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Pleuritis (Pleurisy): Causes, Symptoms and Treatment

Pleuritis, or pleurisy, is an inflammation of the pleura, the tissue lining the lungs. It typically causes sharp, breathing-related chest pain and requires medical evaluation.

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Things worth knowing about "Pleuritis"

Pleuritis, or pleurisy, is an inflammation of the pleura, the tissue lining the lungs. It typically causes sharp, breathing-related chest pain and requires medical evaluation.

What is Pleuritis?

Pleuritis (also called pleurisy) is an inflammation of the pleura, the two-layered membrane that surrounds the lungs and lines the inside of the chest cavity. Under normal conditions, the two pleural layers glide smoothly against each other during breathing. When inflamed, the surfaces become rough and irritated, causing the characteristic sharp chest pain associated with this condition.

There are two main forms: dry pleuritis (pleuritis sicca), in which there is no fluid accumulation, and exudative pleuritis, in which excess fluid collects between the pleural layers, forming what is called a pleural effusion.

Causes

Pleuritis can be triggered by a variety of underlying conditions:

Viral infections: The most common cause, including influenza, Coxsackievirus, and Epstein-Barr virus.
Bacterial infections: Such as pneumonia or tuberculosis.
Autoimmune diseases: Including systemic lupus erythematosus (SLE) and rheumatoid arthritis.
Pulmonary embolism: A blood clot in the lungs can trigger pleural inflammation.
Cancer: Malignant tumors such as pleural mesothelioma or lung cancer.
Heart conditions: For example, Dressler syndrome following a heart attack.
Medications and radiation therapy may rarely cause pleuritis as a side effect.

Symptoms

The hallmark symptom of pleuritis is sharp, stabbing chest pain that worsens with deep breathing, coughing, or sneezing. Other common symptoms include:

Shortness of breath and shallow breathing (to minimize pain)
Dry, irritating cough
Fever and general malaise (depending on the underlying cause)
With pleural effusion: the pain may decrease, but increasing breathlessness can occur due to fluid buildup

Diagnosis

Diagnosis involves a combination of clinical assessment and investigations:

Physical examination: A doctor may hear a characteristic pleural friction rub through a stethoscope in the dry form of the disease.
Imaging: Chest X-ray or ultrasound to detect pleural effusion; a computed tomography (CT) scan provides more detailed information.
Blood tests: Inflammatory markers such as CRP and ESR, as well as antibody tests if an autoimmune cause is suspected.
Thoracentesis: If an effusion is present, fluid may be drawn out and analyzed to help identify the cause.

Treatment

Treatment of pleuritis is always directed at the underlying cause:

Pain Relief and Anti-Inflammatory Therapy

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac are the first-line treatment for pain and inflammation.
Colchicine may be added to reduce the risk of recurrence.
Corticosteroids are used in severe cases or when an autoimmune disease is the underlying cause.

Treating the Underlying Cause

Bacterial infection: Antibiotics
Viral cause: Rest, fluids, and symptomatic management
Autoimmune disease: Immunosuppressive therapy
Pulmonary embolism: Anticoagulants (blood thinners)

Managing Pleural Effusion

A significant pleural effusion may be drained through a procedure called thoracentesis to relieve pressure and improve breathing.

Outlook and Prognosis

The prognosis of pleuritis largely depends on its underlying cause. Viral pleuritis often resolves completely within a few weeks. When the underlying condition is diagnosed and treated promptly, most patients recover well. In rare cases, complications such as pleural adhesions or a thickened pleura (fibrothorax) may develop and permanently affect lung function.

References

Sahn SA, Heffner JE. Pleurisy. In: Harrison's Principles of Internal Medicine. 21st edition. McGraw-Hill Education, 2022.
Light RW. Pleural Diseases. 6th edition. Lippincott Williams and Wilkins, 2013.
Zarogoulidis P et al. Pleuritis as a side effect of antineoplastic treatment. Journal of Thoracic Disease, 2013. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3698226/

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