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Pleurisy
 

Introduction

     Pleurisy is an inflammation of the lining of the lungs that causes pain when you take a breath or cough.

Causes

 

  • Infections:

    1. Viruses

    2. Bacteria

    3. Parasites

    4. Fungi

    5. Mycoplasma

      6.

    6. Tuberculosis

  • Connective tissue diseases:

    1. Systemic Lupus Erythematosus

    2. Rheumatoid Arthritis

  • Organ failures:

    1. Pancreatitis

    2. Liver failure -- Cirrhosis

    3. Kidney or renal failure -- uremia, nephritic syndrome

  • Cancers:

    1. Breast Cancer

    2. Bronchogenic Carcinoma

  • Chemicals:

- Asbestos

  • Other:

- Pulmonary Emboli -- blood clot to the lungs

Symptoms

   

  • Fever

  • Cough

  • Chills

  • Shortness of breath

  • Weight loss

  • Poor appetite

  • Sharp chest pain with breathing.  Pain can limit the movement on the side of the chest with pleurisy.

  • Rapid shallow breaths

  • Inability to take a deep breath due to chest pain

Screening and Diagnostics

  • History:

    1. Symptoms

    2. Medications

    3. Illnesses

    4. Surgeries

    5. Allergies

    6. Occupation

    7. Travel

    8. Habits

  • Exam:

    1. Body temperature may be elevated

    2. Rapid respiration

    3. Normal chest expansion during respiration is affected.

    4. Listening to the chest with a stethoscope, the doctor will hear the friction rub (i.e., creaky, coarse, rubbing sound).

    5. The heart sound and breath sounds may be muffled due to presence of effusion.

  • Tests:

    1. Blood tests may show evidence of infection -- elevated number of white blood cells and ESR.

    2. Blood may show evidence of cancer -- elevation of CA-125 (Ovarian Cancer), CA-19-9 (Pancreatic Cancer and others)

    3. Blood may show organ failure:

       

      • High BUN/Creatinine -- Kidney failure

      • High liver or pancreatic enzymes

      • Low oxygen levels

       

    4. Chest X-Ray -- Pneumonia, asbestos

    5. CAT scan (using computers) and Ultrasound (using sound) can show fluid or effusion.

    6. Thoracentesis -- done by inserting a needle into the pleura.  The removed effusion can then be sent to a laboratory for analysis.

Treatment

  • Treat underlying disorder

  • Rest

  • Oxygen, if levels are low

  • Aspirin and other NSAIDs (e.g., Ibuprofen, Indocin, etc.) are effective in reducing the inflammation, fever, and pain.

  • Painkillers such as codeine can help.

  • In severe pain, a nerve block is performed using a numbing agent (e.g., Xylocaine) that is injected into the nerves between the ribs for temporary relief of pain.

  • Therapeutic Thoracentesis is done to remove the effusion, which helps breathing.

Prognosis

     Recovery depends on what is causing the pleurisy.

Complications   

  • Breathing difficulty

  • Complications associated with the original illness

  • Collapsed lung due to thoracentesis

Prevention   

     Early treatment of bacterial respiratory infections can prevent pleurisy.
 
 

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