Pleurisy
Pleurisy, also known as pleuritis, is a condition characterized by chest pain that intensifies with breathing. This pain arises from inflammation of the pleura, the thin membranes surrounding the lungs, which can become irritated due to a variety of causes, including viral or bacterial infections, trauma, or underlying health conditions like sickle cell disease and advanced kidney failure. Symptoms typically include chest pain that may feel stabbing or burning, and can worsen with coughing, deep breathing, or movement. In some cases, individuals may also experience shortness of breath.
The duration of pleurisy varies depending on its cause, ranging from a few days to several weeks. Treatment is tailored to the underlying condition, often beginning with pain management and potentially involving further interventions like fluid drainage or oxygen therapy for more serious cases. Diagnosing pleurisy may require imaging studies such as chest X-rays or CT scans, especially when symptoms are severe or persistent. Understanding pleurisy is essential for timely diagnosis and treatment, making it a significant area of focus for those experiencing chest discomfort or respiratory issues.
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Pleurisy
ALSO KNOWN AS: Pleuritis
ANATOMY OR SYSTEM AFFECTED: Chest, lungs
DEFINITION: A syndrome of chest pain made worse by breathing
CAUSES: Viral infection of the lung, such as influenza or mumps; bacterial infection of the lung, such as pneumonia or tuberculosis; trauma (muscle sprain, fractured rib); sickle cell disease; advanced kidney failure; recent heart attack; rheumatologic diseases (lupus, rheumatoid arthritis); asbestos exposure; punctured lung; pulmonary embolism; lung cancer
SYMPTOMS: Chest pain with respiration, ranging from discomfort to severe stabbing or burning sensation and worsened by coughing or chest movement; sometimes shortness of breath
DURATION: Depends on cause; a few days to many weeks
TREATMENTS: Depends on cause; may include pain management, drainage of fluid, oxygen therapy, hospitalization
Causes and Symptoms
The lungs sit within the chest wall just underneath the rib cage. The pleura is a very thin double lining covering the outer surface of the and the undersurface of the ribs. During normal breathing, the lungs expand and relax, stretching their pleural and moving it back and forth against the pleural membrane lining the rib cage. To minimize friction, a very small amount of fills the space between them.
“Pleurisy” is a descriptive term that refers to chest pain with respiration. It occurs when the pleural membranes become irritated or inflamed. The pain is usually localized at the area of inflammation, but it can radiate toward the neck, shoulder, or abdomen. The pain may be mild discomfort or a severe stabbing or burning sensation. In addition to deep breathing, coughing or movements of the chest can exacerbate symptoms. Because of the pain, the patient may employ rapid, shallow breathing.
Patients with symptoms of a recent cold or respiratory infection likely have pleurisy caused by a virus; however, a more serious cause, such as pneumonia, may also be responsible. Tuberculosis is another infectious cause to be considered.
Patients with recent injuries to the chest or unusually strenuous activity may have pleurisy attributable to a muscle or a fractured rib. Patients with sickle cell disease, advanced kidney failure, a recent heart attack, rheumatologic diseases such as and rheumatoid arthritis, or exposure are also prone to pleurisy.
The most worrisome causes of pleurisy are (punctured lung), (blood in the lung), or lung cancer. These causes are more likely to be associated with shortness of breath, although this symptom is not reliably present.
Treatment and Therapy
Treatment of pleurisy depends on the underlying cause. In most cases, a chest x-ray is indicated. In some cases, a collection of fluid in the pleural space will be visible. However, patients with pleurisy may often have a normal chest x-ray. In concerning cases, particularly those associated with shortness of breath and abnormally low oxygen levels, further radiologic studies, such as a computed tomography (CT) scan or magnetic resonance imaging (MRI), may be necessary.
Pleurisy caused by viral infections, trauma, rheumatologic diseases, and is generally treated with pain medications, and the symptoms resolve within one to two weeks. Patients with kidney or heart disease may need drainage of the pleural fluid with a needle or tube placed into the pleural space through the back.
The more serious causes of pleurisy require specialized treatments based on the cause; typically, temporary oxygen supplementation is required, and sometimes hospitalization is necessary.
Bibliography
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"What Are Pleurisy and Other Pleural Disorders?" National Heart, Lung, and Blood Institute, September 21, 2011.