Overview

Pleuritis, also known as pleurisy, is a medical condition characterized by inflammation of the pleura, the thin membrane that lines the lungs and the inner chest wall. The primary symptom of pleuritis is sharp chest pain that worsens with breathing, coughing, or sneezing. This condition can arise from a variety of underlying causes, including infections, autoimmune disorders, or injury to the chest. While pleuritis can be painful and alarming, it is often treatable with proper medical care. Early diagnosis and management are essential to address the underlying cause and prevent complications like pleural effusion (fluid buildup in the pleural space).

Causes

Pleuritis can develop due to numerous factors that trigger irritation or inflammation of the pleural membranes. Common causes include:

• Viral Infections: Respiratory viruses, such as influenza or COVID-19, are among the most frequent causes of pleuritis.
• Bacterial Infections: Pneumonia and tuberculosis can lead to pleural inflammation.
• Autoimmune Disorders: Conditions like lupus, rheumatoid arthritis, and systemic sclerosis can cause pleuritis as part of their systemic inflammation.
• Pulmonary Embolism: Blood clots in the lungs can irritate the pleura and lead to pleuritic chest pain.
• Chest Trauma: Injury to the chest wall, such as rib fractures or blunt force trauma, can cause pleuritis.
• Lung Cancer or Metastasis: Tumors involving the pleura may cause persistent pleuritic pain.
• Medications: Certain drugs, including some chemotherapy agents and heart medications, have been associated with pleural inflammation.
• Other Causes: Conditions like pancreatitis or uremia (advanced kidney disease) may also result in pleuritis.

Symptoms

The hallmark symptom of pleuritis is chest pain, but other associated symptoms can occur depending on the underlying cause:

• Sharp Chest Pain: Typically localized on one side, worsens with deep breaths, coughing, or sneezing.
• Pain Radiating to Shoulder or Back: Sometimes pleuritic pain can extend to the shoulder or upper back.
• Shortness of Breath: Breathing may become shallow to avoid exacerbating the pain.
• Cough: A dry or productive cough may accompany pleuritis, especially if caused by infection.
• Fever and Chills: Common when pleuritis is associated with infection like pneumonia or tuberculosis.
• Pleural Friction Rub: A crackling or grating sound heard with a stethoscope, caused by inflamed pleural layers rubbing together.
• Fatigue: General tiredness, especially in infectious or autoimmune causes.

Diagnosis

Diagnosing pleuritis involves a combination of clinical evaluation, imaging studies, and laboratory tests to determine the cause of pleural inflammation.

• Medical History and Physical Examination: Doctors assess the nature of chest pain and associated symptoms, followed by auscultation to detect pleural rubs.
• Chest X-ray: Helps identify lung infections, pleural effusion, or other abnormalities.
• CT Scan: Provides detailed images of the lungs and pleura, useful in detecting small effusions or tumors.
• Ultrasound: Useful in assessing pleural fluid and guiding thoracentesis (fluid drainage).
• Blood Tests: To identify signs of infection, inflammation, or autoimmune diseases (e.g., elevated white cell count, CRP, ANA, RF).
• Thoracentesis: If pleural effusion is present, a sample of pleural fluid is extracted and analyzed for infection, malignancy, or other causes.
• Electrocardiogram (ECG): Performed to rule out cardiac causes of chest pain, like pericarditis or myocardial infarction.

Treatment

The treatment of pleuritis focuses on relieving pain and addressing the underlying cause of the inflammation.

Symptomatic Treatment

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): First-line therapy to reduce inflammation and relieve chest pain.
• Analgesics: Pain relievers such as acetaminophen may be used in mild cases.
• Cough Suppressants: Used when persistent coughing worsens pleuritic pain.

Targeted Treatment

• Antibiotics: Prescribed if a bacterial infection, such as pneumonia, is the cause.
• Antiviral Medications: In certain viral infections, supportive care is usually sufficient, but antivirals may be considered in severe cases.
• Immunosuppressive Therapy: Corticosteroids or disease-modifying agents are used when pleuritis is due to autoimmune diseases.
• Anticoagulation: Blood thinners are given if pleuritis is related to pulmonary embolism.
• Thoracentesis or Chest Tube: Removal of pleural fluid in cases of large effusion to relieve pressure and aid breathing.

Prognosis

The prognosis of pleuritis is generally favorable, especially when the underlying cause is identified and treated promptly. Viral pleuritis often resolves within a few days to a week with rest and symptomatic care. Bacterial pleuritis improves significantly with appropriate antibiotic therapy.

In cases related to chronic conditions such as autoimmune diseases or malignancy, long-term treatment may be necessary to manage recurrent inflammation. Complications such as pleural effusion or pleural thickening can occasionally develop but are treatable with medical or surgical interventions.

Most individuals recover completely, returning to normal activities after the inflammation subsides. Regular follow-up is important to ensure the underlying cause is adequately managed and to monitor for any recurrence of symptoms.