| Pleurisy is an inflammation of the membrane that covers the lungs and lines the inside of the chest cavity (pleura). A symptom of another underlying condition, pleurisy is characterized by sharp chest pain (pleurodynia) that is worse when breathing in (inspiration), when coughing, or with chest movement.
The pleura has two layers, the inner and outer membranes, which are very thin and close together. A small amount of fluid is normally present between the layers to act as a lubricant, so that the surfaces glide easily over each other when the lungs inflate and deflate during breathing. When the pleura is roughened by inflammation, the membranes rub against each other, causing pain, and a chest sound that ranges from a faint squeak to a loud creak (friction rub) is heard with a stethoscope (auscultation).
Depending on its cause, pleurisy can occur either with (pleural effusion) or without (dry pleurisy) an accumulation of fluid. Pleurisy with pleural effusion is more common and is associated with less pain because the fluid accumulation keeps the pleural membranes separated, helping to minimize rubbing. However, pleural effusion can cause pressure on the lungs, leading to breathing problems (respiratory distress) or possibly lung collapse. Large accumulations of fluid also compromise breathing and may cause coughing, shortness of breath with rapid breathing (tachypnea), bluish skin from lack of oxygen (cyanosis), and retractions.
Many conditions can cause pleurisy, including bacterial infections (pneumonia or tuberculosis), viral infections, rheumatic diseases, immune disorders, chest trauma, certain cancers, pancreatitis, liver cirrhosis, heart or kidney failure, and asbestos-related disease.Risk: Pleurisy affects men and women at all ages. Incidence and Prevalence: Once a common disease, pleurisy is now quite infrequent due to the development of antibiotics. |
Source: Medical Disability Advisor
| History: Symptoms include a sharp, stabbing chest pain that is usually worse with coughing, deep breathing, or when breathing in (inhalation or inspiration). The pain may be focused in one area (localized), or it may spread to the shoulder and/or back. In rare cases, the individual will complain of a constant, dull ache. Individuals may report that holding their breath or pressing on their chest provides pain relief. Some individuals will also complain of shortness of breath. A recent or current respiratory illness with symptoms of cough, fever, and a general ill feeling (malaise) may be evident. Physical exam: The exam may reveal rapid, shallow breathing. Often, the individual is bent over toward the side of the pain. Listening to breath sounds with a stethoscope (auscultation) may reveal a rough, squeaky, or creaking sound (friction rub) over the area of pain that accompanies inspiration and expiration, as well as decreased breath sounds. Auscultation may also reveal a crackling sound (rales) if pneumonia is present, or a continuous, low-pitched, snore-like sound (rhonchi) if either pneumonia or bronchitis are present. In severe cases, the individual may have a bluish color to the complexion (cyanosis) due to a lack of oxygen. Tests: Specific tests will vary, depending on the suspected cause of the individual's pleurisy. A chest x-ray may be taken to look for signs of accumulated fluid (pleural effusion), pneumonia, tuberculosis, pulmonary embolism, lung cancer, a fractured rib, or other physical injury. Blood samples may be tested to help diagnose pneumonia, rheumatic fever, pulmonary embolism, or other diseases. A CT scan or an ultrasound may be used to help confirm and/or pinpoint the location of fluid buildup. When fluid is present, a sample may be collected and analyzed to help determine the underlying cause (thoracentesis). This involves inserting a needle through the chest wall into the pleural space and collecting fluid. When fluid is not present and the cause of pleurisy is unclear, a sample of the pleural tissue (pleural biopsy) can be obtained and analyzed under a microscope. A complete blood count (CBC) with differential can help determine the presence of a bacterial versus a viral infection. |
Source: Medical Disability Advisor
| The initial treatment is usually aimed at relieving the individual's pain by prescribing pain killers (analgesics) and medication to reduce inflammation (anti-inflammatories). Lying on the painful side may also provide some relief.
If a significant amount of fluid has accumulated, it may need to be drained by a procedure called thoracentesis. A needle will be inserted through the chest wall into the pleural space, and the excess fluid will be extracted. In severe cases, a chest tube may need to be surgically inserted and remain in place for several days so that fluid can drain.
Further treatment is aimed at treating the underlying precipitating disease. Bacterial infections are treated with appropriate antibiotics; viral infections usually run their course without medications. |
Source: Medical Disability Advisor
| The prognosis for pleurisy depends on the seriousness of the underlying cause. For instance, if the underlying cause is a bacterial lung infection, treatment with antibiotics and symptomatic relief of pain will usually provide full recovery. However, if the underlying cause is lung cancer, the prognosis may range from poor to grim, depending on the location of the tumor and whether or not the cancer has spread to other parts of the body. |
Source: Medical Disability Advisor
| Possible complications might include inflammation of the membranous sac enclosing the heart (pericarditis), pus in the pleural cavity (empyema), breathing difficulty, or collapse (atelectasis) of the lung. |
Source: Medical Disability Advisor
| Work restrictions and accommodations will vary according to the severity of the individual's symptoms and his or her job requirements. Individuals whose jobs require heavy work or prolonged physical activity may experience a longer period of disability.
In general, activities requiring significant amounts of bending or reaching should be avoided. Jobs that are physically demanding or require significant activity may be difficult due to decreased lung capacity. In these cases, temporary reassignment to a more sedentary position would be helpful. Frequent breaks may also be required. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Did individual have any medical history that could possibly contribute to the development of pleurisy (lung infection, tuberculosis, cancer, systemic lupus erythematosus, sarcoidosis, etc.)?
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Did individual present with symptoms of sharp, stabbing chest pain that is usually worse with coughing or deep breathing or on inspiration?
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Did physical exam reveal any characteristic findings such as tachypnea, pleural pain, cyanosis, pleural friction rub, or rales and rhonchi?
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Were specific diagnostic tests, such as a chest x-ray, CT scan of the chest, or thoracentesis, done to determine the underlying problem and/or detect the presence of an infectious process?
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Was the individual referred to an appropriate specialist (pulmonologist, oncologist)?
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If diagnosis was uncertain, were other conditions with similar symptoms (empyema, pleural effusion, pulmonary embolus, etc.) ruled out?
Regarding treatment:
- Were analgesics and anti-inflammatories prescribed?
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Was thoracentesis to drain accumulated fluid indicated?
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Was antimicrobial therapy indicated for underlying pulmonary infection?
Regarding prognosis:
- Based on the age, general health, and underlying cause of the pleurisy, what was the expected outcome?
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Does individual have any comorbid conditions that could affect recovery and prognosis, such as cancer, chronic lung disease, immune suppression, etc.? If so, were these conditions addressed in the treatment plan?
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Did individual suffer any associated complications that could prolong disability?
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Source: Medical Disability Advisor
| Blaivas, Allen J., ed. "Pleurisy." MedlinePlus. Ed. Allen J. Blaivas. 27 Jan. 2004. National Library of Medicine. 23 May 2005 <http://www.nlm.nih.gov/medlineplus/ency/article/001371.htm>. |
Source: Medical Disability Advisor
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