pleurisy

Pleurisy, or pleuritis, is inflammation of the pleura, the two thin membranes that surround the lungs and line the chest wall. The inflamed pleura rubs against the other surface during breathing, producing sharp chest pain that worsens with deep inspiration, coughing, or movement. The pain can be localized or felt in the shoulder.

Causes of pleurisy include infections such as viral or bacterial pneumonia and tuberculosis, autoimmune diseases (for example systemic lupus erythematosus and rheumatoid arthritis), pulmonary embolism, malignancy, trauma or surgery, uremia, and certain drugs. It often arises as a reaction to an underlying condition rather than as a standalone disease.

Diagnosis relies on history, physical examination, and targeted testing. A pleural friction rub may be heard on auscultation. Chest X-ray helps identify pneumonia or effusion; ultrasound can detect pleural fluid, and CT may provide further detail. If fluid is present, thoracentesis allows analysis of the pleural fluid. Light’s criteria distinguish exudative from transudative effusions; testing may include cell counts, protein and LDH levels, glucose, Gram stain and culture, cytology, and TB testing as indicated.

Treatment focuses on the underlying cause and symptom relief. Nonsteroidal anti-inflammatory drugs or acetaminophen are commonly used for pain. Antibiotics or antivirals are prescribed if an infectious cause is identified. Pleural drainage via needle aspiration or chest tube is needed for sizable or purulent effusions. Recurrent effusions may require pleurodesis or indwelling catheters.

Prognosis varies with the underlying condition; pleurisy itself often improves with appropriate treatment. Complications can include persistent effusion, empyema, pneumothorax, or restricted lung expansion.