Pleuritis (Pleurisy)

What happens in pleuritis

The pleura has two layers: one covering the lungs and one lining the chest wall. A small amount of fluid between them lets them glide as you breathe. When inflamed, the surfaces become rough and rub against each other. The outer layer has pain nerves, so each breath causes sharp pain. Sometimes fluid builds up between the layers (pleural effusion), which may reduce the pain but cause breathlessness.

Symptoms

• sharp, stabbing chest pain that worsens on breathing in, coughing, sneezing, laughing or moving
• pain that eases when holding the breath or pressing on the painful side
• pain that may spread to the shoulder (from irritation of the diaphragm) or back
• shallow, rapid breathing to avoid pain
• shortness of breath, especially with effusion
• cough, fever and chills depending on the cause

A doctor may hear a pleural friction rub, a creaking sound like walking on fresh snow, with a stethoscope.

Causes

Conditions that mimic pleuritis

• pericarditis: sharp chest pain that eases when leaning forward
• costochondritis: tender rib cartilage, pain reproduced by pressing
• muscle strain, shingles before the rash, and heart attack

Diagnosis

The priority is ruling out life-threatening causes.

• history and examination, including listening for a friction rub and checking oxygen levels
• chest X-ray: pneumonia, effusion, pneumothorax or masses
• blood tests: blood count, inflammatory markers, D-dimer if a clot is possible, and autoimmune tests such as ANA
• CT pulmonary angiography if pulmonary embolism is suspected
• ultrasound to detect small effusions and guide drainage
• ECG to check for heart problems
• thoracentesis: removing and testing fluid from an effusion

Treatment

Treating the cause

• viral: usually settles on its own within 1 to 2 weeks
• bacterial pneumonia: antibiotics. Infected fluid (empyema) needs drainage
• pulmonary embolism: blood thinners
• autoimmune: treatment of the underlying disease, sometimes steroids
• pneumothorax: observation, needle aspiration or a chest tube

Pain relief

• NSAIDs such as ibuprofen or indomethacin reduce pain and inflammation. Follow the label dose and avoid them with kidney disease, stomach ulcers or blood thinners unless your doctor agrees
• acetaminophen (paracetamol) as an alternative
• lying on the painful side can splint the chest and ease pain
• a pillow held against the chest when coughing

Avoid strong cough suppressants unless advised, because coughing helps clear the lungs. Take a few slow deep breaths regularly to prevent lung collapse and infection.

Outlook

Viral pleurisy usually improves within days to 2 weeks. Recovery from other causes depends on the underlying condition. Large or infected effusions may leave some scarring of the pleura.

Frequently asked questions

What does pleurisy feel like?

Pleurisy causes a sharp, stabbing chest pain that gets worse when you breathe in, cough, sneeze or move. It often eases when you hold your breath. The pain may spread to your shoulder or back, and you may breathe shallowly to avoid it.

What causes pleuritis?

The most common cause is a viral infection. Others include pneumonia, pulmonary embolism, autoimmune diseases such as lupus, chest injury, collapsed lung, cancer and some medicines. Doctors check for serious causes first.

How long does pleurisy last?

Pleurisy caused by a virus usually improves within a few days to 2 weeks. Pleurisy from pneumonia, a blood clot or autoimmune disease lasts until the underlying cause is treated. See a doctor if pain lasts more than 2 weeks.

Is pleurisy serious?

Pleurisy itself is often mild, but it can be a sign of serious conditions such as pneumonia, a blood clot in the lung or a collapsed lung. Sudden chest pain with breathlessness, coughing blood or fainting needs emergency care.

How do you treat pleurisy at home?

Rest, take anti-inflammatory medicines such as ibuprofen if suitable, lie on the painful side for comfort, and hold a pillow against your chest when coughing. Take some deep breaths regularly. These measures help once a doctor has ruled out serious causes.