What Is Pleurisy?

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.

The Pleura

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).

The visceral and parietal pleurae are separated by a very thin space referred to as the pleural cavity, which normally contains three to four teaspoons of pleural fluid. This thin layer of fluid reduces friction on the lungs when you breathe in and out.

The parietal pleura (not the visceral) is innervated by nerves. That's why pain arises when it becomes irritated and inflamed.

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:

• Coughing
• Fever and chills
• Unintentional weight loss
• Cyanosis (blueness of the skin from oxygen deprivation)

Causes

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 as influenza (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., an empyema).

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:

• Myocardial infarction (heart attack)
• Pericarditis
• Aortic dissection
• Congestive heart failure
• Pulmonary embolism
• Pneumonia
• Pneumothorax
• Chronic obstructive lung disease (COPD)

Autoimmune Diseases

Various autoimmune diseases, like systemic lupus erythematosus (SLE or lupus) and rheumatoid arthritis, can cause pleurisy.

Hemothorax

Pleurisy may also be caused by any condition that causes blood to buildup in the pleural space—what's called a hemothorax. This can include an injury to the chest, chest or heart surgery, or lung or pleural cancer.

Cancer and Other Diseases

Cancers like lymphoma or mesothelioma can also cause pleurisy, as can chronic kidney disease, inflammatory bowel disease, pancreatitis, or rare diseases, like familial Mediterranean fever (FMF).

Medications

Certain drugs, such as procainamide and Apresoline (hydralazine), may cause a lupus-like reaction that leads to pleurisy.

Diagnosis

The diagnosis of pleurisy is made by using a combination of a careful history and physical examination, plus lab tests and imaging studies.

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:

• Did your chest pain come on suddenly over minutes or did it progress over hours to weeks? Sudden chest pain indicates a potentially serious, life-threatening cause of pleurisy.
• Does your pain stay in one place or does it move (radiate) to your shoulder, neck, or back?
• Are you experiencing problems breathing or any other associated symptoms (e.g., fever, chills, nausea, sweating, cough, or weight loss)?

Physical Exam

During the physical exam, your healthcare provider will listen to your lungs with a stethoscope. Normally, the pleura is smooth, but when it's affected by pleuritis, it becomes rough, rubs together, and sometimes produces a grating sound called a friction rub.

In addition to a lung exam, your healthcare provider will check your vital signs to 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:

• Chest X-ray
• Ultrasound
• Chest computerized tomography (CT) scan
• Chest magnetic resonance imaging (MRI)

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:

• Complete blood count (CBC): A high white blood cell count may be a sign of infection.
• Antinuclear antibody (ANA) and anti-double-stranded DNA (anti-dsDNA): If both are positive, a diagnosis of lupus is highly suggested.
• D-Dimer test: If elevated, a pulmonary embolus may be present.

Electrocardiogram (ECG)

Various abnormalities on an ECG can 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 like tuberculosis or pleural cancer.

Treatment

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, a corticosteroid may 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 a thoracentesis may also be performed. Sometimes, if there is a lot of fluid—or if there is air present, as with a pneumothorax—a chest tube may 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:

• Pleurodesis: A procedure whereby pleural fluid is drained and a chemical is then placed in the pleural cavity to help seal the space between the parietal and visceral membranes.
• Indwelling pleural catheter (IPC): This is a small tube that is placed into the pleural cavity to allow for repeated drainage at home.
• Pleurectomy: A type of surgery in which part of the affected pleura is removed

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.