Pleurisy

Overview

Pleurisy is a fairly common condition in which the pleural membranes surrounding the lungs and lining the chest cavity become inflamed and swollen. This not only produces a stabbing pain in the chest, it can also interfere with normal breathing. Depending on the underlying cause responsible for this condition, treatment approaches and prognosis can vary. The outlook is generally good but in the absence of treatment, there can be severe complications.

What Is Pleurisy?

Pleurisy or pleuritis is the inflammation of the pleural membranes.

The visceral pleura wraps around the lungs and the parietal pleura lines the inside of the chest.

A small quantity of lubricating fluid present in the space between these two membranes helps to minimize friction from expansion and contraction of the lungs during breathing.

When these membranes become inflamed, the pressure and friction from normal inflation and deflation of the lungs produce a sharp pain in the chest. Infection may or may not be present.

Why Does It Happen?

Normally, the two pleural membranes rub smoothly against one another with every inhalation and exhalation. This is facilitated by a lubricating fluid present in the space between the two membranes. When the pleural membranes become irritated and swollen, they rub against each other painfully as the lungs expand and contract. Under normal circumstances, the pressure in the gap between the two pleurae remains low in order to facilitate normal inhalation and exhalation. When there is a perforation in lung tissue, this pressure gradient creates a suction force that draws in fluid or even air from the lungs into the space between the pleurae.

The causes of pleurisy range from physical trauma to infection to an underlying chronic medical disorder. These are:

• Viral or bacterial infection as in the case of tuberculosis, influenza or pneumonia.
• Bronchitis.
• A chronic inflammatory illness such as systemic lupus erythematosus or rheumatoid arthritis.
• Cancer of the lungs or breasts.
• Tumors in the pleural membranes.
• Pulmonary embolism or clots in the blood vessels of the lungs.
• Sickle cell anemia.
• Liver cirrhosis.
• Heart failure.
• Kidney disorders.
• Pancreatitis or inflammation of the pancreas.
• Exposure to substances such as asbestos and ammonia through inhalation.
• Trauma to the chest region. For example fracture of the ribs or trauma from surgical procedures.
• Leakage of air into the space between the pleurae from a hole in the lung.
• Taking chemotherapy or radiation therapy.
• Side effects of certain medications.

What Are The Signs of Pleurisy?

The exact nature of symptoms associated with pleurisy depends on the cause of the condition. Since the pleurae contain nerve endings, pleuritis produces a sharp or stabbing pain. Coughing or even normal inhalation tends to aggravate this pain. If the cause of pleurisy is an infection, then the typical symptoms of infection such as fever will also be observed. Symptoms of pleurisy include:

• Sharp pain in the chest, usually on one side. This pain worsens with breathing or coughing. It can manifest either in the front or the back.
• Tenderness in the chest area.
• Pain can spread to the shoulder, neck or the abdomen.
• Shallow breathing.
• Shortness of breath, often as a result of pleural effusion or fluid buildup between the pleural membranes.
• A dry cough.

What Are Two Types of Pleurisy?

Depending on whether or not pleural effusion is involved, pleurisy may be categorized as either wet or dry.

• Dry pleurisy: The volume of the pleural fluid remains normal and symptoms such as chest pain are explained by the rubbing together of the inflamed pleural membranes with inhalation.
• Wet pleurisy: Here, pleuritis is accompanied by an excess buildup of fluid between the pleural membranes. This has the effect of reducing the pain but this abnormal quantity of fluid puts pressure on the lungs and reduces their ability to expand fully. As a result of this, the patient feels short of breath.

Complications Related To Pleurisy

Pleural effusion or excess buildup of fluid between the pleurae is one of the most common complications of pleurisy. In case of an infectious disease such as pneumonia, there is the risk of developing empyema. This occurs when the fluid between the pleurae becomes infected with bacteria and thickens because of the formation of pus. This causes difficulty in breathing and the pus needs to be drained out to offer relief. Another possible critical outcome is a collapse of the lungs.

Permanent scarring resulting in the formation of adhesions is also possible. This can lead to permanent impairment of respiratory function.

Diagnosing Pleurisy

A physical examination reveals some local tenderness.  Using a stethoscope, the physician listens to the sounds of breathing. A scratchy rubbing sound observed during breathing points to dry pleurisy. The patient’s medical history might indicate a disorder that could be the underlying cause for the pleuritis.

In instances of wet pleurisy, the patient will also exhibit shallow breathing. Chest X-ray helps to ascertain whether or not pleural effusion is involved. If it is, a small sample of the fluid will be aspirated out to test whether an infection is present. Blood tests help identify the cause of the infection and detect autoimmune disease if any is present.

Further imaging tests would be required in order to assess the extent of effusion. It may also be required if the physician suspects that pleurisy is a result of a disorder of other organs such as the liver or pancreas. Tests such as computerized tomography (CT) or magnetic resonance imaging (MRI) can reveal any other abnormalities such as tumors, lung abscesses or pulmonary embolism that could be responsible for pleurisy.

Treatment and prevention

Antibiotics are prescribed for pleurisy which is caused due to bacteria. When an infection is a cause it generally does not require any treatment as it resolves itself.  Chest pains associated with pleurisy are relieved by non-steroidal anti-inflammatory drugs such as ibuprofen. It is rather difficult to prevent pleurisy as it is infection or bacteria that were still present in your system after a recent case of tuberculosis or pneumonia for instance. Though, an early diagnosis can help in the reduction of the treatment process.

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