What is pleurisy?
Pleurisy is a condition in which the layer covering the lungs, called the pleura, becomes inflamed. It is sometimes called pleuritis.
The most common symptom of pleurisy is a sharp chest pain that feels worse with breathing.
Other symptoms includeand a dry cough.
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When to see your doctor
You should visit your doctor if you have chest pain that does not improve or gets worse after three to five days.
However, if your chest pain is accompanied by a high temperature, coughing up phlegm or blood, or breathing difficulties, you should seek immediate medical attention.
Your doctor can listen to your chest to check for the distinctive dry, crunching sound that suggests you may have pleurisy.
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What causes pleurisy?
Pleurisy is usually caused by another condition. In most cases it's the result of a viral infection (such as the) or a bacterial infection (such as ).
In rarer cases, pleurisy can be caused by conditions such as a blood clot that blocks the flow of blood into the lungs (a) and .
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How is pleurisy treated?
Treatment for pleurisy will depend on the underlying cause. For example, pleurisy that is caused by a viral infection will often resolve without needing treatment.
However, pleurisy caused by a bacterial infection will usually need to be treated with antibiotics, and people who are frail or already in poor health may be admitted to hospital.(NSAIDs), such as , are often used to relieve the chest pain associated with pleurisy.
In some cases of pleurisy, the pleura can become filled with too much fluid. If this happens, it may be necessary to drain the fluid to prevent breathing difficulties.
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The most common symptom of pleurisy is sharp chest pain when breathing in and out.
The pain may be worse when you cough, sneeze or move around and it may be relieved by taking shallow breaths.
As well as chest pain, other symptoms of pleurisy includeand a dry cough.
When to seek medical advice
Visit your doctor if you have chest pain that does not improve or gets worse after around five to seven days.
When to seek immediate medical advice
Contact your doctor immediately if your symptoms suggest that you have a serious underlying condition. For example, if you have symptoms such as:
- a high temperature (fever) of 40°C (104°F)
- coughing up thick phlegm or blood
- serious breathing difficulties
- intense chest pain that comes on suddenly
- swelling in your arms or legs (this could indicate a blood clot)
- persistent cough
- unexplained weight loss
If it is not possible to talk to your doctor immediately, or you can contact your local out-of-hours service.
Pleurisy is the inflammation of the pleura. It is usually caused by another condition, such as an infection.
In some cases, no cause is indentified.
The pleura is the layer located between the lungs and ribcage. It is made up of two parts, one is attached to the ribcage and the other is attached to the lungs.
Between these sections is a thin layer of liquid that lubricates the pleura, helping to reduce friction when you breathe in and out.
If the pleura is inflamed, the surfaces of the two layers can become rough and the fluid can become sticky. This can cause the layers to rub together, resulting in pain and discomfort.
An infection is the most common cause of pleurisy. Any type of infection has the potential to spread to the pleura, but viral infections are usually responsible.
Viruses known to cause pleurisy include:
- the influenza (flu) virus
- the Epstein-Barr virus - which causes glandular fever
- cytomegalovirus (CMV) - a common virus found in most people which does not usually cause any noticeable symptoms
- parainfluenza - the virus that causes the childhood condition called
In some cases, pleurisy is caused by bacteria, such as:
- streptococcal bacteria](/health-library/conditions/streptococcal-infections) - often associated with [pneumonia, throat infections and some types of skin infections, such as and
- staphylococcal bacteria - often associated with skin infections, food poisoning and, more seriously, blood poisoning (sepsis)
Other possible causes of pleurisy include:
- injury - if the ribs are bruised or fractured the pleura can become inflamed
- pulmonary embolism - a blood clot that develops inside the lungs
- sickle cell anaemia- a blood disorder that usually affects people of African or Caribbean descent
- chemotherapy](/health-library/treatments/chemotherapy/#definition) and [radiotherapy
- mesothelioma - a type of cancer caused by inhaling asbestos
Autoimmune conditions, such asand , are another possible cause of pleurisy. In these conditions, something goes wrong with the immune system (the body’s natural defence against infection and illness) and it begins to attack healthy tissue.
Pleurisy can usually be diagnosed by studying your symptoms, although further tests are sometimes needed.
Your doctor will ask about your symptoms and recent medical history. The doctor will also use a stethoscope to listen to your chest. If you have pleurisy, your lungs will make a distinctive dry, crunching sound known as a friction rub.
Further tests may be needed to identify the underlying cause of your pleurisy and to assess the severity of the condition. These tests can include:
- to determine whether you have an infection or an autoimmune condition
- an , where sound waves are used to build up a picture of the inside of your lungs
- a , where a series of X-rays is taken and a computer used to create a more detailed three-dimensional image of your lungs
Ifor is suspected, it may be necessary to remove a small sample of pleural or lung tissue for further testing. The tissue can be removed using a thin tube or fine needle which is inserted through your skin into the pleural space or lungs. Before the procedure, is used to numb your skin so you do not feel any pain.
Alternatively, a small tube called a bronchoscope can be passed down your throat and used to remove a tissue sample. The procedure can be uncomfortable but you will be given a mild sedative to help you relax, and local anaesthetic to numb your throat. The procedure is quick and only takes a few minutes.
Treatment for pleurisy
Treatment for pleurisy usually involves relieving pain and treating the underlying cause of the condition.
If treated promptly, pleurisy usually resolves without any lasting damage to the lungs.
The chest pain associated with pleurisy can be treated using a type of painkiller known as(NSAIDs). Most often, is used. If NSAIDs are ineffective or unsuitable, you may be prescribed another painkiller such as or codeine.
It may seem strange, but lying down on the side of your chest that hurts may also help reduce the pain.
Treating the underlying cause
It may also be necessary to treat the underlying cause of your pleurisy.
If you have pleurisy caused by a bacterial infection, you will need a course of. Depending on the severity of your symptoms, this may be either in the form of tablets or injections. Combinations of different antibiotics are usually used.
However, if you have pleurisy caused by a viral infection, further treatment may not be required because the infection will usually resolve on its own after a few days.
In cases where your symptoms are particularly severe or you are already in poor health, you may need to be admitted to hospital so your body’s functions can be supported until your condition stabilises.
In some cases, pleurisy causes a build up of excess fluid around the lungs called pleural effusion.
Pleural effusion can result in shortness of breath that gets progressively worse. This is more likely to occur in cases of pleurisy caused by aor a bacterial infection.
If pleural effusion does not clear up as your pleurisy is treated, or if you are very short of breath, a tube will need to be inserted so the fluid can be drained away.
The tube may be inserted either using(where you are asleep) or (you are awake and the area where the tube is inserted is numbed).
If a lot of fluid has to be drained away, you may need to stay in hospital for a few days.