Overview

Pleurisy, also known as pleuritis, is a condition characterized by inflammation of the pleura—the double-layered membrane surrounding the lungs and lining the chest cavity. Under normal circumstances, the pleura helps the lungs glide smoothly against the chest wall during breathing. However, when inflamed, these layers rub together, causing sharp chest pain, especially during inhalation.

Although pleurisy can affect individuals of any age, it is often a complication of another underlying medical condition. With timely diagnosis and appropriate treatment, pleurisy can be managed effectively, and many people recover fully.

Main symptoms

The hallmark symptom of pleurisy is chest pain that worsens when breathing deeply, coughing, or sneezing. The pain is typically:

  • Sharp or stabbing in nature

  • Localized to one side of the chest

  • Made worse by movement or breathing

Other symptoms may include:

  • Shortness of breath

  • Dry or productive cough

  • Fever and chills (if an infection is present)

  • Pain in the shoulder or upper back

  • Rapid, shallow breathing to minimize discomfort

In some cases, fluid may accumulate between the pleural layers, causing pleural effusion, which can reduce pain but lead to more difficulty breathing.

Causes

Pleurisy is not a disease itself but a symptom of various underlying conditions. Common causes include:

  • Viral infections: The most frequent cause of pleurisy, especially flu and other respiratory viruses.

  • Bacterial infections: Such as pneumonia or tuberculosis.

  • Fungal infections: Though less common, fungal pathogens can inflame the pleura.

  • Pulmonary embolism: A blood clot in the lungs can lead to pleuritic pain.

  • Autoimmune diseases: Conditions like lupus or rheumatoid arthritis can trigger pleural inflammation.

  • Lung cancer or mesothelioma: Can irritate or invade the pleura.

  • Chest trauma: Injury to the rib cage or lungs may inflame the pleura.

  • Certain medications: Like procainamide or hydralazine, which can induce drug-related lupus.

Risk factors

Factors that may increase the risk of developing pleurisy include:

  • Recent respiratory infection

  • Smoking

  • Chronic illnesses such as lupus or arthritis

  • Exposure to asbestos

  • Immune system suppression

  • Blood clotting disorders

How it’s diagnosed

Diagnosis of pleurisy usually begins with a thorough physical examination and a review of medical history. Diagnostic steps may include:

  • Auscultation: Listening to the lungs with a stethoscope to detect the characteristic friction rub of inflamed pleura.

  • Chest X-ray: To check for pneumonia, lung tumors, or pleural effusion.

  • CT scan: Provides a more detailed view of the lungs and pleura.

  • Ultrasound: Helps detect fluid between the pleural layers.

  • Blood tests: Can identify infections, autoimmune markers, or signs of inflammation.

  • Thoracentesis: A procedure to remove and analyze pleural fluid for diagnosis.

  • Electrocardiogram (ECG): To rule out cardiac causes of chest pain.

Possible complications

While pleurisy itself can be painful, the real concern lies in its complications:

  • Pleural effusion: Accumulation of fluid that can compress the lungs.

  • Empyema: Pus collection in the pleural space due to infection.

  • Atelectasis: Collapse of lung tissue from pressure or shallow breathing.

  • Sepsis: If the underlying infection spreads into the bloodstream.

Early treatment reduces the likelihood of complications.

Treatment options

Treatment of pleurisy depends on its cause.

  • Viral pleurisy: Often resolves on its own; supportive care with rest, fluids, and anti-inflammatory medication is recommended.

  • Bacterial pleurisy: Requires antibiotics targeting the specific pathogen.

  • Autoimmune pleurisy: Managed with corticosteroids or other immunosuppressants.

  • Pleural effusion: May require thoracentesis or a chest tube for drainage.

  • Pain management: NSAIDs like ibuprofen or stronger analgesics may be prescribed.

  • Cough suppressants: To reduce pain caused by coughing.

Home care and recovery

While under treatment, certain lifestyle modifications can aid recovery:

  • Rest and avoid strenuous activities

  • Take medications as prescribed

  • Use hot compresses on the chest to ease pain

  • Practice deep breathing exercises to prevent lung collapse

  • Elevate the upper body while sleeping to ease breathing

Full recovery may take days to weeks depending on the severity and underlying cause.

Prevention

You can reduce the risk of developing pleurisy by:

  • Treating respiratory infections promptly

  • Getting vaccinated against influenza and pneumonia

  • Avoiding smoking and exposure to secondhand smoke

  • Managing chronic diseases like lupus or arthritis effectively

  • Avoiding exposure to asbestos and other lung irritants

When to seek help

Seek immediate medical attention if you experience:

  • Sudden, intense chest pain when breathing

  • Shortness of breath

  • High fever or chills

  • Persistent cough

  • Signs of infection (green/yellow sputum, extreme fatigue)

Prompt treatment can prevent complications and ensure quicker recovery.

Living with pleurisy

While pleurisy can be alarming, especially due to sharp chest pain, it is often treatable. Many people recover completely, especially if the cause is viral or bacterial. For those with chronic underlying diseases, managing the root condition is key to preventing recurrence.

Emotional support and education about the illness also play a crucial role in recovery. Breathing exercises, physical therapy, and lifestyle adjustments can help patients regain confidence and normal function.