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Pleurisy is a condition where the pleura become inflamed. The pleura is a thin membranous tissue that lines the outside of the lung and the inside of the chest cavity. Pleurisy, also known as pleuritis, can be caused by numerous conditions.

Causes

When the pleura become inflamed or irritated, these two tissue layers begin to rub against each other and this produces pain when breathing in and out. This pleuritic pain tends to decrease or stop when the breath is held.

Pleurisy can be caused by:

  • A bacterial infection (pneumonia).
  • A viral infection (influenza).
  • A fungal infection.
  • Rib fracture.
  • Certain medications.
  • Rheumatoid arthritis.
  • An inherited disease such as sickle cell anaemia.
  • Lung cancer near the pleural surface.

Symptoms

The symptoms and signs of pleurisy may include:

  • Shortness of breath due to trying to reduce the amount of inhaling and exhaling.
  • Chest pain that gets worse with sneezing, coughing or breathing.
  • In some cases, a fever or a cough.
  • Pleurisy might also refer to the shoulders or the back.
Fluid can buildup in the space between the two mentioned layers of pleura and the affected person will develop a pleural effusion. A reasonable amount of pleural fluid will decrease pleurisy because the two irritated layers aren't in contact with each other anymore, but a large amount of pleural fluid can compress the lung to a point where it can result in collapse of the organ. The pleural fluid can also become infected and this is then called an empyema.

Diagnosis

To diagnose pleurisy, a doctor may request:

  • Blood tests - to look for signs of an infection or autoimmune condition.
  • Chest X-ray - to check if the lungs are inflating completely, or if there is fluid or air between the ribs and lungs.
  • Ultrasound - can be done to look for a pleural effusion.
  • CT scan - to get more detailed images to look for blood clots in the lungs or detect other causes of pleurisy.
  • Electrocardiogram (ECG or EKG) - this investigation may be done to rule out possible heart-related issues as a cause of the chest pain. 
  • Thoracentesis - here, pleural fluid is collected in order to be sent for laboratory analysis. A local anaesthetic is injected between the ribs around the area where fluid was noticed on imaging studies, and the doctor inserts a needle with a syringe to remove the fluid.
  • Thoracoscopy or pleuroscopy - if cancer or tuberculosis is a suspected reason for the pleurisy and pleural fluid development, then the specialist will perform a procedure where they can directly visualize the inside of the chest. Here, they will look for any problems or abnormalities, or attempt to obtain a tissue specimen/biopsy if it's needed.

Treatment

The treatment of pleurisy, and of pleural fluid accumulation, will depend on the cause of the condition. So, if a bacterial pneumonia is the reason behind the symptoms, then a course of antibiotics will be prescribed in order to manage the infection. If the cause is of viral origin, then the pleuritic pain tends to resolve on its own.

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