The lung slides along the chest wall when a deep breath is taken. Both surfaces have a thin lining called the pleura to allow this sliding to occur. On occasion, viral infections can cause the pleura to become inflamed, and then instead of sliding smoothly, the two linings scrape against each other, causing pain. This pain hurts with a deep breath and is described as pleuritic.
Viral infections are a common cause of pleurisy, although there are many other infectious causes including tuberculosis. Other diseases that can inflame the pleura include:
- Collagen vascular diseases like sarcoidosis and systemic lupus erythematosus
- Cancer
- Kidney failure
- Rheumatoid arthritis
- Complications of radiation therapy
- Complications of chemotherapy
- Complication of surgery
The physical exam may be relatively unremarkable, revealing only a friction rub over the site of pleural inflammation. If a significant amount of fluid leaks from the inflammation, the space between the lung and the chest wall (the pleural space) can fill with fluid, known as an effusion. When listening with a stethoscope, there may be decreased air entry in the lung.
Often a chest x-ray is done to assess the lung tissue and the presence or absence of fluid in the pleural cavity.
Pleurisy is usually treated with an anti-inflammatory medication. This will often treat an effusion as well. If the effusion is large and is causing shortness of breath, thoracentesis (thora=chest + centesis=withdrawing fluid) may be done. For thoracentesis, a needle is placed in the pleural space and the fluid withdrawn. For more, please read the Pleurisy article.
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