Symptoms

The leading symptom of pleurisy is a breath-dependent pain. This pain can be localized throughout the entire chest and is particularly pronounced during inhalation. If pleurisy is accompanied by a highly pronounced accumulation of fluid in the pleural space (pleural effusion), in some cases there is no pain at all, as the pleural leaves do not rub directly against each other.

The effusion can also lead to difficult breathing with respiratory distress. In the dry form without or with only slight effusion, however, the pleural leaves rub directly against each other and thus lead to a typical auscultation finding in addition to severe pain: when breathing in, the examiner hears a so-called “leather creaking” with a stethoscope. In addition to these symptoms, fever, fatigue, shortness of breath, coughing and a reduced general condition can also be symptoms of pleurisy.

The duration of the symptoms of pleurisy varies greatly. It depends on the underlying disease that triggered the inflammation and when an adequate therapy was initiated. A pleurisy due to a flu-like infection usually heals without consequences after a few weeks with appropriate therapy.

Inflammation of the pleura due to a malignant underlying disease can be much more difficult to treat. If the inflammation lasts longer, scars can form between the pleura and the lung, which permanently restrict breathing. Pain is mainly caused by dry pleurisy.

When breathing, the layers of the pleura rub against each other and cause stabbing and burning pain. Those affected therefore breathe short and shallow. If the inflammation and irritation of the pleura persists for a longer period of time, fluid can form that accumulates in the space between the pleura and the lung, resulting in a so-called pleural effusion and a wet pleurisy.

From this moment on, patients no longer have any pain. With appropriate treatment and administration of painkillers, the symptoms usually also disappear after a few days. Adequate pain therapy is essential for healing.

It is important that patients breathe well in order to ventilate their lungs sufficiently.Due to pain, this is often not possible in the case of dry pleurisy, so painkillers should be taken. The basic diagnosis consists of taking a medical history and describing the typical symptoms, such as pain or a feeling of pressure in the chest, relieving posture or shortness of breath. During the physical examination using a stethoscope, the doctor listens for altered breathing sounds of the patient.

In dry pleurisy, the typical pleural rubbing (leather creaking) can be heard, whereas in the wet form the breathing sounds may be attenuated. Ultrasound may reveal a pleural effusion and an irregular lung contour as signs of the inflammation. In addition, fever, laboratory values and especially the inflammation values such as the CRP value can give indications of pleurisy.

If the exact cause is not known, an X-ray of the lungs is taken to rule out pneumonia. Recently, the imaging of the lung by MRI has made great progress, so that in special cases an MRI of the lung should also be considered. In order to exclude a pulmonary embolism, a vascular imaging in the legs can be helpful and in the case of persistent inflammation and high fever, a blood culture and a pleural puncture are performed.

During this procedure the pleural effusion is punctured and the material is examined for bacteria, viruses, fungi and tumor cells. In this way the cause can often be found. However, this invasive measure is only necessary if the symptoms do not improve.

An uncomplicated pleurisy does not need to be punctured. X-rays and ultrasound are among the diagnostic methods used to diagnose pleurisy. In pleurisy, a small amount of fluid (pleural effusion) usually forms between the lungs and diaphragm. In an X-ray image taken using the hard beam technique, a radiologist can assess how much of the fluid is present. With this imaging technique, the bones are poorly exposed and soft tissue is well exposed.