Pleurisy

Pleurisy is a condition that appears when the pleura becomes inflamed. The pleura is the layer of tissue that covers your lungs. It is very important as it protects your lungs from rubbing against your chest cavity every time you breathe. The pleura has two layers. In order for your lungs to move smoothly, there is a bit of fluid between these two layers. When the pleura gets inflamed or swollen, it causes a lot of pain. You will feel a pain in your chest every time your lungs expand as you take every breath. Moreover, when you want to inhale deeply or sneeze, and even when you laugh, you will feel a sharp pain in the area where the pleura is inflamed. Most of the times, the main cause that triggers this problem is an infection. This is why it is very important to treat the infection as soon as possible. Otherwise, the pain could turn into pleurisy and the pain becomes even more stabbing.

How does the pleura work?

As we mentioned above, the pleura contains two layers of lining tissue. These two layers are called the visceral pleura and the parietal pleura. They are lubricated by the pleural fluid. In the case of a healthy person, there is about 10-20 ml of clear liquid that lubricates the layers. This fluid is continually absorbed and replaced, mainly through the outer lining of the pleura. The space between these two layers is always negative. The introduction of air (positive pressure) into the space (such as from a knife wound) will result in a collapse of the lung.

Symptoms

There are various signs and symptoms that might indicate the pleurisy:

  • 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

The pain caused by pleurisy is so dangerous as it can also affect your shoulders and back.

There are some cases when the pleurisy becomes pleural effusion. This means that the fluid builds up in the small space between the two layers of pleural tissue. When there is enough fluid between these two layers, the pain lessens and sometimes even disappears because now the layers do no longer get into contact. On the other hand, when there is too much fluid between the layers, it might compress your lungs to the point that they partially or completely collapse. This means that your will breathe with difficulty and you will start coughing intensively. On top of that, the extra fluid might become infected causing empyema. The most frequent sign if empyema is fever.

What causes pleurisy?

There are various conditions that can cause pleurisy:

  • Infections: bacterial (including those that cause tuberculosis), fungi, parasites, or viruses
  • Inhaled chemicals or toxic substances: exposure to some cleaning agents like ammonia
  • Collagen vascular diseases: lupus, rheumatoid arthritis
  • Cancers: for example, the spread of lung cancer or breast cancer to the pleura
  • Tumors of the pleura: mesothelioma or sarcoma
  • Congestion: heart failure
  • Pulmonary embolism: blood clot inside the blood vessels to the lungs. These clots sometimes severely reduce blood and oxygen to portions of the lung and can result in death to that portion of lung tissue (termed lung infarction). This, too, can cause pleurisy.
  • Obstruction of lymph channels: as a result of centrally located lung tumors
  • Trauma: rib fractures or irritation from chest tubes used to drain air or fluid from the pleural cavity in the chest
  • Certain drugs: drugs that can cause lupus-like syndromes
  • Abdominal processes: such as pancreatitis, cirrhosis of the liver, gallbladder disease, and damage to the spleen.
  • Pneumothorax: air in the pleural space, occurring spontaneously or from trauma.

Diagnosis

As soon as you feel some of the symptoms above, you should contact your doctor immediately. During examination, your doctor will ask you about your medical history and will do 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.
  • Computerized tomography (CT) scan. A chest CT scan can show if there is a blood clot in the lung or find other causes of pleuritic pain.
  • Ultrasound. 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. 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.
  • Thoracoscopy or pleuroscopy. This procedure that allows for direct visualization inside your chest to look for any abnormalities or to obtain a tissue sample (biopsy) if needed.

Treatment

Before recommending any treatment, the doctor needs to know exactly what is the 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.

Lifestyle and home remedies

If you want to relieve the symptoms of pleurisy, there are some steps you should follow:

  • Take medication. Take medication such as ibuprofen 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.

References:

https://www.mayoclinic.org/diseases-conditions/pleurisy/diagnosis-treatment/drc-20351866

https://www.medicinenet.com/pleurisy/article.htm

https://www.webmd.com/lung/understanding-pleurisy-basics#1

 

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