Pleurisy is an inflammation of the pleura, the lining of the
lungs, with subsequent pain
Information about Pleurisy
Pleurisy may develop in the presence of lung inflammation (for example, pneumonia,
tuberculosis), rheumatic diseases, chest trauma, certain cancers, and asbestos-related
disease. The main symptom is pain over the chest wall at the site of the inflammation. In
some circumstances, the pain may be felt in the shoulder.
The pain is increased by deep breathing, coughing, and chest movement. The normally smooth
pleural surfaces, now roughened by inflammation, rub together with each breath, and may
produce a rough, grating sound called a "friction rub". This can be heard with
the stethoscope or an ear held against the chest.
Fluid often accumulates at the site of pleural inflammation. A localized collection of
fluid separates the lung pleura from the chest wall pleura causing the chest pain to
disappear even though the illness may be worsening.
Large accumulations of fluid compromise breathing and may cause coughing, shortness of
breath with rapid breathing (tachypnea), cyanosis, and retractions.
Symptoms of Pleurisy
- Recent or present respiratory illness with its symptoms
- Localized chest pain on the chest wall
- Pain with each breath
- Worsened by coughing
- Worsened by deep breathing
Diagnosis of Pleurisy
Physical examination may show abnormal lung sounds:
- A friction rub -- a rough scratchy sound that accompanies inspiration and expiration
- Rales (may be present if there is an accompanying pneumonia)
- Rhonchi (may be present with accompanying pneumonia or bronchitic process)
- Decreased breath sounds (may be present if there is a collection of fluid around the
- CBC (may help differentiate bacterial versus viral infection)
- X-ray of the chest
- Ultrasound of the chest
- Thoracentesis (a collection of fluid from the pleural cavity)
Causes of Pleurisy
A variety of conditions can give rise to pleurisy. The following list represents the
most common sources of pleural inflammation.
- Infections, including pneumonia, tuberculosis, and other bacterial or viral respiratory
- Immune disorders, including systemic lupus erythematosus, rheumatoid arthritis, and
- Diseases, including cancer, pancreatitis, liver cirrhosis, and heart or kidney failure
- Injury, from a rib fracture, collapsed lung, esophagus rupture, blood clot, or material
such as asbestos
- Drug reactions, from certain drugs used to treat tuberculosis (isoniazid), cancer
(methotrexate, procarbazine), or the immune disorders mentioned above (hydralazine,
procainamide, phenytoin, quinidine).
The hallmark symptom of pleurisy is sudden, intense chest pain that is usually located
over the area of inflammation. Although the pain can be constant, it is usually most
severe when the lungs move during breathing, coughing, sneezing, or even talking. The pain
is usually described as shooting or stabbing, but in minor cases it resembles a mild
cramp. When pleurisy occurs in certain locations, such as near the diaphragm, the pain may
be felt in other areas such as the neck, shoulder, or abdomen (referred pain). Another
indication of pleurisy is that holding one's breath or exerting pressure against the chest
causes pain relief.
Pleurisy is also characterized by certain respiratory symptoms. In response to the
pain, pleurisy patients commonly have a rapid, shallow breathing pattern. Pleural effusion
can also cause shortness of breath, as excess fluid makes expanding the lungs difficult.
If severe breathing difficulties persist, patients may experience a blue colored
Additional symptoms of pleurisy are specific to the illness that triggers the
condition. Thus, if infection is the cause, then chills, fever, and fatigue will be likely
Diagnosis of Pleurisy
The distinctive pain of pleurisy is normally the first clue physicians use for
diagnosis. Doctors usually feel the chest to find the most painful area, which is the
likely site of inflammation. A stethoscope is also used to listen for abnormal chest
sounds as the patient breathes. If the doctor hears the characteristic friction rub, the
diagnosis of pleurisy can be confirmed. Sometimes, a friction rub is masked by the
presence of pleural effusion and further examination is needed for an accurate diagnosis.
Identifying the actual illness that causes pleurisy is more difficult. To make this
diagnosis, doctors must evaluate the patient's history, additional symptoms, and
laboratory test results. A chest x ray may also be taken to look for signs of accumulated
fluid and other abnormalities. Possible causes, such as pneumonia, fractured ribs,
esophagus rupture, and lung tumors may be detected on an x ray. Computed tomography scan
(CT scan) and ultrasound scans are more powerful diagnostic tools used to visualize the
chest cavity. Images from these techniques more clearly pinpoint the location of excess
fluid or other suspected problems.
The most helpful information in diagnosing the cause of pleurisy is a fluid analysis.
Once the doctor knows the precise location of fluid accumulation, a sample is removed
using a procedure called thoracentesis. In this technique, a fine needle is inserted into
the chest to reach the pleural space and extract fluid. The fluid's appearance and
composition is thoroughly examined to help doctors understand how the fluid was produced.
Several laboratory tests are performed to analyze the chemical components of the fluid.
These tests also determine whether infection-causing bacteria or viruses are present. In
addition, cells within the fluid are identified and counted. Cancerous cells can also be
detected to learn whether the pleurisy is caused by a malignancy.
In certain instances, such as dry pleurisy, or when a fluid analysis is not
informative, a biopsy of the pleura may be needed for microscopic analysis. A sample of
pleural tissue can be obtained several ways: with a biopsy needle, by making a small
incision in the chest wall, or by using a thoracoscope (a video-assisted instrument for
viewing the pleural space and collecting samples).
Treatment of Pleurisy
The pain of pleurisy is usually treated with analgesic and anti-inflammatory drugs,
such as acetaminophen, ibuprofen, and indomethacin. People suffering from pleurisy may
also receive relief from lying on the painful side. Sometimes, a painful cough will be
controlled with codeine-based cough syrups. However, as the pain eases, a person with
pleurisy should try to breathe deeply and cough to clear any congestion, otherwise
pneumonia may occur. Rest is also important to aid in the recovery process.
Treating the source of Pleurisy
The treatment used to cure pleurisy is ultimately defined by the underlying cause.
Thus, pleurisy from a bacterial infection can be successfully treated with antibiotics,
while no treatment is given for viral infections that must run their course. Specific
therapies designed for more chronic illnesses can often cause pleurisy to subside. For
example, tuberculosis pleurisy is treated with standard anti-tuberculosis drugs. With some
illnesses, excess fluid continues to accumulate and causes severe respiratory distress. In
these individuals, the fluid may be removed by thoracentesis, or the doctor may insert a
chest tube to drain large amounts. If left untreated, a more serious infection may develop
within the fluid, called empyema.
Alternative treatment of Pleurisy
Alternative treatments can be used in conjunction with conventional treatment to help
heal pleurisy. Acupuncture and botanical medicines are alternative approaches for
alleviating pleural pain and breathing problems. An herbal remedy commonly recommended is
pleurisy root (Asclepias tuberosa), so named because of its use by early American
settlers who learned of this medicinal plant from Native Americans. Pleurisy root helps to
ease pain, inflammation, and breathing difficulties brought on by pleurisy. This herb is
often used in conjunction with mullein (Verbascum thapsus) or elecampane (Inula
helenium), which serve as expectorants to clear excess mucus from the lungs. In
addition, there are many other respiratory herbs that are used as expectorants or for
other actions on the respiratory system. Herbs thought to combat infection, such as
echinacea (Echinacea spp.) are also included in herbal pleurisy remedies. Anitviral
herbs, such as Lomatium dissectum and Ligusticum porteri, can be used if the
pleurisy is of viral origin. Traditional Chinese medicine uses the herb ephedra (Ephedra
sinica), which acts to open air passages and alleviate respiratory difficulties in
pleurisy patients. Dietary recommendations include eating fresh fruits and vegetables,
adequate protein, and good quality fats (omega-3 fatty acids are anti-inflammatory and are
found in fish and flax oil). Taking certain nutritional supplements, especially large
doeses of vitamin C, may also provide health benefits to people with pleurisy. Contrast
hydrotherapy applied to the chest and back, along with compresses (cloths soaked in an
herbal solution) or poultices (crushed herbs applied directly to the skin) of respiratory
herbs, can assist in the healing process. Homeopathic treatment, guided by a trained
practitioner, can be effective in resolving pleurisy.
Prognosis of Pleurisy
Prompt diagnosis, followed by appropriate treatment, ensures a good recovery for most
pleurisy patients. Generally speaking, the prognosis for pleurisy is linked to the
seriousness of its cause. Therefore, the outcome of pleurisy caused by a disease such as
cancer will vary depending on the type and location of the tumor.
Prevention of Pleurisy
Preventing pleurisy is often a matter of providing early medical attention to
conditions that can cause pleural inflammation. Along this line, appropriate antibiotic
treatment of bacterial respiratory infections may successfully prevent some cases of
pleurisy. Maintaining a healthy lifestyle and avoiding exposure to harmful substances (for
example, asbestos) are more general preventative measures.