- Chronic pleurisy is the chronic inflammation of the pleural membranes with or without a pleural effusion.
- Patients develop a sharp stabbing pain.
- The outcomes will vary.
What is Pleurisy?
Pleurisy, also known as pleuritic is when the pleural membranes lining your lungs and chest cavity rub against each other causing a sharp stabbing pain that exacerbates while you breathe in.
Pleurisy can be categorized as acute or chronic pleurisy depending on the duration of the illness.
Chronic pleurisy is the chronic inflammation of pleural membranes with or without a pleural effusion.
What can Cause Chronic Pleurisy?
Chronic conditions like tuberculosis, lung tumors and autoimmune disorders like rheumatoid arthritis and lupus can be causes of chronic pleuritis. Pleurisy can also be associated with a condition known as pneumothorax where a problem associated with punctured lung appears such as an air leakage into the pleural cavity. The causes for this condition can be a chest injury that involves a broken rib or a tumor in the pleura.
What are the Symptoms?
These patients develop a sharp stabbing pain on one side of the chest which worsens while breathing. It is more painful on inspiration and therefore, these people tend to take rapid shallow breaths. This pain may radiate to the shoulder. It reduces when pressure is applied to the painful area and by holding one's breath. Difficulty in breathing is also experienced because of the pain.
Cough is another symptom of pleuritic, especially if there is fluid build-up within the pleural cavity. Coughing itself exacerbates the pain because as you cough, it causes the inflamed pleura to rub against each other and result in a severe sharp pain. Pleural effusion or the building up of fluids in the pleural spaces can result in a condition known as empyema. Empyema is the condition in which the extra fluid becomes infected and it is often accompanied by a fever.
Chronic pleurisy is a condition that troubles patients for a long time. Hence these individuals will have an unexplainable weight loss and decrease in body strength. They will complain of loss of appetite, fever in the evening, night sweats and irregular bowel movements.
What Physical Signs are Observed During Examination?
The chest may appear flat or slightly retracted on the affected side. When your doctor listens to your lungs, reduced breath sounds and a crackling friction sound may be heard. This is produced by the rubbing of pleural membranes.
How is it Diagnosed?
A good detailed medical history will be more than enough to make the diagnosis of chronic pleurisy.
Various methods that help in diagnosis of the disease are:
• Chest X-Rays: Chest X-rays help in the detection of any kind of inflammation in the lungs. A decubitus chest X-ray is also recommended which is done when the patient is lying on his side allowing the free fluid to form a layer.
• Blood Tests: Blood tests help in determining the infection or its underlying cause. It also helps in revealing any kind of disorders related to the immune system.
• Thoracentesis: During this procedure, a needle is inserted into the region where imaging tests are positive for fluidbuild-up. This fluid is then removed and analyzed for the presence of infections. This test is invasive in nature and has various risks associated with it. Hence this is done quite rarely.
• Computed Tomography scan: Computed Tomography scan provides a series of detailed cross sectional images of the inside of chest in order to get a closer look at the inflamed tissue.
• Ultrasound: High-frequency sound waves are also used to create an image of inner chest cavity that helps the doctor to confirm if there is a fluid build-up.
• Biopsy: This is conducted if cancer is seen as a possible cause of the disease. Also, it is done in the case of dry pleurisy or when fluid analysis fails to provide any information. The exact sites for biopsy are confirmed using an X-ray or CT scan. After this, small incisions are made in the skin of the affected area using sterile procedures and a small tissue sample is collected using a biopsy needle. The tissue is then analysed for infections or any abnormal growth.
• Thoracoscopy: A small incision in the chest wall area is made in this procedure. Then a camera is attached to a tube and inserted into the pleural cavity to locate the inflamed tissue and for the samples to be collected for further analysis in the laboratory.
Can you Treat Chronic Pleurisy?
Yes, it can be treated. The important thing is treating the underlying cause of the pleuritic. For instance, if it is due to a pneumonia, the pneumonia should be treated with antibiotics. Adequate rest is also recommended to fasten the healing process. Also, lying on the side that has pain helps in easing out the pain by creating enough pressure on the painful area.
Other measures you can follow are:
• Analgesics such as paracetamol and NSAIDS to reduce the pain.
• Cough medication for cough.
• Antipyretics such as Acetaminophen to reduce the fever.
• Medications that help in breaking up any blood clots or mucus.
• Bronchodilators are also used during the treatment.
• Patients with pleural effusion are treated with a drain tube in the chest to drain out the excessive fluid.
Acupuncture and botanical medicines are alternative ways to lessen the pleural pain and problems associated with breathing. Contrast hydrotherapy in combination with the compresses applied to chest and back helps fasten the healing process. Herbs such as pleurisy root (Asclepias tuberose) also helps in easing out pain and breathing difficulties associated with pleurisy. This herb is used in combination with other herbs such as mullein to clear the mucus from lungs.
Additionally, including fresh fruits, vegetables and adequate proteins are recommended for the patients. Omega-3 fatty acids that have anti-inflammatory properties (prevent inflammation) are found in fish and flax seeds. They are also recommended and should be included in the diet. The outcome of pleuritis will vary from person to person. It basically depends on the duration of the illness, the cause, the previous history of the patient and his or her general health conditions.