Table of ContentsView AllTable of ContentsThe PleuraSymptomsCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
The Pleura
Symptoms
Causes
Diagnosis
Treatment
Pleurisy—also called pleuritis—refers to inflammation of the pleura, the membrane that covers your lungs and chest cavity. The main symptom of pleurisy is sharp chest pain that worsens with deep breathing or when coughing. Some potential causes of pleurisy are potentially life-threatening, like a heart attack or a blood clot in the lung. Others causes are related to an underlying disease process like infection, cancer, or an autoimmune disorder, such as lupus.
Verywell / Brianna Gilmartin
The pleura is actually a membrane that contains two thin membranes—one that covers your lungs (the visceral pleura) and one that lines the inside of your chest cavity (the parietal pleura).
Pleurisy Symptoms
The key symptom of pleurisy is sharp, stabbing, or burning chest pain that occurs with breathing, coughing, sneezing, or laughing. The chest pain may be felt in the shoulder or neck (referred pain).
In addition, breathing difficulties may arise. These are usually due to pain and excess fluid buildup in the pleural cavity, which can compress or even collapse a lung (i.e.,atelectasis).
Besides pain and possible breathing problems, other potential symptoms of pleurisy (depending on the underlying cause) may include:
There are many potential causes of pleurisy, and the following are just a few of them. Some are very serious, so immediate medical attention is warranted for pleuritic (or any) chest pain.
Infection
Infection with a virus, such asinfluenza (the flu), is a common cause of pleurisy. Other types of infections, like those from a bacterium, fungus, or parasite, may also cause pleurisy.
Sometimes with bacterial causes of pleurisy, a collection of pus forms within the pleural cavity (i.e., anempyema).
Heart and Lung Issues
Various heart and lung conditions, some potentially life-threatening, may be the culprit behind a person’s pleurisy or cause symptoms similar to pleurisy. These conditions include:
Autoimmune Diseases
Various autoimmune diseases, likesystemic lupus erythematosus (SLE or lupus)andrheumatoid arthritis, can cause pleurisy.
Hemothorax
Cancer and Other Diseases
Cancers likelymphomaormesotheliomacan also cause pleurisy, as canchronic kidney disease,inflammatory bowel disease,pancreatitis, or rare diseases, likefamilial Mediterranean fever (FMF).
Medications
Certain drugs, such as procainamide and Apresoline (hydralazine), may cause a lupus-like reaction that leads to pleurisy.
Medication-Induced Lupus Symptoms and Treatment
Medical History
During the medical history, your healthcare provider will ask you several questions about your symptoms. Answers to these questions can help pinpoint the cause behind your pleurisy.
Here are a few examples of potential questions:
Physical Exam
In addition to a lung exam, your healthcare provider will check yourvital signsto see whether or not you have a fever, low blood pressure, a fast heart or breathing rate, or low oxygen saturation. These findings can provide clues into your underlying diagnosis.
Then, depending on your healthcare provider’s suspicions, other organs, such as your heart, skin, or digestive tract, may be evaluated.
Imaging Tests
The majority of people with pleuritic chest pain will undergo an imaging test.
Such tests may include one or more of the following:
Blood Tests
Various blood tests may also be ordered to sort out the cause of your pleurisy.
Here are just a couple of examples of blood tests your healthcare provider may order:
Electrocardiogram (ECG)
Various abnormalities on anECGcan indicate an underlying heart problem, like a heart attack or pericarditis.
Thoracentesis
If excess fluid is found in the pleural cavity, a thoracentesis may be done. In this procedure, a fine needle is inserted through the chest into the pleural space to withdraw fluid. In addition to doing this to ease symptoms (e.g., shortness of breath), the fluid can be analyzed in the lab to define the diagnosis (e.g., infection, cancer etc.).
Biopsy
Less commonly, a pleural biopsy—where a small sample of the inflamed pleura is removed—is performed. This is done to confirm certain diagnoses liketuberculosisor pleural cancer.
The first step in treating pleurisy is to diagnose and urgently address potentially life-threatening causes, most notably pulmonary embolism, heart attack, pericarditis, aortic dissection, pneumonia, and pneumothorax.
Once these conditions are ruled out or promptly addressed, the treatment of pleurisy involves two steps—pain control and treating the underlying condition.
Nonsteroidal anti-inflammatory drugs (NSAIDs)are a commonly used type of medication for easing the pain of pleurisy. If a person does not respond well enough to NSAIDs or cannot tolerate or take them, acorticosteroidmay be prescribed.
Once pain is under control, a healthcare provider will address the underlying etiology. For example, for pleurisy related to an infection, antibiotics (bacterial) or antifungals (fungal) may be prescribed.
Drainage of infected fluid through athoracentesismay also be performed. Sometimes, if there is a lot of fluid—or if there is air present, as with a pneumothorax—achest tubemay be inserted into the pleural cavity to effectively remove the fluid (or air).
One or more procedures may actually be warranted in cases of pleurisy, especially for recurrent or malignant (cancerous) pleural fluid build-up. Some such procedures include:
A Word From Verywell
Pleurisy is a serious medical condition that warrants prompt medical attention. While being evaluated for pleurisy, try to remain calm and patient. Even though getting to the bottom of your pain can be a bit tricky and tedious, once the cause is discovered, you can move forward with a treatment plan.
4 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Reamy BV, Williams PM, Odom MR.Pleuritic Chest Pain: Sorting Through the Differential Diagnosis.Am Fam Physician. 2017;96(5):306-312.Jeon D.Tuberculous pleurisy: an update.Tuberc Respir Dis (Seoul). 2014;76(4):153-9. doi:10.4046/trd.2014.76.4.153Korczyński P, Górska K, Konopka D, Al-haj D, Filipiak KJ, Krenke R.Significance of congestive heart failure as a cause of pleural effusion: Pilot data from a large multidisciplinary teaching hospital.Cardiol J. 2018. doi:10.5603/CJ.a2018.0137Ryan H, Yoo J, Darsini P.Corticosteroids for tuberculous pleurisy.Cochrane Database Syst Rev. 2017;3:CD001876. doi:10.1002/14651858.CD001876.pub3Additional ReadingMittoo S, Fell C.Pulmonary Manifestations of Systemic Lupus Erythematosus.Semin Respir Crit Care Med. 2014. 35(2):249-54. doi: 10.1055/s-0034-1371537National Heart, Lung, and Blood Institute. (n.d.).Pleurisy and Other Pleural Disorders.https://www.nhlbi.nih.gov/health-topics/pleurisy-and-other-pleural-disordersReamy BV, Williams PM, Odom R.Pleuritic Chest Pain: Sorting Through the Differential Diagnosis.Am Fam Physician. 2017 Sep 1;96(5):306-12.
4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Reamy BV, Williams PM, Odom MR.Pleuritic Chest Pain: Sorting Through the Differential Diagnosis.Am Fam Physician. 2017;96(5):306-312.Jeon D.Tuberculous pleurisy: an update.Tuberc Respir Dis (Seoul). 2014;76(4):153-9. doi:10.4046/trd.2014.76.4.153Korczyński P, Górska K, Konopka D, Al-haj D, Filipiak KJ, Krenke R.Significance of congestive heart failure as a cause of pleural effusion: Pilot data from a large multidisciplinary teaching hospital.Cardiol J. 2018. doi:10.5603/CJ.a2018.0137Ryan H, Yoo J, Darsini P.Corticosteroids for tuberculous pleurisy.Cochrane Database Syst Rev. 2017;3:CD001876. doi:10.1002/14651858.CD001876.pub3Additional ReadingMittoo S, Fell C.Pulmonary Manifestations of Systemic Lupus Erythematosus.Semin Respir Crit Care Med. 2014. 35(2):249-54. doi: 10.1055/s-0034-1371537National Heart, Lung, and Blood Institute. (n.d.).Pleurisy and Other Pleural Disorders.https://www.nhlbi.nih.gov/health-topics/pleurisy-and-other-pleural-disordersReamy BV, Williams PM, Odom R.Pleuritic Chest Pain: Sorting Through the Differential Diagnosis.Am Fam Physician. 2017 Sep 1;96(5):306-12.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Reamy BV, Williams PM, Odom MR.Pleuritic Chest Pain: Sorting Through the Differential Diagnosis.Am Fam Physician. 2017;96(5):306-312.Jeon D.Tuberculous pleurisy: an update.Tuberc Respir Dis (Seoul). 2014;76(4):153-9. doi:10.4046/trd.2014.76.4.153Korczyński P, Górska K, Konopka D, Al-haj D, Filipiak KJ, Krenke R.Significance of congestive heart failure as a cause of pleural effusion: Pilot data from a large multidisciplinary teaching hospital.Cardiol J. 2018. doi:10.5603/CJ.a2018.0137Ryan H, Yoo J, Darsini P.Corticosteroids for tuberculous pleurisy.Cochrane Database Syst Rev. 2017;3:CD001876. doi:10.1002/14651858.CD001876.pub3
Reamy BV, Williams PM, Odom MR.Pleuritic Chest Pain: Sorting Through the Differential Diagnosis.Am Fam Physician. 2017;96(5):306-312.
Jeon D.Tuberculous pleurisy: an update.Tuberc Respir Dis (Seoul). 2014;76(4):153-9. doi:10.4046/trd.2014.76.4.153
Korczyński P, Górska K, Konopka D, Al-haj D, Filipiak KJ, Krenke R.Significance of congestive heart failure as a cause of pleural effusion: Pilot data from a large multidisciplinary teaching hospital.Cardiol J. 2018. doi:10.5603/CJ.a2018.0137
Ryan H, Yoo J, Darsini P.Corticosteroids for tuberculous pleurisy.Cochrane Database Syst Rev. 2017;3:CD001876. doi:10.1002/14651858.CD001876.pub3
Mittoo S, Fell C.Pulmonary Manifestations of Systemic Lupus Erythematosus.Semin Respir Crit Care Med. 2014. 35(2):249-54. doi: 10.1055/s-0034-1371537National Heart, Lung, and Blood Institute. (n.d.).Pleurisy and Other Pleural Disorders.https://www.nhlbi.nih.gov/health-topics/pleurisy-and-other-pleural-disordersReamy BV, Williams PM, Odom R.Pleuritic Chest Pain: Sorting Through the Differential Diagnosis.Am Fam Physician. 2017 Sep 1;96(5):306-12.
Mittoo S, Fell C.Pulmonary Manifestations of Systemic Lupus Erythematosus.Semin Respir Crit Care Med. 2014. 35(2):249-54. doi: 10.1055/s-0034-1371537
National Heart, Lung, and Blood Institute. (n.d.).Pleurisy and Other Pleural Disorders.https://www.nhlbi.nih.gov/health-topics/pleurisy-and-other-pleural-disorders
Reamy BV, Williams PM, Odom R.Pleuritic Chest Pain: Sorting Through the Differential Diagnosis.Am Fam Physician. 2017 Sep 1;96(5):306-12.
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