Pleural effusion is when excess fluid builds up in the pleural space of the lungs. The lungs are…
What is pleurisy?
Pleurisy is inflammation of the thin membranes (pleura) that line the lungs and chest wall. These double-layered membranes lubricate and protect the lungs as they expand and contract inside the ribcage. If you have pleurisy, the pleural membranes become rough and rub together, causing sharp, stabbing pains in the chest.
In most cases, pleurisy occurs when a viral or bacterial infection of the airways spreads to the lining of the lungs. Less commonly, pleurisy may be caused by another medical condition or lung problem.
Pleurisy is also sometimes referred to as pleuritis or pleuritic chest pain.
The lungs are surrounded by a thin membrane, known as the visceral pleura. A second, outer membrane, known as the parietal pleura, lines the inside of the chest cavity and attaches to the ribcage. The narrow pleural space between the two membranes contains about four teaspoons of fluid. This fluid allows the two layers to glide smoothly across one another as the lungs expand and contract during breathing.
Pleurisy occurs when the pleural membranes become inflamed, usually due to an infection of the airways with viruses or bacteria. During inflammation, the surfaces become rough and the fluid can get sticky. This causes the two membranes to rub together, causing pain in the chest.
Any type of infection can lead to pleurisy, but the most common cause is a virus that spreads from the airway to the lining of the lungs. Viruses known to cause pleurisy include cytomegalovirus, Epstein-Barr virus and those that also cause influenza and parainfluenza. Less commonly, pleurisy may be caused by a bacterial infection, such as the type that causes pneumonia or tuberculosis.
Viruses and bacteria irritate the pleural membranes in the same way they irritate the lining of the nose and airways during a common cold.
Any other factor that results in damage and inflammation to the lung surface or pleural membranes can cause pleurisy. Some examples include a chest injury, blood clot in a lung (pulmonary embolism), collapsed lung (pneumothorax) or lung cancer.
In most cases, pleurisy related to an underlying lung problem or medical condition will have an additional set of symptoms related to the cause.
The chances of developing pleurisy are increased by one or more of the following factors:
- Being prone to viral or bacterial infections;
- Exposure to asbestos;
- A chest injury, such as a rib fracture, and;
- An underlying lung condition.
Pleurisy can be described as 'wet' or 'dry', depending on whether a build-up of fluid occurs in the pleural space between the two pleural membranes.
In wet pleurisy, an abnormal volume of fluid collects in the pleural space. Sometimes the fluid is produced as part of the body's natural immune response to infection, or it may be due to poor drainage. The medical term for this build-up of fluid is pleural effusion.
Although a large amount of fluid can reduce pain by preventing the pleural membrane from rubbing together, the related increase in pressure can lead to complications, such as a collapsed lung or infection.
As the name suggests, dry pleurisy describes inflammation of the lung lining without abnormal fluid production. Sometimes, dry pleurisy can develop into wet pleurisy over time.
Signs and symptoms
The most common symptom of pleurisy is a moderate to severe stabbing pain in the chest that feels worse during breathing, coughing or sneezing. Sometimes, the pain may also be felt in the neck, back or shoulder. It may be continuous, or it may come and go.
Other symptoms of pleurisy include:
- Fever and chills;
- An ongoing dry cough;
- Fast, shallow breathing, and;
- Shortness of breath.
Symptoms of pleurisy usually last between a few days to about two weeks.
Methods for diagnosis
A diagnosis of pleurisy is usually based upon symptoms and characteristic findings from listening to the chest with a stethoscope. Your doctor may also collect a blood sample or look more closely at your chest and lungs using an X-ray, ultrasound or computerised tomography (CT) scan.
Types of treatment
Treatments for pleurisy will depend on the underlying cause.
For example, pleurisy caused by a viral infection usually clears up after a few days without the need for prescription medication. However, your doctor may recommend rest and an over-the-counter medication, such as paracetamol or ibuprofen, to help control the pain.
In contrast, you may be prescribed an antibiotic medication if your pleurisy is caused by a bacterial infection.
Potential complications of pleurisy include:
The outlook for pleurisy differs from person to person, depending on the cause. Pleurisy caused by a viral infection usually clears on its own in a few days without any particular treatment, while pleurisy caused by a bacterial infection can also be successfully treated in most cases, but complications and lasting lung damage are more likely.
Although pleurisy is not technically contagious, the viruses and bacteria that cause it may be spread by coughing, sneezing and having close contact with infected people. For this reason, it may be possible in some cases to prevent pleurisy by avoiding people who are unwell and staying away from organised activities if you have an infection. Similarly, practicing good hygiene habits may help to prevent the spread of viruses and bacteria.
Vaccinations against Streptococcus pneumonia (pneumococcal bacteria), Haemophilus influenzae type B (Hib) and the seasonal flu virus may also help to prevent the infections that could lead to pleurisy.