PLEURISY

Pleurisy may develop in the presence of a lung inflammation (for example, pneumonia, tuberculosis), rheumatic diseases, chest trauma, certain cancers, and asbestos-related disease.

What is Pleurisy?

Pleurisy is an inflammation of the pleura, the thin tissue lining of the lungs. This causes sharp chest pain, known as pleuritic pain.

What are the Symptoms of Pleurisy?

The main symptom is pain over the chest wall at the site of the inflammation. In some circumstances, the pain may be felt in the shoulder.

The pain is increased by deep breathing, coughing, and chest movement. The normally smooth pleural surfaces, now roughened by inflammation, rub together with each breath, and may produce a rough, grating sound called a "friction rub". This can be heard with the stethoscope or an ear held against the chest.

Fluid often accumulates at the site of pleural inflammation. A localized collection of fluid separates the lung pleura from the chest wall pleura causing the chest pain to disappear even though the illness may be worsening.

Large accumulations of fluid compromise breathing and may cause coughing, shortness of breath with rapid breathing (tachypnea), cyanosis, and retractions.

Recent or present respiratory illness with its symptoms:

  • Cough
  • Fever
  • Malaise
  • Localized chest pain on the chest wall
  • Pain with each breath
  • Worsened by coughing
  • Worsened by deep breathing

How is Pleurisy Diagnosed?

Physical examination may show abnormal lung sounds:

  • A friction rub -- a rough scratchy sound that accompanies inspiration and expiration
  • Rales (may be present if there is an accompanying pneumonia)
  • Rhonchi (may be present with accompanying pneumonia or bronchitic process)
  • Decreased breath sounds (may be present if there is a collection of fluid around the lung

Tests:

  • CBC (may help differentiate bacterial versus viral infection)
  • X-ray of the chest
  • Ultrasound of the chest
  • Thoracentesis (a collection of fluid from the pleural cavity)

How is Pleurisy Treated?

Treatment is directed at the underlying illness. Bacterial infections are treated with appropriate antibiotics. Tuberculosis requires special treatment. Viral infections normally run their course without medications. Pleural fluid may be removed by thoracentesis, and evaluated for signs of infection.

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