Pleurisy is an inflammation of the membrane that separates your lungs from the chest wall. It can cause sharp and stabbing chest pain that worsens when you breathe or cough.
So what causes this painful inflammation of the pleura? How is pleurisy diagnosed? And most importantly, how can you find quick relief?
Emergency physicians use specific tests to confirm the condition and rule out serious complications that can mimic pleurisy’s symptoms.
How Is Pleurisy Diagnosed? Tests and Procedures
Pleurisy is diagnosed using imaging scans, laboratory tests, and physical exams to confirm inflammation and identify the underlying cause.
Your doctor may listen to your lungs with a stethoscope to detect abnormal sounds caused by the friction between the inflamed pleural layers.
Diagnostic tests used to confirm pleurisy include:
- Chest X-ray: First imaging test that reveals fluid buildup and other abnormalities in the lungs.
- CT scan: A more detailed imaging test that provides a clearer view of the pleura and surrounding structures.
- Ultrasound: In cases of pleural effusion (fluid buildup), an ultrasound can help locate the fluid and guide treatment.
- Blood tests: Blood tests can identify infections, autoimmune conditions, and inflammatory markers causing pleurisy.
- Thoracentesis: If fluid has accumulated in the pleural space, a sample may be taken using a needle for laboratory analysis.
Results interpretation typically takes 1-2 hours once all tests are complete, allowing doctors to confirm pleurisy and begin appropriate treatment based on the underlying cause.
Signs of Pleurisy You Shouldn’t Ignore
The primary symptom of pleurisy is sharp, stabbing chest pain, often worsening with deep breaths, coughing, sneezing, or even movement. However, pleurisy can present with additional symptoms, including:
- Shortness of breath: Due to the discomfort, patients may try to take shallow breaths, leading to breathing difficulties.
- Coughing: A dry, persistent cough.
- Fever: Depending on the underlying cause of the pleurisy, fever may be present.
- Pain that radiates: Pleuritic chest pain may extend to the shoulders or back, making it hard to determine the exact source of discomfort.
Pleurisy signs in children can be hardto identify. They may struggle to describe their pain, instead showing reluctance to move or play. Watch for short, shallow breathing patterns in your child, as it could be a sign they’re trying to minimize chest movement and avoid pain.
How Symptoms Guide Diagnostic Decisions
The timing and nature of chest pain provide crucial diagnostic clues that help doctors distinguish pleurisy from heart problems, muscle strain, or other chest conditions. Unlike heart attack pain that may come and go, pleurisy pain remains consistently sharp and predictable, always worsening with breathing, coughing, or movement.
Pain Pattern Recognition
Doctors specifically assess:
- Pain onset – Sudden versus gradual development over days
- Pain triggers – Movement, breathing, or coughing consistently worsens pleurisy pain
- Pain location – Usually one-sided rather than central chest pain
- Pain quality – Sharp and stabbing rather than crushing or burning
- Associated symptoms – Fever suggests infection, while isolated pain may indicate other causes
Patients often try to minimize chest movement unconsciously, leading to the characteristic shallow, rapid breathing pattern that doctors recognize during examination.
What Causes Pleurisy?
Several underlying conditions can lead to pleurisy, so identifying the root cause is essential for proper treatment. Common causes of pleurisy include:
- Viral infections: Respiratory viruses are among the most frequent causes of pleurisy. Influenza and other viral infections can trigger inflammation of the pleura.
- Bacterial infections: In some cases, bacterial infections such as pneumonia or tuberculosis can result in pleurisy. Bacterial pleurisy tends to be more severe and may require antibiotics for treatment.
- Pulmonary embolism: This occurs when a blood clot travels to the lungs, blocking blood flow and causing inflammation and pain in the pleura.
- Autoimmune disorders: Conditions like lupus or rheumatoid arthritis can cause inflammation of various body tissues, including the pleura.
- Lung cancer: Although less common, pleurisy can be a symptom of lung cancer, especially if a tumor presses against the pleura.
- Rib fractures or chest trauma: Physical injury to the chest can cause inflammation and lead to pleurisy.
- Heart failure: Fluid buildup in the lungs due to congestive heart failure can irritate the pleura and result in pleurisy.
Pleurisy Treatment
Pleurisy treatment focuses on reducing inflammation, managing pain, and addressing the underlying cause. Most patients experience symptom relief within 3-7 days of starting appropriate treatment, though complete recovery depends on the underlying condition.
1. Medications:
- Anti-inflammatory drugs: Anti-inflammatory drugs serve as the first-line treatment for most pleurisy cases. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, reduce both inflammation and pain.
- Antibiotics: If pleurisy is caused by bacterial infections, antibiotics are necessary to clear the infection. Common antibiotics include amoxicillin, azithromycin, or levofloxacin, with treatment typically lasting 7-14 days depending on the specific infection and severity.
- Antiviral medications: In cases where a viral infection is the culprit, antivirals may be used, although viral pleurisy often resolves on its own with supportive care.
- Steroids: For pleurisy associated with autoimmune conditions, corticosteroids may be prescribed to reduce inflammation.
- Pain management: Depending on the severity of the pain, stronger prescription pain relievers may be recommended.
Always consult your doctor before starting any medication for pleurisy symptoms.
2. Drainage of fluid (Thoracentesis):
If pleurisy leads to significant fluid buildup in the pleural space (pleural effusion), draining the fluid can alleviate pain and improve breathing. In some cases, a chest tube may be inserted to continuously drain the fluid.
3. Treatment of underlying conditions:
Long-term success requires addressing the root cause of pleurisy. Treatment approaches vary significantly based on the underlying condition:
- Pneumonia treatment – Antibiotics plus respiratory support until infection clears
- Autoimmune disease management – Long-term immunosuppressive medications
- Pulmonary embolism – Blood thinners and clot-dissolving medications
- Heart failure – Diuretics and cardiac medications to reduce fluid buildup
Most patients recover completely with appropriate treatment, though those with chronic conditions may experience recurring episodes requiring ongoing management.
Complications of Pleurisy
While pleurisy can often be managed effectively, it can lead to complications, especially if left untreated. The most common complications include:
- Pleural effusion: Fluid accumulation in the pleural space, which can cause difficulty breathing and may require medical intervention.
- Atelectasis: This occurs when part of the lung collapses due to pressure from fluid buildup, leading to breathing difficulties.
- Empyema: If the fluid in the pleura becomes infected, it can turn into pus, leading to a serious condition called empyema that often requires drainage and antibiotics.
Pleurisy Prevention
While it’s not always possible to prevent pleurisy, certain measures can reduce your risk:
- Vaccination: Stay up-to-date with vaccinations for pneumonia, influenza, and other respiratory infections.
- Timely treatment of infections: Address respiratory infections promptly to reduce the risk of them spreading to the pleura.
- Manage chronic conditions: For individuals with autoimmune diseases, regular treatment and monitoring can help prevent inflammation of the pleura.
If you or a loved one is experiencing signsof pleurisy, seek medical attention for appropriate care and treatment.
At ER of Fort Worth, we provide expertmedical care, with on-site imaging and clinical laboratory services.
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FAQs
What helps pleurisy go away?
Treatment for pleurisy depends on the underlying cause, such as antibiotics for infections or anti-inflammatory medications for pain relief. Rest, proper hydration, and addressing the root condition are key to recovery.
Is pleurisy an emergency?
Pleurisy can be an emergency if accompanied by severe symptoms like difficulty breathing, high fever, or chest pain that worsens rapidly.
How to sleep with pleurisy?
To sleep with pleurisy, try lying on the side that causes less pain, which can help reduce discomfort from breathing movements. Elevating your upper body may also ease pressure on the chest and improve breathing. However, you should promptly visit your doctor to avoid complications.
Is pleurisy contagious?
No, pleurisy itself is not contagious. However, underlying infections that cause pleurisy (like viral or bacterial pneumonia) may be contagious.
