Pleurisy - Symptoms, Risk factors and Treatment

Pleurisy, also known as pleuritis, is a type of chest pain in which the pleura become inflamed.

The pleura are two layers that surround your lungs to avoid friction between the lungs and chest wall while breathing. In between the two layers of pleura, there is a space, known as the pleural space which is filled with a little amount of fluid, known as pleural fluid, that helps in lubrication in between these two layers. 

In pleurisy, these layers around your lungs (pleura) become irritated or inflamed, which causes the two layers to rub against each other resulting in pain when you breathe.

Causes of pleurisy:

Sometimes, the exact cause of pleurisy remains unidentified. However, pleurisy can be caused by the following:

Pneumonia:

Pneumonia refers to an infection of the lung. Mostly bacterial infections cause pneumonia and pleurisy. However, pneumonia can also be due to viruses or fungi.

Other causes of pleurisy:

Causes other than pneumonia include:

• Lung cancer
• Mesothelioma (cancer due to asbestos exposure)
• Pulmonary embolism (blood clot in vessels of lungs)
• Injury to the chest ( gunshot, stab, fractured ribs)
• Asbestosis ( inflammation of the lungs due to asbestos inhalation)
• Autoimmune diseases (SLE, Rheumatoid arthritis, etc.)
• Medications for hypertension (hydralazine)
• Tuberculosis
• Sickle cell anemia

Symptoms of pleurisy:

Chest pain: Pleurisy typically represents chest pain that is sharp and stabbing in nature. This pain is also known as pleuritic chest pain, and it increases in intensity when you breathe. The pain may also be felt at the shoulder. To minimize the pain, the patient may lie on the affected side to reduce chest movements on that side.

Other symptoms:

• Symptoms other than chest pain include:
• 
  
• Fever or chills
• Cough with sputum
• Shortness of breath

Diagnosis of pleurisy:

To diagnose pleurisy and detect the underlying cause, your doctor may ask you questions about your pain and associated symptoms (history) and may also listen to your chest by a stethoscope ( auscultation). For further clarity, you may have to undergo the following tests:

Imaging:

It may involve tests like an X-ray, CT scan, or ultrasound to view your lungs and pleura and see if anything is wrong.

Blood tests:

Blood tests may indicate if you have an infection or any other problem.

Thoracentesis:

In this procedure, your doctor will make a small incision in your chest wall and collect a sample of your pleural fluid for further analysis under the microscope. It is done along with imaging to detect the irritated area. Due to the associated risks, it is rarely done nowadays.

Thoracoscopy:

In this procedure, your doctor will make a small incision in your chest wall and insert a tube called a thoracoscope, which has a camera to check for the inflamed area and then collect a sample of tissue from that area.

Biopsy:

In this procedure, your doctor will insert a needle in your chest and collect a small piece of tissue from the pleura. This sample is sent to the laboratory for further analysis and diagnosis of different diseases such as cancer, tuberculosis, etc.

Complications of pleurisy:

Pleural effusion:

It is a condition when too much fluid builds up in between the two layers of the pleura that puts pressure on your lungs, making it harder for you to breathe. It may also cause a collapse of a part of your lungs, a condition known as atelectasis.

Empyema:

In this condition, pus accumulates in the pleural space. It is mostly due to a bacterial infection that may make it harder for you to breathe due to pressure. Moreover, this infection may spread to other organs.

Sepsis:

Sepsis is a condition in which infection spreads in the body, and the body reacts to it by turning on inflammatory mechanisms.

Septic shock:

It is a drop in blood pressure due to sepsis which makes sepsis life-threatening.

Treatment of pleurisy:

The treatment of pleurisy is generally aimed at treating the underlying problem. Your doctor may prescribe the following drugs to treat pleurisy:

Antibiotics: If pleurisy is due to a bacterial infection, antibiotics are used to clear up the bacteria and treat pleurisy.

Antifungals: If there is a fungal infection of the lungs and pleura, antifungals may be prescribed.

NSAIDs: Non-steroidal anti-inflammatory drugs, such as acetaminophen (paracetamol) or ibuprofen may be prescribed to treat the pain.

Antitussives: These are cough medications. Your doctor may prescribe cough syrups that contain codeine to treat cough.

Anticoagulants: These are medications that break up a clot in the blood vessels. If pleurisy is due to a blood clot ( as in pulmonary embolism), anticoagulants may be given.

Diuretics: Pleurisy can cause pleural effusion, a condition in which too much fluid accumulates in between the layers of the pleura. To clear up this fluid and make breathing easier, diuretics are prescribed.

Bronchodilators: These medications are mostly given through inhalers and are used to treat asthma. They can also be used in pleurisy to open up the airways and ease breathing.

Conclusion:

Pleurisy is a type of chest pain that can occur due to a variety of causes. From basic infections to lung cancer, it can indicate different diseases and lung conditions. If left untreated, it can become complicated, and permanent damage can occur. If you notice any symptoms of pleurisy, it is advisable to seek medical help.