Pleurisy

Pleurisy, also known as pleuritis, is the inflammation of the pleurae, the membranes surrounding the lungs and lining the chest cavity. This condition can lead to sharp chest pain during breathing, which might also become a constant dull ache. It is frequently associated with other symptoms like shortness of breath, cough, fever, or weight loss, depending on the cause. The commonest cause is a viral infection, but bacterial infections, pneumonia, and pulmonary embolism are also potential culprits.

Signs and Symptoms

The hallmark symptom of pleurisy is a sudden sharp, stabbing, burning, or dull pain in the chest during breathing. This pain worsens with deep breaths, coughing, sneezing, or laughing, and may radiate to the shoulder or back. Other symptoms can include a dry cough, fever and chills, rapid shallow breathing, shortness of breath, fast heart rate, and sore throat followed by joint pain and swelling.

Related Problems

Complications can affect the pleural space, including pleural effusion, pneumothorax, and hemothorax. Pleural effusion, the buildup of excess fluid in the pleural space, may ease the chest pain but can lead to lung collapse and difficulty in breathing. Pneumothorax, the accumulation of air or gas in the pleural space, can also cause lung collapse and is characterised by sudden pain and shortness of breath. Hemothorax, the collection of blood in the pleural space, often results from chest injuries and can cause lung collapse and shock.

Causes

Pleurisy can be caused by various conditions. Viral infections are the most common cause, but other causes include bacterial infections, pneumonia, pulmonary embolisms, autoimmune disorders (such as lupus and rheumatoid arthritis), lung cancer, chest injuries, and certain medications.

Diagnosis

Diagnosing pleurisy involves a combination of medical history, physical examination, and diagnostic tests. During a physical examination, a doctor might detect pleural friction rub using a stethoscope. Additional diagnostic tests can include:

• Chest X-ray: To detect air or fluid in the pleural space and potential causes like pneumonia or lung tumours.
• Blood Tests: To identify bacterial or viral infections, pneumonia, rheumatic fever, or other underlying conditions.
• ECG: To rule out heart conditions.
• Ultrasound, CT, and MRI: To locate fluid, detect tumours, and provide detailed images of the lungs and pleural space.
• Arterial Blood Gas: To assess oxygen and carbon dioxide levels.
• Thoracentesis: To remove and analyse pleural fluid.
• Biopsy: To diagnose tuberculosis or cancer.

Treatment

Treatment aims to relieve symptoms, remove fluid, air, or blood from the pleural space, and address the underlying cause. Procedures such as thoracentesis or chest tube insertion can drain fluid or air. Medications like paracetamol (acetaminophen), ibuprofen, and codeine-based cough syrups can manage pain and cough. In cases of infected pleural fluid, antibiotics or antifungal medications are necessary. Pleurodesis may be used to prevent recurrent fluid buildup in cancer patients.

Lifestyle Changes

Managing pleurisy can also involve lifestyle changes such as lying on the painful side for comfort, breathing deeply and coughing to prevent pneumonia, and getting adequate rest.

Alternative Treatments

Some alternative treatments are being looked at for their anti-inflammatory properties, like extracts from the Brazilian folk remedy Wilbrandia ebracteata ("Taiuia"), which have shown promising results in reducing pleural inflammation in laboratory studies.

Prognosis

While pleurisy can be serious, the prognosis is generally excellent with appropriate treatment. Early diagnosis and treatment of the underlying cause are very important for full recovery.

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Self-assessment MCQs (single best answer)

What is pleurisy?

Which of the following is a common cause of pleurisy?

What is the hallmark symptom of pleurisy?

What can pleural effusion lead to in severe cases?

Which diagnostic test is primarily used to detect air or fluid in the pleural space?

What is thoracentesis?

Which of the following medications can be used to manage pain and cough in pleurisy?

What is pleurodesis used for?

Which of the following lifestyle changes can help manage pleurisy?

What is the general prognosis for pleurisy with appropriate treatment?