Pleurisy is an inflammation of the membranes (pleurae) that cover the lungs and line the inside of the chest cavity (pleural cavity). Pleurisy is characterized by sharp chest pain (pleurodynia) that is worse when breathing in (inspiration), when coughing or sneezing, or with chest movement.
The pleura consists of two layers that are very thin and close together; the inner membrane (visceral pleura) that envelops the lungs, and the outer membrane (parietal pleura), which lines the pleural cavity. A small amount of fluid, approximately 0.13 ml/kg of body weight, is normally present between the layers to act as a lubricant, so that the surfaces glide easily over each other during breathing. When the pleurae are roughened by inflammation, the membranes may rub against each other, causing pain and a chest sound that ranges from a faint squeak to a loud creak (friction rub) when the lungs are listened to with a stethoscope (auscultation).
Depending on its cause, pleurisy can occur either with an accumulation of fluid (pleural effusion) or without it (dry pleurisy). Pleurisy with pleural effusion is more common and is associated with less pain because the fluid accumulation helps keep the pleural membranes separated, minimizing friction. However, pleural effusion can cause pressure on the lungs, leading to breathing problems (respiratory distress) or possibly lung collapse (atelectasis). Large accumulations of fluid may compromise breathing and cause coughing, shortness of breath (dyspnea), rapid breathing (tachypnea), bluish skin from lack of oxygen (cyanosis), and a sucking in of the skin around the bones of the chest and between the ribs during inhalation (chest retractions).Incidence and Prevalence: In the US, the incidence of pleural effusion is approximately 1.5 million cases per year. In developed countries, the prevalence of pleural effusion is 320 per 100,000 individuals (Rubins). Although pleurisy affects men and women equally, two-thirds of the pleural effusions that are associated with malignancy or systemic lupus erythematosus occur in women (Rubins). |
Source: Medical Disability Advisor
| Many conditions may cause pleurisy, including bacterial infections (e.g., pneumonia or tuberculosis), viral infections, rheumatic diseases, immune disorders, chest trauma, certain cancers, pancreatitis, liver cirrhosis, heart or kidney failure, impaired lymphatic drainage, and asbestos-related disease. |
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 his or her breath or pressing on the chest provides pain relief. Some individuals will also complain of dyspnea. A recent or current respiratory illness with symptoms of cough, fever, and generally feeling ill (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. Auscultation may reveal a rough, squeaky sound (pleural 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 is present. In severe cases, the individual may exhibit cyanosis. 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 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 complete blood count (CBC) with differential may help determine the presence of a bacterial infection. A computed tomography (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. |
Source: Medical Disability Advisor
The initial treatment is usually aimed at relieving the individual's pain by prescribing painkillers (analgesics) and medication to reduce inflammation (anti-inflammatory drugs). Lying on the painful side may also provide some relief. Steroids are more effective and can be used if severe symptoms are present.
If a significant amount of fluid has accumulated in the pleural space, it may need to be drained by a surgical procedure called thoracentesis. A needle will be inserted through the chest wall into the pleural space, and the excess fluid will be extracted using a syringe. In severe cases or when lung atelectasis is present, a chest tube may need to be surgically inserted and remain in place for several days so that fluid can drain and the affected lung segment(s) can re-inflate.
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 the cancer has spread to other parts of the body (metastasized). |
Source: Medical Disability Advisor
| Possible complications include inflammation of the membranous sac enclosing the heart (pericarditis), pus in the pleural cavity (empyema), breathing difficulty, or partial or complete 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. Physically demanding jobs that require significant activity may be difficult to perform due to decreased lung capacity. In these cases, temporary reassignment to a more sedentary position would be helpful. Frequent breaks may be required.Risk: Jobs that require exposure to heavy fumes, dusts, and respiratory irritants are best avoided if possible, although a paper mask may be sufficient protection in most cases. More advanced mask systems as per OSHA guidelines should also be followed in certain industries. Capacity: Capacity is measurable with pulmonary function testing, often with metabolic stress ECHO testing to determine oxygenation. Tolerance: Tolerance may be enhanced by ensuring medication compliance if prescribed, verifying the absence of concurrent conditions such as anemia that may contribute to dyspnea, and possibly offering rapid testing and a physician evaluation should the individual experience symptom recurrence. |
Source: Medical Disability Advisor
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.)?
-
Did individual present with symptoms of sharp, stabbing chest pain that is usually worse with coughing or deep breathing or on inspiration?
-
Did physical exam reveal any characteristic findings such as tachypnea, pleural pain, cyanosis, pleural friction rub, rales, and rhonchi?
-
Were blood samples drawn to help diagnose pneumonia, rheumatic fever, pulmonary embolism, or other diseases? Was CBC with differential performed to rule out bacterial infection
-
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?
-
Was the individual referred to an appropriate specialist (pulmonologist, oncologist)?
-
If diagnosis was uncertain, were other conditions with similar symptoms (e.g., empyema, pleural effusion, pulmonary embolus) ruled out?
Regarding treatment:
- Were analgesics and anti-inflammatory drugs prescribed?
-
Was thoracentesis to drain accumulated fluid indicated?
-
Was antimicrobial therapy indicated for underlying pulmonary infection?
Regarding prognosis:
- Based on the age and general health of individual and underlying cause of the pleurisy, what was the expected outcome?
-
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?
-
Did individual experience any associated complications that could prolong disability?
|
Source: Medical Disability Advisor
| CitedRubins, Jeffrey. "Pleural Effusion." eMedicine. Ed. Ryland P. Byrd. 5 Sep. 2014. Medscape. 31 Oct. 2014 <http://emedicine.medscape.com/article/299959-overview>.Venekamp, L. N., B. Velkenirs, and M. Noppen. "Does 'Idiopathic Pleuritis' Exist? Natural History of Non-Specific Pleuritis Diagnosed after Thoracoscopy." Respiration: International Review of Thoracic Diseases 72 (2005): 74-78. |
| GeneralVyas, Jatin M. "Pleurisy." MedlinePlus. 1 Sep. 2013. National Library of Medicine. 31 Oct. 2014 <http://www.nlm.nih.gov/medlineplus/ency/article/001371.htm>. |
Source: Medical Disability Advisor
|
Feedback |
|
Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment. If you are seeking medical advice, please contact your physician. Thank you! |
Send this comment to:
Sales
Customer Support
Content Development
|
|
|
| |
|
|
|
|
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the author, editors, and publisher are not engaged in rendering medical, legal, accounting or other professional service. If medical, legal, or other expert assistance is required, the service of a competent professional should be sought. We are unable to respond to requests for advice. Any Sales inquiries should include an email address or other means of communication.
|