Pleurisy is a condition in which the pleura — a membrane consisting of a layer of tissue that lines the inner side of the chest cavity and a layer of tissue that surrounds the lungs — becomes inflamed. Also called pleuritis, pleurisy causes sharp chest pain (pleuritic pain) that worsens during breathing.

A variety of underlying conditions can cause pleurisy. Treatment of pleurisy involves pain control and treating the underlying condition.

The signs and symptoms of pleurisy might include:

  • Chest pain that worsens when you breathe, cough or sneeze
  • Shortness of breath — because you are trying to minimize breathing in and out
  • A cough — only in some cases
  • A fever — only in some cases

Pain caused by pleurisy also might affect your shoulder or back.

In some cases of pleurisy, fluid builds up in the small space between the two layers of tissue (pleural space). This is called pleural effusion. When there is a fair amount of fluid, pleuritic pain lessens or disappears because the two layers of pleura are no longer in contact. A large amount of fluid in the pleural space can create pressure, compressing your lung to the point that it partially or completely collapses. This makes breathing difficult and might cause you to cough. The extra fluid can also become infected. This is called an empyema. An empyema is often accompanied by fever.

When to see a doctor

Call your doctor right away if you experience unexplained, intense chest pain during breathing.

You might have a problem with your lungs, heart or pleura or an underlying illness for which you need prompt medical care.

Two large, thin layers of tissue called pleura separate your lungs from your chest wall. One layer wraps around the outside of the lungs. The other layer lines the inner chest wall. Between these two layers is a small space (pleural space) that's usually filled with a very small amount of liquid. The layers act like two pieces of smooth satin gliding past each other, allowing your lungs to expand and contract when you breathe without any resistance from the lining of the chest wall.

Pleurisy occurs when the pleura becomes irritated and inflamed. As a result, the two layers of the pleural membrane rub against each other like two pieces of sandpaper, producing pain when you inhale and exhale. The pleuritic pain lessens or stops when you hold your breath.

Causes of pleurisy include:

  • A viral infection, such as the flu (influenza)
  • A bacterial infection, such as pneumonia
  • A fungal infection
  • Rheumatoid disease, such as rheumatoid arthritis
  • Certain medications
  • Lung cancer near the pleural surface

You're likely to start by seeing your family doctor. However, when you call to set up your appointment, you might be urged to seek immediate medical care if you are experiencing severe, unexplained chest pain.

Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

  • Keep a record of any symptoms, including where your chest pain starts and how far it spreads.
  • Write down any key medical information, including recent hospitalizations, medications, vitamins or supplements you're taking and any medical conditions you have. Also note whether any family members — especially children — or close friends have recently been ill.
  • Write down any key personal information, including recent travel abroad and major life changes. Your doctor might also be interested in your work history, including possible environmental exposure to asbestos.
  • Bring a family member or friend along, if possible, to help you remember questions to ask and what your doctor said.
  • Write down questions to ask your doctor.

Questions to ask your doctor

Questions to ask the doctor include:

  • What do you think is the underlying cause of my symptoms?
  • What kinds of diagnostic tests or procedures do I need, if any?
  • What treatment approach do you recommend, besides pain relievers?
  • How soon after I begin treatment can I expect to feel better?
  • Are there self-care steps I can take to improve my discomfort?
  • Do you recommend that I stay home from work or school? For how long?
  • Will it help if I stop smoking?
  • Am I at risk of long-term complications from this condition?
  • I have other health conditions. How can I best manage them together?

Don't hesitate to ask other questions.

What to expect from your doctor

Be ready to answer questions your doctor might ask:

  • How would you describe your symptoms?
  • What, if anything, seems to improve or worsen your symptoms?
  • Have you been diagnosed with or treated for any other health conditions?
  • Have you recently traveled?
  • Have you been involved in any work, projects or hobbies over the years that might have exposed you to asbestos?
  • Do or did you smoke? For how long?

What you can do in the meantime

While you wait for your appointment:

  • Take an over-the-counter pain reliever, such as ibuprofen (Advil, Motrin IB, others)
  • Try to find a comfortable position and stay in it
  • Apply a cold compress to your chest

Your doctor will start by asking about your medical history and doing a physical exam, including examining your chest with a stethoscope.

To determine if you have pleurisy your doctor might recommend:

  • Blood tests. A blood test might tell your doctor if you have an infection. Other blood tests also might detect an autoimmune disorder, such as rheumatoid arthritis or lupus, in which the initial sign is pleurisy.
  • Chest X-ray. A chest X-ray can show if your lungs are fully inflating or if there is air or fluid between the lungs and ribs. Your doctor might recommend a special type of chest X-ray in which you lie on your side (decubitus chest X-ray).
  • Computerized tomography (CT) scan. In a CT scan, a computer translates information from X-rays into images of thin sections (slices) of your chest, producing more-detailed images. A chest CT scan can show if there is a blood clot in the lung or find other causes of pleuritic pain.
  • Ultrasound. This imaging method uses high-frequency sound waves to produce precise images of structures within your body. Your doctor might use ultrasound to determine whether you have a pleural effusion.
  • Electrocardiogram (ECG or EKG). Your doctor might recommend this heart-monitoring test to rule out certain heart problems as a cause for your chest pain.

Diagnostic procedures

In some cases, your doctor might remove fluid and tissue from the pleural space for testing. Procedures might include:

  • Thoracentesis. To remove fluid for laboratory analysis, your doctor might suggest thoracentesis. In this procedure, your doctor injects a local anesthetic between your ribs to the area where fluid was seen on your imaging studies. Next your doctor inserts a needle through your chest wall between your ribs to remove fluid for laboratory analysis. Your doctor might insert the needle with the help of ultrasound guidance.
  • Pleural biopsy. If tuberculosis or cancer is a suspected cause of your condition, your doctor might perform thoracentesis with pleural biopsy — removal of a sample of tissue of the outer pleura to be examined in a pathology laboratory. The biopsy needle has a small hook on the end that lifts away a small piece of tissue. Your doctor might use ultrasound guidance for this procedure.
  • Thoracoscopy. This procedure, performed while you're under a general anesthetic, allows a surgeon to see inside your chest and obtain a sample of pleural tissue.

Treatments used in pleurisy and pleural effusion focus primarily on the underlying cause. For example, if bacterial pneumonia is the cause, an antibiotic will control the infection. If the cause is viral, pleurisy will resolve on its own.

The outcome of pleurisy treatment depends on the seriousness of the underlying disease. If the condition that caused pleurisy is diagnosed and treated early, a full recovery is typical.

The following steps might help relieve symptoms related to pleurisy:

  • Take medication. Take medication such as ibuprofen (Advil, Motrin IB, others) as needed to relieve pain and inflammation.
  • Get plenty of rest. Find the position that causes you the least discomfort and try to stay in it. Even when you start to feel better, be careful not to overdo it.
Jan. 02, 2014