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Pleuritis Symptoms – Recognizing Pleurisy

Pleuritis (pleurisy) causes sharp chest pain that worsens with breathing. Learn about the typical symptoms, possible causes, and when to seek medical attention.

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Things worth knowing about "Pleuritis Symptoms"

Pleuritis (pleurisy) causes sharp chest pain that worsens with breathing. Learn about the typical symptoms, possible causes, and when to seek medical attention.

What is Pleuritis?

Pleuritis, also known as pleurisy, is an inflammation of the pleura – the two-layered tissue that surrounds the lungs and lines the chest cavity. Under normal conditions, a thin layer of fluid between these two layers allows smooth breathing movements. When the pleura becomes inflamed, the layers rub against each other, causing the characteristic symptoms of the condition.

Common Symptoms of Pleuritis

The symptoms of pleuritis can vary depending on the severity and underlying cause. The most frequently reported complaints include:

Sharp or stabbing chest pain: The hallmark symptom of pleuritis is a one-sided chest pain that worsens significantly when breathing deeply, coughing, sneezing, or making certain movements. The pain often eases when breathing shallowly or resting.
Difficulty breathing (dyspnea): Many patients unconsciously breathe shallowly to avoid pain, which can lead to a feeling of breathlessness.
Dry cough: An irritating, painful cough often accompanies the condition.
Pleural friction rub: A doctor listening to the lungs may detect a characteristic scratching or creaking sound caused by the inflamed pleural layers rubbing against each other.
Radiating pain: Pain may radiate to the shoulder or abdomen, especially when the diaphragm is involved.
Fever and general malaise: Particularly in cases with an infectious cause, patients commonly experience fever, chills, fatigue, and a general feeling of being unwell.

Additional Symptoms When a Pleural Effusion Develops

If fluid accumulates between the pleural layers as a result of the inflammation – a condition known as a pleural effusion – the sharp chest pain may actually decrease, as the fluid acts as a buffer between the layers. Instead, patients may then experience:

Progressive shortness of breath
A feeling of pressure or heaviness in the chest
Dry cough
In severe cases: rapid heartbeat and bluish discoloration of the lips (cyanosis)

Possible Causes of Pleuritis

Pleuritis is not a stand-alone disease but is usually the result of another underlying condition. Common causes include:

Viral infections: The most common cause, including influenza or Coxsackievirus infections
Bacterial infections: Such as pneumonia or tuberculosis
Autoimmune diseases: Such as lupus erythematosus or rheumatoid arthritis
Pulmonary embolism: A blood clot in the lung can trigger pleuritis
Cancer: Both primary pleural tumors and metastases from other cancers
Trauma or injury: Such as after a rib fracture or chest injury

Diagnosis

Pleuritis is diagnosed through a combination of the following approaches:

Physical examination: Listening to the lungs (auscultation) to detect the characteristic pleural friction rub
Imaging: Chest X-ray or ultrasound to identify a possible pleural effusion
Blood tests: Measuring inflammatory markers such as CRP and white blood cell count
CT scan: Used for unclear findings or when a serious underlying cause is suspected

When to Seek Immediate Medical Help

The following symptoms require immediate medical evaluation:

Sudden onset of severe chest pain
Marked shortness of breath or difficulty breathing
High fever above 39 °C (102 °F)
Bluish discoloration of the lips or fingernails
Rapid or irregular heartbeat

Treatment

Treatment depends on the underlying cause. General measures include:

Pain relief: Anti-inflammatory painkillers such as ibuprofen or diclofenac
Antibiotics: If a bacterial infection is the cause
Treatment of pleural effusion: If necessary, through a thoracentesis (draining the excess fluid)
Treatment of the underlying condition: For example, immunosuppressive medications for autoimmune diseases

References

Kasper DL et al. (eds.) – Harrison's Principles of Internal Medicine, 20th edition, McGraw-Hill Education, 2018
Light RW – Pleural Diseases, 6th edition, Lippincott Williams & Wilkins, 2013
Kass SM, Williams PM, Reamy BV – Pleurisy. American Family Physician, 2007; 75(9): 1357–1364

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