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Pleurisy

Definition:
Pleurisy occurs when the double membrane (pleura) that lines the chest cavity and surrounds each of your lungs becomes inflamed. Also called pleuritis, pleurisy typically causes sharp pain, almost always during the act of breathing.

One layer of the pleura overlies each lung. The other layer lines the inner chest wall. The two layers of pleura are like two pieces of smooth satin rubbing against each other with almost no friction, allowing your lungs to expand and contract when you breathe without any resistance from the lining of the chest wall.

When inflamed, the two layers of the pleural membrane in the affected side of your chest rub against each other, producing the pain of pleurisy when you inhale and exhale. Between breaths, you feel almost no pain.

Pleurisy occurs as a complication of a wide variety of underlying conditions. Relieving pleurisy involves treating the underlying condition, if it's known, and taking pain relievers.

Causes:
The underlying medical conditions that can cause pleurisy are numerous. Pleurisy causes include :
  • An acute viral infection, such as the flu (influenza)
  • Pneumonia, in those cases in which the infected portion of the lung involves the pleural surface
  • Autoimmune conditions, such as lupus, rheumatoid arthritis and autoimmune hepatitis
  • Tuberculosis and other infections
  • A clot in an artery of your lungs (pulmonary embolism)
Pleurisy can also occur as a result of trauma to your chest or after heart surgery. In some cases, the cause is unknown (idiopathic).

When to seek medical advice :
Call your doctor if you experience any of the following :

  • Intense, persistent chest pain
  • Shortness of breath
  • High fever

These signs and symptoms point to a problem with your lungs, and may also indicate an underlying illness for which you need prompt medical care.

Symptoms:
Inflammation of the membranes surrounding your lungs may cause the following signs and symptoms of pleurisy :
  • Shortness of breath
  • Chest pain during breathing
  • Dry cough
  • Fever and chills, depending on the cause

The sharp, fleeting pain in your chest that pleurisy causes is made worse by coughing, sneezing, moving and deep breathing. In some cases, pain may extend from your chest to your shoulder. You may find relief from pain when you hold your breath or when you apply pressure over the painful area.

When an accumulation of fluids (pleural effusion) is associated with pleurisy, the pain usually disappears because the fluid serves as a lubricant. However, if enough fluid accumulates, it puts pressure on your lungs and interferes with their normal function, causing shortness of breath. If the fluid becomes infected, the signs and symptoms of dry cough, fever and chills may appear. An infected pleural effusion is called an empyema.

Diagnosis:

Your doctor may make a diagnosis based on your signs and symptoms. When examining you and listening to your chest, your doctor may hear a "friction rub" that may sound like the crunching sound of walking on very dry snow.

Your doctor also might use the following diagnostic procedures to determine the underlying cause of pleurisy:

  • Imaging. A chest X-ray may show an area of inflammation in your lungs that indicates pneumonia. Your doctor will want to investigate an unexplained abnormality seen on an X-ray with additional imaging, usually beginning with a computerized tomography (CT) scan. In a CT procedure, a computer translates information from X-rays into images of thin sections (slices) of your chest.CT scans produce more-detailed images of your internal organs than do conventional X-ray studies. Sometimes doctors want a special type of chest X-ray in which you lie on your side where the pleurisy is to see if there's any fluid that doesn't appear on a standard chest X-ray. This type of X-ray is called a decubitus chest X-ray. Your doctor may also use ultrasound to determine whether you have a pleural effusion.
  • Blood test. A blood test may tellyour doctor if you have an infection and, if so, what type of infection you have. Other blood tests may also detect an autoimmune disorder, such as rheumatoid arthritis or lupus, in which the initial sign is pleurisy.
  • Thoracentesis. To remove fluid for laboratory analysis, your doctor may suggest a procedure called thoracentesis. In this procedure, your doctor first injects a local anesthetic, then inserts a needle through your chest wall between your ribs to remove fluid. In addition, a sample of tissue (pleural biopsy) for microscopic analysis may be obtained if your doctor is concerned that the fluid collection may be caused by tuberculosis or cancer. If only a small amount of fluid is present, your doctor may insert the needle with the help of ultrasound over the site of the fluid.
  • Video-assisted thoracic surgery (VATS). Another way of obtaining a sample of pleural tissue is by a surgical procedure called video-assisted thoracic surgery. In VATS, a tube is inserted to collapse a lung to about a quarter of its normal size. This creates space for your doctor to insert a pen-sized instrument through your chest wall to take a tissue sample under video guidance. You'll need general anesthesia for this procedure.

Treatment:
The most important goal in relieving pleurisy or pleural effusion is treatment of the underlying condition that's causing your signs and symptoms. For example, if the cause of pleurisy is a bacterial infection of your lung (pneumonia), an antibiotic may control the infection. But, for pleurisy due to a viral infection, antibiotics won't be effective. Most viral infections run their course without treatment.

Over-the-counter or prescription nonsteroidal anti-inflammatory drugs (NSAIDs) may help relieve some of the signs and symptoms of pleurisy. Prescription codeine may help control a cough as well as the pain. If you have a large buildup of fluid, you may need to stay in the hospital to have the fluid drained over a period of several days through a tube inserted into your chest.

The outcome of pleurisy treatment may depend on the seriousness of the underlying disease.

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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