Pleurisy

Pleurisy symptoms

The main symptom of pleurisy, or other problems that affect the pleura, is 'pleuritic' chest pain. This is usually a sharp stabbing pain.

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 by coughing, as this causes the two parts of the inflamed pleura to rub over each other.

Other symptoms of pleurisy

If the inflammation of your pleura is caused by a more serious cause you are likely to have other symptoms. These symptoms include:

• 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.

How long do pleurisy symptoms last?

This depends on the cause. Pleurisy caused by a virus usually settles within a few days. If it's caused by something else, it can take longer.

When to see a doctor

Speak to a doctor if you have symptoms of pleurisy. It can be difficult to tell if chest pain is due to something serious, so it's best to err on the side of caution.

You should get emergency medical help. Call 999 (if in the UK), or go to your nearest Emergency Department) if you have:

• Severe chest pain.
• Coughing up blood.
• Breathlessness or other breathing difficulties.

Diagnosing pleurisy

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.

How do you test for pleurisy?

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.

How serious is pleurisy?

This depends on the cause.

Viral pleurisy isn't serious. It gets better after a few days and doesn't cause serious problems.

Other causes of pleurisy can be serious. For example, major lung infections (pneumonia) and blood clots on the lung (pulmonary emboli) can be life-threatening.

Pleurisy treatment

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) or a blood clot in the lung (pulmonary embolism), the treatment depends on the cause. Other treatments may include:

• Antibiotics, for bacterial lung infections such as pneumonia.
• A procedure to drain fluid from around the lung, if there is a collection of fluid there (a pleural effusion).
• Blood thinners, for a blood clot on the lung (pulmonary embolism).

What is the pleura?

Lungs and airways with 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 causes 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). This is the most common serious cause of pleuritic chest pain.
• Chest injuries.
• A collapsed lung (pneumothorax).
• Lung cancer.
• Inflammation associated with some forms of arthritis.

Is pleurisy contagious?

This depends on the cause. Although pleurisy itself isn't contagious, some of the causes of pleurisy, like viral and bacterial infections, are contagious. Others - like blood clots in the lung or lung cancer - can't be spread from person to person.

Can I prevent pleurisy?

It's difficult to prevent pleurisy completely. But there are some things that can reduce the chances of developing one of the causes of pleurisy, such as:

• Getting vaccinations when recommended (eg the flu vaccine).
• Hygiene, such as washing your hands after using the toilet, before preparing or eating food, before touching your face, and before and after caring for other people. This can reduce the chances of getting viral or bacterial infections.
• Avoiding or stopping smoking. Smoking increases the risk of lung infections and other serious causes of pleurisy, like lung cancer.
• Maintaining a healthy weight. Having overweight or obesity increases the risk of blood clots.

Pleurisy complications

This depends on the cause of pleurisy. Viral pleurisy normally improves without any treatment. Other more serious causes of pleurisy, such as bacterial infections, can cause complications like:

• Fluid around the lung (a pleural effusion).
• Pus collecting around the lung with bacterial pneumonia (an empyema).
• A trapped lung that won't inflate fully (atelectasis).
• Sepsis, with bacterial infections.
• Breathing difficulties.