Pleurisy: What Is It?
Pleurisy or pleuritis is the inflammation of the membranes that line your lungs and the inside of your chest wall. The pleura are made of two layers – the visceral pleura and the parietal pleura. The visceral pleura line your lungs, and the parietal pleura line the inside of your chest cavity. Between these two layers is a small space known as the pleural cavity. It contains a small amount of lubricating fluid that allows the two pleural layers to rub against each other smoothly. As you breathe, the double-layered pleura is meant to protect and lubricate the surface of the lungs. When healthy, the layers of the pleura glide smoothly across each other effortlessly. However, it is a different story if the pleura is infected and inflamed.
In pleurisy, these pleural membranes become infected. This could be due to an infection following a lung condition such as pneumonia, tuberculosis, a lung tumor, an autoimmune disease, and a chest injury, among others. Inflammation of the pleura makes the layers rough and causes severe pain as they rub against each other due to the friction.
The rubbing has often been described as being similar to that of sandpaper being rubbed--rough, harsh, and extremely painful.
Pleurisy can be categorized into two forms: wet pleurisy and dry pleurisy. Wet pleurisy is when the inflammation causes an exudative fluid to build up within the pleural cavity, whereas dry pleurisy is when there is no fluid build-up within the pleural cavity.
Viral infections have been found to be the most common cause of pleurisy and in most cases can be cured. Pleurisy can affect people of all ages but it has been seen that people over the age of 65 are at higher risk.
What Are The Signs and Symptoms?
- Pleuritic Chest Pain
The most common symptom of pleurisy is a sudden onset of chest pain. This is a sharp, stabbing pain associated with breathing. It is usually felt in the chest in the location of inflammation, but sometimes this pain can be felt in your shoulder or neck.
The pain is worse when breathing in because on inspiration, the lungs expand, and these pleural membranes come into contact, causing severe, sharp pain. Due to this reason, people with pleurisy tend to take shallow and rapid breaths to minimize their pain. Coughing and sneezing also exacerbate the pain.
Holding your breath, applying pressure to the area causing the pain, or lying on the side of the chest pain limits chest movements, and therefore, will reduce the pain. In some cases when fluid builds up within your pleural cavity, a condition known as pleural effusion, the pleural membranes get separated due to the fluid layer. This will reduce your pain. Therefore, keep in mind that just because the pain is reduced does not mean you have been cured completely; it could be a sign that your condition is worsening.
Pleural effusion can cause additional complications as there is a greater strain on the lungs. In severe cases, it can even lead to lung collapse.
- Shortness of Breath
You will feel that you are short of breath. This is because due to the pain, you tend to reduce breathing in and out.
You may also find it difficult to breathe when more fluid begins to build up within the pleural cavity. The presence of a large amount of fluid in the pleural cavity applies pressure to your expanding lungs to the point that it collapses, either partially or completely.
- Fever with chills
Fever is seen only in some cases of pleurisy.
Fluid building up in your pleural cavity causes you to cough, although this is only seen in some cases of pleurisy.
The other associated symptoms will vary from one person to another, depending on the cause of pleurisy.
- Other Possible Symptoms
- Shoulder and back pain
- Joint pain
- Muscle aches
The symptoms largely depend on the underlying infection.
For example, a person with pneumonia will complain of a high fever, productive cough with yellowish sputum, and difficulty in breathing. However, a person with a lung tumor will present an unexplainable weight loss, loss of appetite, cough, and sometimes a low-grade fever.
Pain in pleurisy is a very distinctive chest pain that gets aggravated by breathing in. However, it can be mistaken for that of heart disease.
Diagnosis of pleurisy usually begins with an examination of the pain point in the chest. It has been observed that the friction generated by the two inflamed layers can usually be heard using a stethoscope, upon the patient's respiration. This makes it easier to confirm pleurisy. Further on, blood tests are ordered to determine whether you have an infection and what caused it.
In the case of wet pleurisy, imaging tests such as an ultrasound, a chest x-ray, or a CT scan are conducted to see the extent of fluid collection in the cavity. Thoracocentesis, a process by which pleural fluid is extracted and analyzed, is also a must for pleural effusion. It helps determine the exact cause of the disease.
Prevention and Treatment
The prevention or treatment of pleurisy is largely dependent on understanding the underlying infection that has led to it. It is imperative that you report any kind of abnormality felt in the chest immediately before it has any chance of worsening.
Once the treatment has begun, it is recommended that adequate rest be taken so as to assist your body in the healing process. A healthy diet and lifestyle changes have been known to help as well.
Thanks to advancements in science, pleurisy is no longer the dread, deadly disease it once was. Today, deaths from this illness are few and far between, especially since it is now easy to determine the underlying infection.
However, one must be aware that although pleurisy is treatable and the prognosis is positive, there can be massive repercussions if the condition is left untreated and not caught in time. Common complications include hemothorax (blood collecting in the pleural cavity) and pneumothorax (collapsed lung).