Pleurisy

What is pleurisy? Pleurisy (also called pleuritic chest pain) is chest pain caused by inflammation of the lining of the lungs, or pleura.

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The pain is typically sharp or stabbing, and most noticeable when you breathe deeply, cough, or sneeze.

What causes pleurisy? Pleurisy occurs when the lining of the lungs become inflamed and irritate the nearby nerve endings. Causes include:

  1. Viruses (the most common cause), including CMV, EBV, influenza, RSV, coxsackie, and mumps
  2. Bacterial infection, such as pneumonia or tuberculosis
  3. Certain cancers, including lung cancer and mesothelioma
  4. Chest injury
  5. Pulmonary embolism (blood clot to the lungs)
  6. Asbestos-related disease, such as pleural effusion or diffuse pleural thickening
  7. Rheumatic disease, such as rheumatoid arthritis or systemic lupus erythematosus (“lupus”)
  8. Heart surgery
  9. Other lung diseases, such as sarcoidosis
  10. Sickle cell disease, certain genetic disorders
  11. Chronic kidney failure

How will my doctor test me? The first step will be a medical history and physical examination. In addition to pleuritic chest pain, you might be having fever, night sweats, weight loss, shortness of breath, or sore throat. Your doctor will examine your chest with his/her hands and a stethoscope, listening for evidence of the inflamed pleural layers rubbing against each other (“pleural friction rub”) and for pleural effusion (fluid in the pleural space). Imaging of the lungs can be accomplished by chest X-ray or chest CT. Other testing can include blood tests (such as CBC, or complete blood count), lung scan, or blood oxygen measurement.

How is pleurisy treated? If there is fluid present in the pleural space, the doctor will remove it by a procedure called thoracentesis. The main treatment aims for pleurisy are to treat the underlying cause and to relieve the pain. Generally, the prognosis is good, but depends upon the cause.

Call your doctor if you have symptoms of pleurisy, especially if it is associated with shortness of breath, blue discoloration of skin or nail beds, unexplained fever, weight loss, or coughing up blood.

Where can I learn more?
Celli BR. Diseases of the diaphragm, chest wall, pleura, and mediastinum. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 100.