Pleurisy
Pleurisy is due to inflammation of the pleura next to the lung. It is most often caused by infection with a germ (a viral infection). In these cases the pain can be severe but soon goes. Various other lung disorders can also cause a 'pleuritic pain' similar to pleurisy. A pleuritic pain is a chest pain which is typically sharp and 'stabbing' in a part of the chest. The pain is usually made worse when you breathe in or cough.
What is pleurisy?
Pleurisy means inflammation of the pleura. Pleurisy, or other problems that affect the pleura, can cause a 'pleuritic' chest pain. This is usually a sharp stabbing pain.
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You may feel a pleuritic chest pain anywhere in the chest depending on the site of the inflammation, or problem with the pleura. The pain is made worse by breathing in, or coughing, as this causes the two parts of the inflamed pleura to rub over each other.
You may have other symptoms, depending on the cause of the pleurisy.
What is the pleura?
The pleura is a thin membrane with two layers. One layer lines the inside of the chest wall. The other layer covers the lungs.
Between the two layers of pleura (the pleural cavity) is a tiny amount of fluid. This helps the lungs and chest wall to move smoothly when you breathe.
What are the causes of pleurisy?
Causes of pleurisy include:
- Viral infection (the most common cause) - pain typically lasts a few days and goes as the virus clears away and the inflammation settles.
- Bacterial infection (commonly bacterial pneumonia).
- Fungal infection (more common in people with a weakened immune system).
- Blood clots in the lung (pulmonary embolism).
- Chest injuries.
- A collapsed lung (pneumothorax).
- Lung cancer.
- Inflammation associated with some forms of arthritis.
If the inflammation of your pleura is caused by a more serious cause you are likely to have other symptoms. See a doctor if any of the following occur with a pleuritic chest pain:
- Pain that develops slowly over several days or weeks.
- Pain that does not ease and go after a few days.
- Breathlessness (shortness of breath) or other breathing difficulties.
- Coughing up blood.
- Any other symptom that you are unsure of, or cannot explain.
Do I need any tests?
The most important thing when diagnosing the cause of a pleuritic pain is for a doctor to talk to you about your symptoms and to examine you. Most of the causes of the more serious causes of pleuritic pain will have other symptoms apart from the pain, as mentioned above. A doctor's examination may also show up some signs which may point to the cause.
A doctor may arrange tests such as a chest X-ray if you develop pleuritic pain and the cause is not clear. A chest X-ray is normal in the common infection with a germ (a viral pleurisy) but may show up abnormalities when there are some other causes of the pain. Other tests are sometimes done if a serious cause is suspected.
What is the treatment for pleurisy?
If you have an infection with a germ (a viral pleurisy), take painkillers regularly until the pain eases. Your doctor may prescribe stronger painkillers if the pain is severe.
If you have other causes of pleuritic pain, such as a serious lung infection (pneumonia), blood clots in the lung (pulmonary embolism), etc, the treatment depends on the cause.
Further reading and references
BTS Pleural Disease Guidelines; British Thoracic Society (2010) - BMJ
Chest pain of recent onset; NICE Clinical Guideline (March 2010, updated Nov 2016)
Kass SM, Williams PM, Reamy BV; Pleurisy. Am Fam Physician. 2007 May 175(9):1357-64.
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