Pleura, the thin tissues which line the chest walls and the lungs rub together during breathing. In a normal condition that does not cause any problem as there is no friction between these tissues when they are in a healthy state (the pleural fluid also helps).
But, when this tissue becomes swollen or irritated due to inflammation caused by an infection such rubbing action generates considerable pain. Pleurisy or Pleuritis or Pleuritic chest pain is the inflammation of the lining of the lungs that causes pain during breathing or coughing.
What is Pleurisy?
Pleurisy is the condition of the lungs that results in characteristic sharp pain in the chest cavity which worsens during breathing. Such condition is often associated with excess fluid (known as the pleural effusion) accumulation between two pleural layers.
The nerve endings generating pain signals in the lungs are located within the pleura. Therefore, inflammation of pleural tissue results in sharp pain particularly during breathing in the chest. Such pain is often associated with shortness of breath, tenderness in a chest, and cough.
However, pleurisy or pleuritis is now a rare disease and cannot be regarded as a universal condition. The advent of potent antibiotics over the years has made the treatment of lung infection resulting from bacterial infection (the primary cause of Pleurisy) quite successful. Currently viral infection is the only cause of Pleurisy.
Causes, incidence, and risk factors:
You may suffer from Pleurisy when inflammation is developed in your lungs because of infections that may be bacterial, fungal or vital. Tuberculosis and pneumonia are a common cause of Pleurisy. Other causes of Pleurisy include asbestos-related diseases, certain cancers, chest trauma, and rheumatic disorders.
The normal smooth lining of your lungs, which is known as the pleura, gets rough when you have Pleurisy. During breathing these rough linings rub with each other generating a grating sound known as the ‘friction rub’. Healthcare professionals can hear this sound with the help of a stethoscope or just by placing the ear on the chest of the patient.
Common Symptoms of pleurisy:
Sharp chest pain is the most common symptoms of pleurisy. Often the pain radiates to the shoulders as well. The pain worsens while making chest movement or during coughing and breathing.
Putting pressure on the affected area or holding the breath can ease off the pain. Loss of appetite, chills and fever are the accompanying symptoms of pleurisy depending on the cause. In Pleurisy fluid gets collected inside the patient’s lungs resulting in difficult breathing with the following symptoms:
- Shortness of breath
- Rapid breathing (tachypnea)
Fluid buildup (pleural effusion) inside lungs because of Pleurisy can put pressure on the lungs causing them to stop their proper functioning. Initially, fluid buildup can ease up the pain by acting as a cushion.
But, as the fluid accumulation increases patients start experiencing shortness of breath. Further, infection in this fluid (empyema) can cause a dry cough, chills and fever.
Healthcare professionals will listen to the breathing sound of the lungs with the help of a stethoscope for possible abnormalities such as:
- Scratchy and rough sounds due to friction rub
- Pneumonia-causing rales
- The occurrence of rhonchi because of bronchitis or pneumonia
- The decrease in the breathing sounds indicating the presence of fluid around the lungs
Additional tests for confirmation:
Your physician may conduct further tests to confirm the disease. Usually, the following tests are conducted:
- Chest X-ray
- Ultrasound of the chest
- CBC (can aid in determining whether the infection is due to virus or bacteria)
- Thoracentesis (a process of collecting fluids from the inflamed or infected chest cavity)
Determining the cause and location of inflammation is the primary goal in the diagnosis of pleurisy. Healthcare professionals will, therefore, do a physical examination and note your medical history.
The physicians can identify the location of the possible information or swell in your lungs with X-rays. Decubitus chest X-rays may also be done where the X-ray is taken while you are lying on the sides. This allows the accumulated fluid to form a single layer. Thus, physicians can confirm the development of fluids in lungs.
Whether you have any infection and if so the cause of the infection can be determined by the blood tests. It will also help in identifying whether you have any disorders in the immune system.
After confirming accumulation of fluid in the lungs through imaging, your physician may perform thoracentesis. In this method, a needle is inserted into the lungs where the fluid is detected. Then the fluid is removed and detected for any possible infection.
This is not a common test done in pleurisy because of the risks associated and invasive nature of the test.
This scan is done to make further analysis if major anomalies are observed on the chest X-rays. In this case, several cross-sectional and detailed images of your chest are taken with the help of a CT scan.
Much more detailed information on your chest can be obtained from the CT scan images compared to the X-rays. Therefore, physicians can have a better idea of the affected tissues and nature of treatment required.
Another method of detecting the condition of the inner tissues of your lungs is to use the ultrasound technology. Here a sound wave of high frequency is used to create the image of the inside of your lungs as well as the chest cavity.
This again confirms the presence and nature of the inflammation and associated fluid accumulation.
Another useful test to understand the nature and cause of pleurisy are performing the pleural biopsy, which involves the pleura, the membrane layer surrounding the lungs. In this process, a small cut is made by the physician in the skin of the chest wall.
Then a small portion of tissue is removed with the help of a needle as a pleural tissue sample for biopsy. The laboratory analysis of the tissue reveals the possible infection, tuberculosis or cancer.
This is an advanced diagnosis process where the healthcare professional inserts a small camera inside your chest wall by making a tiny incision in the chest wall. The camera is attached to a tube that allows it to be manoeuvred inside the pleural space.
Your physician then visualises the affected with the help of this camera and draw tissue sample for further laboratory analysis. This is known as thoracoscopy.
The treatment options usually depend on the elements responsible for the disease. The Healthcare professionals will first try to understand the underlying reason behind the manifestation of pleurisy.
As discussed earlier there can be various reasons behind pleurisy. If it is due to bacterial infections, then antibiotics can be administered for treatment. But antibiotics will not help in case of viral infections. Such infections usually do not need any modification and go away after running their course.
The fluid generated in the lungs can be removed using thoracentesis and should be checked for the possible signs of infection. Anti-inflammatory drugs usually applied to manage the pain associated with pleurisy.
Soon the Healthcare professional identifies the reason behind the inflammation, the course of treatment is determined. Having adequate rest will help in the healing process. Adding pressure to the affected area reduces the pain, so you may lie on the side having the pain to feel better.
Other treatment programs:
Administration of antibiotics for bacterial infection along with over the counter nonsteroidal anti-inflammatory medicines can help in the treatment process in pleurisy.
Other medications that help in breaking down the collection of mucus and pus or blood clots can be used. The mucus, pus or blood clots are then removed with a tube bronchodilator (similar to the device used in asthma treatment).
You may have to stay in hospitals to drain out the fluids in case the amount of fluid is large.
The chance and extent of recovery highly depend on the underlying cause of pleurisy.
- Collapsed lung because of thoracentesis
- Complications related to the initial illness
- Breathing difficulty
Take the help of healthcare professionals
Seek the assistance of a physician as soon as you notice the symptoms suggestive to pleurisy. Never try to self-medicate as it is a fatal disease in case medical intervention is not made early enough.
If you are having shortness of breath, and see your skin turning blue, immediately call for medical help.
Some pleurisy cases depending on the causative agent may be prevented. Such as early intervention and treatment of pneumonia, management of underlying cause of kidney, lungs, and heart disease can prevent the accumulation of fluid in the lungs (that results in pleurisy).
Timely intervention of lung and respiratory infections can prevent the development of pleurisy.
There may be long-term implications of pleurisy. However, positive results can be expected if medical intervention is promptly made and treatment courses are maintained. Correct identification of the underlying cause of pleurisy will help in your recovery.