Overview

Pleurisy (PLOOR-ih-see) is a condition in which the pleura — two large, thin layers of tissue that separate your lungs from your chest wall — becomes inflamed. Also called pleuritis, pleurisy causes sharp chest pain (pleuritic pain) that worsens during breathing.

One pleural layer of tissue wraps around the outside of the lungs. The other pleural 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. These layers act like two pieces of smooth satin gliding past each other, allowing your lungs to expand and contract when you breathe.

If you have pleurisy, these tissues swell and become inflamed. As a result, the two layers of the pleural lining rub against each other like two pieces of sandpaper. This causes pain when you breathe in and out. The pleuritic pain lessens or stops when you hold your breath.

Treatment of pleurisy involves pain control and treating the cause.

Symptoms

Signs and symptoms of pleurisy might include:

  • Chest pain that worsens when you breathe, cough or sneeze
  • Shortness of breath — often from trying to limit breathing in and out
  • Cough — only in some cases
  • Fever — only in some cases

Pain caused by pleurisy might worsen with movement of your upper body and can spread to your shoulders or back.

Pleurisy can occur along with pleural effusion, atelectasis or empyema:

  • Pleural effusion. In some cases of pleurisy, fluid builds up in the small space between the two layers of tissue. 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 and don't rub together.
  • Atelectasis. A large amount of fluid in the pleural space can create pressure. This can compress your lung to the point that it partially or completely collapses (atelectasis). This makes breathing difficult and might cause coughing.
  • Empyema. The extra fluid in the pleural space can also become infected, resulting in a buildup of pus. This is called an empyema. Fever often occurs along with an empyema.

When to see a doctor

Call your health care provider or seek emergency care 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.

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Causes

A variety of conditions can cause pleurisy. Causes include:

  • Viral infection, such as the flu (influenza)
  • Bacterial infection, such as pneumonia
  • Fungal infection
  • Autoimmune disorder, such as rheumatoid arthritis or lupus
  • Lung cancer near the pleural surface
  • Pulmonary embolism
  • Tuberculosis (TB)
  • Rib fracture or trauma
  • Certain inherited diseases, such as sickle cell disease
  • Certain medications and recreational drugs

April 30, 2022
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  4. Broaddus VC, et al., eds. Pleural effusion. In: Murray and Nadel's Textbook of Respiratory Medicine. 7th ed. Elsevier; 2022. https://www.clinicalkey.com. Accessed Jan. 29, 2022.
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