What Is Pleurisy?

Pleurisy, also known as pleuritis, is inflammation of the pleura—two thin layers of tissue that line the lungs and chest. The inflammation can cause sharp chest pain, especially when breathing deeply or coughing. Common causes of pleurisy include blood clots in the lung, infections, and certain health conditions such as lupus, cancer, and rheumatoid arthritis. 

Healthcare providers may perform a physical exam and order imaging studies and blood tests to diagnose pleurisy. Treatment options for pleurisy vary depending on the underlying cause and may include pain relief medication, antibiotics, or corticosteroids. Pleurisy can affect people of all ages but is most common in those 65 and older. Preventive measures include quitting smoking, avoiding exposure to respiratory infections, and treating health conditions that increase the risk of pleurisy.

This article provides an in-depth look at pleurisy, including pleurisy types, symptoms, causes, diagnosis, treatment, and prevention. 

Types of Pleurisy

There are two main types of pleurisy: dry and wet.

• Dry pleurisy: Little to no fluid accumulates around the lungs. The inflamed pleura rub against each other and produces a sound called “pleural friction rub” as you breathe, which sounds like a raspy breath.
• Wet pleurisy: Involves a fluid buildup around the lungs from the inflamed tissue. The excess fluid can make breathing difficult and cause shortness of breath. 

Symptoms 

The most common symptom of pleurisy is chest pain that worsens with breathing, coughing, or sneezing. The pain is usually sharp and can be felt on one or both sides of the chest. Some people may also feel pain in the shoulder or back. The pain can be so severe that it interferes with normal breathing and your ability to get through your daily activities.

Pleurisy may also cause:

• Shortness of breath
• Cough
• Rapid breathing
• Fever
• Fatigue 

What Causes Pleurisy? 

Pleurisy occurs when the pleura—a thin, double-layered membrane that surrounds the lungs and lines the inside of the chest—becomes inflamed. The pleura helps the lungs move smoothly within the chest as you breathe. When the pleura is inflamed, the layers can rub together, causing pain and discomfort. In some cases, fluid may build up around the lungs in the chest cavity, causing breathing difficulties.

Several conditions can cause pleurisy, including:

• Bacterial and viral respiratory infections 
• Pneumonia 
• Pulmonary embolism (blood clot in the lungs) 
• Autoimmune diseases, such as lupus, rheumatoid arthritis, and human immunodeficiency virus (HIV)
• Certain cancers, such as lung cancer and mesothelioma, although this is rare
• Chest trauma

Risk Factors

Pleurisy can affect anyone, but certain risk factors can increase your odds of developing the condition. Your risk for pleurisy is higher if you:

• Are 65 or older 
• Have a history of lung infections
• Experienced recent chest trauma
• Have an inflammatory condition or autoimmune disease 
• Smoke tobacco or cannabis
• Have lung cancer or scarring in your lungs

How Is Pleurisy Diagnosed?  

Diagnosing pleurisy involves a combination of a physical examination, medical history, and diagnostic tests. To diagnose pleurisy, your healthcare provider will ask about your symptoms, including when they started, how severe the pain is and what makes it worse. Your provider will also ask about your medical history and any risk factors you may have, such as a recent respiratory infection or underlying medical conditions you have.

During the physical examination, your healthcare provider may listen to your chest with a stethoscope to check for abnormal breathing sounds. They will also check your vital signs—including your temperature, heart rate, and breathing rate—to determine the cause of your symptoms.

If your doctor suspects you have pleurisy, they may order one or more diagnostic tests. The specific tests and procedures they order will depend on the suspected underlying cause. In some cases, additional tests may be recommended to rule out other conditions that cause similar symptoms.

Tests used to diagnose pleurisy and determine the underlying cause include:

• Imaging tests: Imaging scans, such as a chest X-ray, computed tomography (CT) scan, and ultrasound, allow doctors to see the inside of your chest cavity to detect abnormalities in the lungs and pleura. 
• Blood tests: Samples of your blood will help identify signs of infection and inflammation. Recommended blood tests include a complete blood count (CBC) and a metabolic panel including serum protein, albumin, and lactate dehydrogenase.
• Fluid testing (thoracentesis): A thoracentesis is a surgical procedure that involves removing fluid around the lungs. A fluid sample is sent to the lab to identify potential causes of pleurisy, such as infection, cancer, or autoimmune disease. 
• Electrocardiogram (ECG): An ECG records the heart's electrical activity, allowing doctors to evaluate the heart’s rhythm and determine if an underlying heart problem is the cause of symptoms. This test is primarily used if you are experiencing persistent chest pain.
• Thoracoscopy: A surgical procedure in which a thin, flexible tube with a camera and light attached is inserted into the chest cavity. This allows your doctor to see the pleura and lungs to identify any abnormalities or signs of inflammation. A small tissue sample (biopsy) may be taken and sent to the lab for further testing to confirm the diagnosis. 

Treatments for Pleurisy  

Pleurisy treatments involve addressing the underlying cause and alleviating symptoms. If a life-threatening condition is the cause of pleurisy (e.g., pulmonary embolism), treatment will begin immediately to improve the chances of recovery.

Pain relief is an essential component of pleurisy treatment. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce pain and inflammation. Corticosteroids may be prescribed if NSAIDs are ineffective or not well-tolerated.

Apart from pain relief, pleurisy treatments depend on the underlying cause. For example, antibiotics may be prescribed if a bacterial infection causes pleurisy. In the case of viral infections, rest and NSAIDs may relieve symptoms until the virus has run its course.

In some cases, drainage of excess fluid from around the lungs may be necessary to relieve symptoms. This may involve inserting a needle or tube through the chest (thoracentesis) to remove the fluid and ease pain.

Prevention

Since an underlying condition usually causes pleurisy, the best way to prevent it is to treat any existing health conditions and prevent conditions that increase the risk of pleurisy. To prevent pleurisy, you can:

• Get vaccinated against influenza, pneumococcal (pneumonia), and COVID-19
• Wash your hands frequently and avoid close contact with people who are sick 
• Quit smoking to improve your lung health 
• Follow your treatment regimen for chronic conditions, such as lupus and rheumatoid arthritis

Living With Pleurisy  

Early diagnosis and treatment are vital for addressing pleurisy and the underlying cause. With appropriate treatment, most people with pleurisy recover fully within a few weeks. If left untreated, pleurisy may come and go or continue indefinitely. The most important thing is to seek medical attention if you have symptoms so diagnosis and treatment can begin promptly. 

If you have pleurisy, follow your recommended treatment plan, get plenty of rest, and call your healthcare provider if your symptoms worsen or you develop new symptoms.