Section 4. Lung and Airway Disorders

Chapter 52. Pleural Disorders

Topics: Introduction | Pleurisy | Pleural Effusion | Pneumothorax

Pleurisy

Pleurisy is inflammation of the pleura.

Pleurisy develops when something (usually a virus or bacterium) irritates the pleura, resulting in inflammation. Certain autoimmune diseases (such as systemic lupus erythematosus) can irritate the pleura. Pleurisy may also develop when cancer spreads from the lung or another part of the body to the pleura, irritating it. Inhalation of asbestos can also cause pleurisy, as can (rarely) the use of certain drugs, such as nitrofurantoin or procainamide. Fluid may accumulate in the pleural space (a condition called pleural effusion), or fluid may not accumulate (a condition called dry pleurisy). After the inflammation subsides, the pleura may return to normal, or adhesions may form that make the pleural layers stick together.

Symptoms and Diagnosis

The most common symptom of pleurisy is chest pain (pleuritic pain), which may begin suddenly. The pain varies from vague discomfort to an intense stabbing pain. It may be felt only when the person breathes deeply or coughs, or it may be felt continuously but may be worsened by deep breathing and coughing. The pain results from inflammation of the outer layer of pleura and is usually felt in the chest wall right over the site of the inflammation. However, the pain may be felt also or only in the upper abdominal region or neck and shoulder as referred pain (see Section 6, Chapter 78).

Breathing may be rapid and shallow because deep breathing induces pain; the muscles on the painful side move less than those on the other side. If a large amount of fluid accumulates, it may separate the pleural layers, so the chest pain disappears. Large amounts of fluid can cause difficulty in expanding one or both lungs when breathing, causing respiratory distress.

Pleurisy is often easy for doctors to diagnose because pleuritic pain is so distinctive. Using a stethoscope, a doctor may hear a squeaky to-and-fro rubbing sound, called a pleural rub. Even though a chest x-ray will not show pleurisy, it may reveal a small accumulation of fluid in the pleural space or give clues to a cause.

Treatment

The treatment of pleurisy depends on the particular cause. If the cause is a bacterial infection, antibiotics are prescribed. If the cause is a viral infection, no treatment is needed for the infection. If the cause is an autoimmune disease, such as systemic lupus erythematosus, treatment with corticosteroids often quickly cures the pleurisy.

A nonsteroidal anti-inflammatory drug (NSAID) (see Section 6, Chapter 78) usually helps relieve the chest pain of pleurisy, regardless of its cause. Codeine and other opioids are stronger pain relievers, but they tend to suppress coughing, which is not a good idea because deep breathing and coughing help prevent lung collapse and subsequent pneumonia. Thus, a person with pleurisy is encouraged to breathe deeply and cough as soon as breathing becomes less painful. Coughing may be less painful if the person or a helper holds a pillow firmly against the part of the chest that hurts. Wrapping the entire chest in wide, nonadhesive elastic bandages may help relieve severe chest pain. However, binding the chest to reduce expansion during breathing increases the risk of lung collapse (atelectasis) and pneumonia.