Brief overview
- Symptoms: Severe pain when breathing (“dry” pleurisy); in “wet” pleurisy decreasing pain and possibly breathing difficulties up to respiratory distress in case of pleural effusion; possibly fever
- Prognosis: Depending on cause, usually good prognosis depending on underlying disease; scarring of pleura up to calcification (pleuritis calcarea) possible as a consequence
- Diagnosis: medical history, physical examination with listening and palpation, chest X-ray, possibly ultrasound and computed tomography, blood test, pleural puncture, thoracotomy (endoscopy of the chest).
- Treatment: treatment of the underlying disease (such as antibiotics in case of bacterial infection); relief of symptoms, with painkillers and antipyretic drugs
What is pleurisy?
Although it is usually referred to as pleurisy, the second layer of the pleura, the lung pleura, is usually also inflamed.
As a rule, pleurisy is noticeable with pain when breathing. Various infectious and non-infectious diseases are possible causes.
What are the symptoms?
The inner layer of tissue of the pleura is called the pleura and covers the lungs. It is joined on the outside by the pleura, which lines the inside of the chest cavity. The pleura and pleura are joined at a fold at the edge of the lung.
In pleurisy, there is usually a change in the fluid between the lung pleura and the pleura, that is, in the pleural space.
- “Moist” pleurisy (pleuritis exsudativa): additional accumulation of fluid between the pleura and the lung (pleural effusion)
Often, pleurisy affects only one side of the body. The left and right lungs, including the pleural cavities, are separated by the mediastinum.
The symptoms of pleurisy are basically the same in men and women.
“Dry” pleurisy: symptoms
The deeper the sufferer breathes in, the more it hurts. That is why many patients only breathe shallowly. Some instinctively adopt a protective posture that relieves the inflamed side. The pain may occur on the left, right, both sides, in front, but also in the back, so that pleurisy sometimes leads to back pain.
Another typical symptom of pleurisy is a creaking or rubbing breathing sound, known as leather rubbing. It occurs because the lung pleura and the pleura in the inflamed areas rub against each other with every movement of the chest.
If the pleurisy spreads to the diaphragm (the muscle plate that lies under the lungs), hiccups often also occur.
“Wet” pleurisy: symptoms
On the other hand, this form of pleurisy often causes other complaints: A sign of pleural effusion is often difficult breathing or even shortness of breath (dyspnea). This happens when the effusion is so large that it significantly compresses the lung. However, with a small effusion, the patient is able to breathe normally.
Shortness of breath is always an emergency. In that case, call for emergency medical services.
Transition from dry to moist
Sometimes fever accompanies the transition from dry to “wet” pleurisy.
Pre-existing disease influences symptoms
Other symptoms of pleurisy depend on the underlying disease. Some examples:
If pneumonia develops, high fever with chills and cough with sputum often occur. If pleurisy develops as a result of tuberculosis, many patients also suffer from cough, fatigue and night sweats.
Cancers such as a malignant tumor of the pleura (pleural mesothelioma) are also possible triggers of pleurisy. Signs of pleural mesothelioma in advanced stages correspond to those of “normal” pleurisy.
How long does pleurisy last?
If the inflammation persists over a longer period of time, it is possible that the pleura and lung pleura will grow together in a scarred manner. Extensive adhesions following pleurisy are also known as pleural calluses or pleural calluses. In extreme cases, it is possible for these calluses to calcify (pleurisy calcarea). This permanently restricts breathing.
Causes and risk factors
- Pneumonia (Pneumonia)
- Tuberculosis
- Coxsackie B virus infection (Bornholm disease)
- Tumors in the area of the pleura
- Connective tissue diseases (collagenoses) such as lupus erythematosus or rheumatoid arthritis
- Pulmonary embolism, pulmonary infarction
- Urea poisoning (uremia)
- Upper abdominal diseases such as pancreatitis
The most common underlying disease of pleurisy is pneumonia: This is because the inflammatory processes spread relatively easily from the lungs to the pleura.
Pleurisy with a bloody pleural effusion is a possible sign of what is known as pleural carcinomatosis. Doctors use this term when a malignant tumor has formed metastases in the pleura. This happens, for example, in lung cancer and breast cancer.
Examinations and diagnosis
First, the physician conducts a detailed interview with the patient to obtain his medical history (anamnesis). He asks the patient to describe the symptoms in detail. In addition, the doctor asks whether other illnesses (past or present) are known, for example pneumonia, tuberculosis or a tumor. If so, the doctor will ask what therapies and medical interventions have been performed.
Physical examination
More precise indications are provided by tapping and listening to the chest (auscultation). Typically, in the case of pleurisy, a creaking breathing sound can be heard with the stethoscope, the so-called leather rubbing. In the case of pleurisy with pleural effusion (pleuritis exsudativa), however, the sound is only attenuated or no longer heard at all.
Imaging procedures
An X-ray examination of the chest (chest X-ray) is particularly important for diagnosing pleurisy. In most cases, the physician takes images of the chest from the front and from the side. A “dry” pleurisy is inconspicuous on the X-ray. A pleural effusion, on the other hand, is usually easy to identify.
The various imaging procedures not only help in the diagnosis of “pleurisy”. They often also serve to clarify the cause of the inflammation. For example, imaging can be used to visualize tuberculosis lesions or tumors.
Further examinations
If the doctor suspects that an autoimmune disease (such as lupus erythematosus) is causing the pleurisy, this can also be clarified by means of a blood test. This tests whether antibodies can be detected in the patient’s blood that mistakenly attack the body’s own tissue (such as the pleura) (autoantibodies).
In some cases, a reflection of the chest (thoracoscopy) is useful. In this procedure, the doctor makes a small opening in the chest wall and inserts a laparoscope over it. Among other things, it is equipped with a small camera and a light source. The doctor uses it to examine the pleural cavity from the inside.
Treatment
Any therapy for pleurisy includes treating the underlying disease.
In other cases, viruses (such as Coxsackie B viruses) are the trigger of pleurisy. Treatment here is limited to relieving the patient’s symptoms (painkillers, fever reducers). Drugs that specifically help against the viruses (like antibiotics against bacteria) are not available here.
Chest drainage is necessary, for example, when the pleural effusion is quite large and causes respiratory distress. The procedure is also performed in the case of a purulent effusion. Smaller, watery effusions, on the other hand, are usually removed by the body itself.
Since pleurisy can have various causes, there is no general answer to the question of whether it requires hospitalization.
Acute respiratory distress is always an emergency – in this case, call the emergency medical services.
Do home remedies help with pleurisy?
Pleurisy is usually a symptom of a more serious condition. Since there are different causes, no blanket home remedy that always works can be recommended. For example, home remedies such as a hot water bottle may help with one cause. In other cases, however, it is heat that worsens the symptoms.