Pleuritis (Pleurisy)
Inflammation of the lung lining causing sharp pain when breathing
Quick Facts
- Type: Respiratory condition
- Affected area: Pleura (lining of the lungs and chest wall)
- Hallmark symptom: Sharp chest pain worse with breathing
- Common causes: Viral infection, pneumonia, inflammation
Overview
Pleuritis, commonly called pleurisy, is inflammation of the pleura, the two thin layers of tissue that line the lungs and the inside of the chest wall. Normally a small amount of fluid lets these layers glide smoothly as you breathe. When they become inflamed, they rub against each other, causing the sharp, stabbing chest pain that defines the condition.
Pleuritis is a symptom of an underlying problem rather than a disease on its own. It can be caused by infections, inflammation, or other lung and chest conditions. Sometimes inflammation is accompanied by fluid building up between the layers, called a pleural effusion. Treatment focuses on relieving pain and addressing the cause.
The sharp, breathing-related pain of pleuritis happens because the inflamed surfaces, which normally slide smoothly past each other, instead rub together with each breath. This is why the pain typically worsens with deep breaths, coughing, or sneezing and eases when breathing is shallow. Because the same kind of pain can come from a wide range of conditions, finding and treating the underlying cause is the most important part of care.
Symptoms
The main symptom is a distinctive chest pain:
- Sharp or stabbing chest pain that worsens with breathing in, coughing, or sneezing
- Pain that may improve when you hold your breath or press on the area
- Pain that can spread to the shoulder or back
- Shortness of breath, partly from taking shallow breaths to avoid pain
- Cough or fever, depending on the cause
Severe shortness of breath, coughing up blood, or sudden severe chest pain should be evaluated urgently, as they can signal a serious cause. Because people often breathe shallowly to limit the pain, they may not realize how much their breathing has changed. Taking note of any fever, cough, or leg swelling alongside the chest pain can help a doctor work out the cause more quickly.
Causes
Many conditions can inflame the pleura. Common causes include:
- Viral infections: A frequent cause, often after a cold or flu-like illness.
- Pneumonia and other lung infections: Including bacterial infections and tuberculosis.
- Pulmonary embolism: A blood clot in the lung, which can cause pleuritic pain and is an emergency.
- Autoimmune diseases: Such as lupus and rheumatoid arthritis.
- Chest injury or rib fracture.
- Other causes: Including certain medications and, less often, cancer.
Risk Factors
- Recent viral or respiratory infection
- Pneumonia or other lung infections
- Autoimmune or inflammatory conditions
- Risk factors for blood clots, such as recent surgery or long immobility
- Chest injury
- Smoking and chronic lung disease
Diagnosis
Because pleuritis has many causes, evaluation aims to find the source:
- Physical exam: Listening to the chest, where a rubbing sound (friction rub) may be heard.
- Chest X-ray: To look for pneumonia, fluid, or other lung problems.
- Blood tests: To check for infection or inflammation.
- CT scan or ultrasound: For more detail or to assess fluid.
- Tests for specific causes: Such as those for blood clots when an embolism is suspected.
Treatment
Treatment targets both the pain and the underlying cause:
- Pain relief: Anti-inflammatory medicines (NSAIDs) often help relieve pleuritic pain.
- Treating the cause: Antibiotics for bacterial infections, treatment for blood clots, or therapy for autoimmune disease as needed.
- Draining fluid: If a significant pleural effusion is present, fluid may be removed.
- Rest and breathing: Controlling pain allows deeper breathing, which helps prevent complications.
Many cases caused by viral infection improve on their own as the infection clears, with treatment focused on comfort.
Prevention
Pleuritis itself cannot always be prevented, but you can reduce risk by:
- Getting recommended vaccinations, such as flu and pneumonia vaccines
- Treating respiratory infections promptly
- Not smoking
- Managing autoimmune conditions with your doctor
- Seeking care early for chest pain or breathing problems
When to See a Doctor
See a doctor for unexplained chest pain that worsens with breathing, especially with fever or cough. Seek emergency care right away if you have:
- Sudden, severe shortness of breath
- Severe or crushing chest pain
- Coughing up blood
- Fainting, a rapid heartbeat, or pain with leg swelling, which can suggest a blood clot in the lung
Frequently Asked Questions
What does pleurisy pain feel like?
Pleurisy typically causes a sharp or stabbing chest pain that gets worse when you breathe in, cough, or sneeze, and often eases when you hold your breath. The pain may spread to the shoulder or back and can make breathing feel shallow.
Is pleuritis contagious?
Pleuritis itself is not contagious, but some of its causes, such as viral infections, pneumonia, or tuberculosis, can be spread to others. Whether you are contagious depends on the underlying cause.
How long does pleurisy last?
When caused by a viral infection, pleurisy often improves within a few days to a couple of weeks as the infection clears. Cases caused by other conditions last as long as the underlying problem takes to treat.
Can pleurisy be serious?
It depends on the cause. Many cases are mild and resolve on their own, but pleuritic pain can also be a sign of a serious problem such as a blood clot in the lung. Sudden severe shortness of breath, coughing up blood, or severe chest pain need emergency care.
How is pleurisy treated?
Treatment usually combines anti-inflammatory medicines to relieve pain with treatment of the underlying cause, such as antibiotics for a bacterial infection. If significant fluid has built up around the lung, it may need to be drained.
References
- Mayo Clinic. Pleurisy — Symptoms and causes.
- National Heart, Lung, and Blood Institute (NHLBI). Pleurisy and Other Pleural Disorders.
- MedlinePlus, U.S. National Library of Medicine. Pleurisy.
- American Lung Association. Pleurisy and Pleural Effusion.