Pleurisy

What did Catherine the Great, Benjamin Franklin, and Elvis Presley have in common? Each of them is believed to have suffered from pleurisy. In all likelihood, some of you have had this painful condition also. The word "pleurisy" comes from a Greek word that refers to the "side of the body". Pleurisy involves inflammation of the tissue layers (pleura) lining the lungs and inner chest wall. When these inflamed layers rub together, particularly when taking a deep breath or coughing, it causes chest pain.

What causes pleurisy? A viral infection, such as the flu, is the most common cause of pleurisy. However, a number of other conditions can be responsible including:

• Bacterial infections of the lung, including pneumonia and tuberculosis


• Pulmonary embolus, a blood clot that goes to the lungs


• Lung cancer


• Autoimmune diseases including Lupus and Rheumatoid Arthritis


• A chest injury , such as bruised or broken ribs


• Gastrointestinal disease, such as pancreatitis or infection in the abdominal cavity(peritonitis).

How do you know if you have pleurisy? The main symptom of pleurisy is pain in the chest, usually only on one side. This pain is worse when you take a deep breath in or cough. Most people describe the pain as "sharp or stabbing" but it can be dull or aching also. The pain is usually better if you take shallow breaths or lie on the side that hurts. Depending on the underlying cause, other symptoms include shortness of breath, cough, and fever or chills. In most instances, the chest pain is what causes people with pleurisy to seek medical attention.

How is pleurisy diagnosed? Because the pain associated with pleurisy is so characteristic, the doctor often suspects the diagnosis just by talking to the patient. Along with the pain, a rough, grating sound known as a "friction rub" (click to hear what this sounds like) can often be heard when a stethoscope is placed against the chest. This sound is produced when the normally smooth tissue layers of the lung become inflamed and roughened. Depending on the suspected underlying cause, other tests including x-ray, computerized tomography (CT scan), and thoracentesis (removing fluid from the pleural space with a needle) may be performed.

How is pleurisy treated? Treatment depends on what is causing the pleurisy. When a viral infection is responsible, taking an anti-inflammatory medication, such as ibuprofen may be all that is necessary. If pleurisy is due to pneumonia, an antibiotic is usually required. Hospitalization and treatment with blood thinners is usually necessary when pulmonary embolism is the cause of pleurisy.

When should someone with pleurisy see the doctor? Diseases that cause pleurisy range from minor to life threatening, however, certain symptoms warrant prompt medical attention. These include:

• High fever, shaking chills, and a cough that produces thick green or yellow sputum


• Shortness of breath


• Intense, persistent chest pain


• Leg swelling which could indicate the presence of a blood clot

Is self-care at home ever appropriate for pleurisy? In cases in which pleurisy follows a viral infection, such as a cold or flu, self-care measures are usually all that is necessary. These measures include taking an anti-inflammatory medication such as ibuprofen (Motrin, Advil, others) or naproxen (Aleve) to reduce the pain and inflammation, "splinting" the chest by lying on the side that hurts, and avoiding exertion or other activities that would cause labored breathing.

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