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Johns Hopkins Symptoms and Remedies

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Pleurisy and Pleural Effusion

What is it?

Pleurisy is inflammation of the pleura—the delicate, two-layered membrane that encases the lungs and lines the inside of the chest cavity. The space between the pleural membranes (pleural space) is normally bathed in a thin lubricating fluid that ensures smooth expansion and contraction of the lungs during breathing.With pleurisy, a section of the pleura becomes inflamed and roughened, causing the two layers of the membrane to rub together painfully. Pleurisy can affect people of any age.Most cases are due to infections and, with treatment, clear up in a few days or weeks. However, some cases are caused by more serious underlying disorders, such as lupus or a pulmonary embolism. If inflammation is severe, fluid may accumulate in the pleural space, a condition known as pleural effusion. The excess fluid often provides lubrication that eases the pain, but it may also compress the underlying lung and make breathing difficult. Although pleural effusion is often associated with pleurisy, pleural effusion can exist in the absence of pleurisy (such as with heart failure). Because pleurisy and pleural effusion are not diseases themselves, but manifestations of an underlying disorder, treatment outcome depends on the seriousness of the underlying cause.

What Causes It?

  • Pleurisy is often caused by lung or chest infections, including tuberculosis, pneumonia, and viral infections. Pleurodynia, a viral infection that most often affects children, may cause outbreaks of pleurisy among family members.
  • Pulmonary embolism (a blood clot in an artery of the lung) is a life-threatening cause of pleurisy.
  • Other causes include autoimmune disorders (such as systemic lupus erythematosus or rheumatoid arthritis), chest injury, and sickle cell disease.
  • Pleural effusion may be caused by a tumor in the pleura (mesothelioma), cancer that has spread from the lung or elsewhere, heart failure, liver disease, kidney disease, or pancreatitis.

Prevention

  • There is no known way to prevent pleurisy or pleural effusions.

Diagnosis

  • Patient history and physical examination are needed.
  • X-rays, ultrasound, or CT (computed tomography) scans of the chest may be done to detect pleural effusions.
  • Aspiration (withdrawal of fluid from the pleural space with a needle) and biopsy may be done.

How to Treat It

  • Underlying disorders are treated. For example, antibiotics are given for bacterial pneumonias.
  • Pain relief medications may be recommended.
  • Wrapping the chest loosely in elastic bandages or holding a pillow against the affected side when coughing may also help to ease pain.
  • If pleural effusion makes breathing difficult, fluid may be withdrawn with a needle (thoracentesis).
  • For very severe cases of recurrent pleural effusion— such as those that may occur with inoperable cancer—doxycycline (an antibiotic), talc, or an anticancer drug is put into the pleural space. The drugs cause scarring and fusion of the two pleural layers, thus preventing future recurrences.

When to Call a Doctor

  • Call a doctor if symptoms of pleurisy develop.