is rich in pain nerves. When inflamed, the roughened surfaces rub with each breath, causing sharp pain. Sometimes fluid builds up between the layers, a pleural effusion, which may reduce pain but cause breathlessness.

Symptoms

• sharp chest pain, often on one side, worse with breathing in, coughing, sneezing, laughing or moving
• pain may spread to the shoulder or back, especially if the diaphragm's pleura is involved
• shallow breathing to avoid pain
• shortness of breath
• dry cough
• fever and chills if infection is the cause
• a grating sound heard through a stethoscope (pleural friction rub)

Causes

Pleurisy vs other chest pain

Heart pain is usually pressure-like and not affected by breathing. Pericarditis causes sharp pain that is worse lying flat and better leaning forward. Muscle strain is tender to press. Because dangerous conditions can cause pleuritic pain, new chest pain should be assessed.

Diagnosis

• examination, including listening for a friction rub and checking oxygen levels
• chest X-ray: pneumonia, effusion, pneumothorax
• ultrasound: detects small effusions and guides drainage
• CT scan, including CT pulmonary angiogram for suspected blood clots
• blood tests: inflammation markers, D-dimer, autoimmune tests, white cell count
• ECG to rule out heart causes
• pleural fluid analysis if there is an effusion

Treatment

Pain relief

• NSAIDs such as ibuprofen or indomethacin are the main treatment for inflammatory pleurisy. Follow the label or prescription dose, and check with a doctor if you have kidney, stomach or heart problems
• acetaminophen (paracetamol) as an alternative
• stronger painkillers for short periods if pain prevents breathing deeply

Treating the cause

• antibiotics for pneumonia
• anticoagulants for pulmonary embolism
• drainage of large effusions or infected fluid (empyema)
• steroids or immunosuppressants for autoimmune disease
• treatment for tuberculosis or cancer

Self-care

• rest and lying on the painful side, which may splint the chest
• holding a pillow against the chest when coughing
• taking a few deep breaths every hour once pain allows, to prevent lung collapse and infection

Outlook

Viral pleurisy usually resolves within 1 to 2 weeks without lasting effects. The outlook for other causes depends on the underlying condition. Untreated effusions or infections can lead to scarring of the pleura.

Frequently asked questions

What does pleurisy feel like?

Pleurisy causes a sharp, stabbing chest pain that worsens when you breathe in, cough, sneeze or move. It is usually on one side and may spread to the shoulder. Many people take shallow breaths to avoid the pain.

What causes pleurisy?

The most common cause is a viral infection. Other causes include pneumonia, blood clots in the lungs, autoimmune diseases such as lupus and rheumatoid arthritis, tuberculosis, chest injuries, collapsed lung and cancer.

How long does pleurisy last?

Viral pleurisy usually improves within a few days and resolves within 1 to 2 weeks. Pleurisy from pneumonia, blood clots or autoimmune disease lasts until the cause is treated. See a doctor if pain lasts longer or worsens.

Is pleurisy serious?

Pleurisy from a virus is usually not serious. However, the same type of pain can come from a blood clot in the lung, pneumonia or a collapsed lung, which are serious. New sharp chest pain with breathlessness should be assessed urgently.

What helps pleurisy pain?

NSAIDs such as ibuprofen are usually the most effective. Resting, lying on the painful side and holding a pillow against the chest when coughing can ease pain. Treating the underlying cause is essential.