Pleurisy: what you need to know
What is pleurisy?
Pleurisy is a lung disease. It means inflammation of the pleura — the thin, 2-layer protective membrane that covers the lungs and also lines the inside of the chest wall. The 2 layers are lubricated by a thin layer of fluid between them. This helps them slide easily over each other when you breathe in and out.
Acute or chronic?
Pleurisy may be either acute, which means it comes on suddenly, causes symptoms, and then goes away again, or it may be chronic, meaning the symptoms are continuous or keep recurring over time.
Wet or dry?
Pleurisy can be described as wet, in which abnormal amounts of fluid accumulate in the space between the 2 pleural layers, or dry, where the inflammation hasn’t formed fluid. Sometimes, after the inflammation subsides, strands of fibrous tissue may form in the pleura which makes the 2 layers stick together. This makes it harder for the underlying lung tissue to expand when the lungs are filling with air.
What causes pleurisy?
Pleurisy may result from a wide variety of conditions including:
- viral or bacterial pneumonia;
- blood clots in the lung (pulmonary embolism);
- allergic reactions to certain medications;
- cancer;
- irritants such as asbestos;
- injury to the lung, for example from a fractured rib; and
- connective tissue diseases, such as systemic lupus erythematosus.
Pleurisy is usually classified into 2 types, primary and secondary.
Primary pleurisy is inflammation that starts in the pleural tissue itself, often from an infection or following an injury, such as a broken rib.
Secondary pleurisy means the pleurisy results from another lung or chest disease such as pneumonia, or even a tumour. The symptoms of primary and secondary pleurisy may be exactly the same.
What are the symptoms of pleurisy?
The most common symptom is chest pain that starts suddenly. Whenever the chest wall moves, such as with breathing in and out, coughing or sneezing, the pleura moves and pain is felt in the outer layer of the pleura. (The inner layer of the pleura next to the lungs has no pain nerves.)
The pain may range from moderate to very severe, and it may either come and go, being made worse by breathing deeply, or it may be continuous.
The pain is often described as a stabbing sensation. It is usually felt in the chest where the inflammation is but it can be felt as referred pain in the shoulder or neck instead, or as well.
Other symptoms of pleurisy may include:
- rapid, shallow breathing because of the pain;
- chills and fever; and
- respiratory distress due to large amounts of fluid in the pleural space making it difficult for the lungs to expand.
Diagnosis
Through a stethoscope, your doctor may hear what is known as a pleural rub — a squeaky rubbing sound in the chest. This makes it easy to diagnose pleurisy. Chest X-rays can’t show pleurisy, but they can show fluid collecting between the pleural layers. Chest X-rays can also sometimes identify the cause of pleurisy, such as lung disease, a tumour, or rib fracture.
Last Reviewed: 05 August 2009
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