What Is Pleurisy?

Overview

Your lungs have two large, thin layers of tissue called the pleura, which separate them from the chest wall. One of the tissue layers lines the inner chest wall, whilst the other wraps around the outside of the lungs. Between the layers, there is a small gap (called the pleural space). The pleural space is filled with a small amount of pleural fluid to allow the layers of tissue to glide past each other when the lungs expand and contract during inhalation and exhalation. 

Pleurisy is inflammation of the pleura. It is usually caused by an infection, but can also be caused by cancer, injury, a blood clot, medications or autoimmune conditions. Most people with pleurisy experience sharp chest pain when they breathe in. Symptoms are treated with a combination of painkillers and addressing the underlying cause. 

Causes of pleurisy 

Pleurisy is usually caused by an infection of some kind. The most common cause is a viral infection, such as:¹

• Influenza - the flu virus
• Epstein-Barr virus - the causative agent of glandular fever, or ‘mono’
• Cytomegalovirus (CMV) - most people carry this virus throughout their lives without it causing any issues
• Parainfluenza - causes respiratory infections and croup in children

Sometimes, infections caused by bacteria can cause pleurisy. These include:

• Pneumonia
• Tuberculosis
• MRSA - a type of bacteria that is antibiotic resistant. Pleurisy caused by MRSA is more likely to occur in a hospital setting

Other causes of pleurisy include: 

• Injury - if your ribs become bruised or even fractured, the pleura underneath the skin can become inflamed too
• Lung cancer
• A blood clot in the lungs (pulmonary embolism)
• Autoimmune conditions, such as rheumatoid arthritis 

Signs and symptoms of pleurisy

The most common symptom of pleurisy is a sharp, stabbing pain in your chest when you breathe deeply. Other symptoms can include:

• Pain felt in your shoulder, which is more severe when you cough or sneeze 
• The pain lessens if you take short breaths
• A dry cough 
• Shortness of breath
• Fatigue
• Fever

Management and treatment for pleurisy

The main way to manage pleurisy is to relieve the pain. NSAIDs such as ibuprofen are most commonly used because they can reduce inflammation as well as pain. Painkillers of different strengths can also be prescribed depending on the severity of the pain.

If the pleurisy is caused by a viral infection, it’ll usually clear up on its own relatively quickly. For bacterial infections, such as pneumonia, antibiotics might be needed. 

In cases where there is a blood clot present, blood thinning medications will be essential. 

Getting plenty of rest and looking after yourself will help to speed up your recovery.

Diagnosis of pleurisy

When visiting your GP with symptoms of pleurisy, it's important to rule out other more serious conditions that might be causing your chest pain, such as a heart attack. Therefore, you will most likely have an ECG. 

In order to diagnose pleurisy, your GP will listen to your chest. There is a distinctive dry and crunching sound that can be heard through a stethoscope in patients with pleurisy²

It’s important to find the root cause of your pleurisy, so the following tests might need to be carried out:³

• Blood tests
• Chest x-rays
• Ultrasound scan
• A CT scan
• A biopsy of lung tissue

By carrying out these extra tests, the severity of the inflammation in the lungs can also be determined. 

Complications of pleurisy

Pleural effusion 

Pleural effusion is a build-up of excess fluid in the pleural cavity between the pleura layers. It is sometimes called ‘water on the lungs’ and can be severe depending on the cause.⁴ It’s more likely to occur if the cause of pleurisy is a pulmonary embolism (blood clot) or a bacterial infection. 

Pleural effusion causes a shortness of breath that gets progressively worse, but you might not even be aware that you have pleural effusion; sometimes it's spotted on a chest X-ray. 

If treatment for pleurisy does not help clear the fluid from your lung, it might need to be drained by inserting a needle or small tube through the chest wall.⁵

Empyema

Although rare, the extra fluid in the pleural space can become infected due to pneumonia or blood clots. The resulting build-up of pus is known as empyema. These build-ups can cause the pleura to stick together and prevent lung expansion. 

Symptoms of empyema can include difficulty breathing and coughing up mucus containing pus. Bacteria from mucus samples are sometimes examined so that the correct antibiotics can be prescribed.

Empyema can also be treated by draining excess fluid, as described earlier.

Atelectasis 

If the build-up of fluid is large, pressure can build up in the lung, causing it to collapse.⁶

Atelectasis doesn’t always cause symptoms, but when it does, they can include wheezing and difficulty breathing.

Treatment for atelectasis is not always necessary in mild cases. However, some options include medications that thin mucus, surgery and chest physiotherapy.

FAQs

How can I prevent pleurisy?

Reducing your risk of contracting the contagious causes of pleurisy is the best way to prevent it. Maintaining good hygiene to avoid the spread of infections and ensuring that you do not smoke will reduce your risk. 

What can I expect if I have pleurisy?

If you have pleurisy, you can expect sharp stabbing chest pain that feels worse when you cough or move around. You may also experience other symptoms mentioned in this article. If caused by a virus, you should expect pleurisy to clear within a few days. 

Early treatment is key, as this can prevent any long-term damage to your lungs.³

Who is at risk of pleurisy?

Pleurisy can affect anybody, but it is more common in those aged 65 and over because they are more likely to develop a chest infection.⁷

How common is pleurisy?

There aren’t many studies available to tell us how common pleurisy is. However, it is assumed to be fairly common because the underlying causes occur regularly and affect many people around the world. 

Is pleurisy contagious?

No, pleurisy is not contagious in itself. However, some of its causes such as viral infections are contagious. 

When should I see a doctor?

If you experience any pain in your chest or difficulty breathing, you should access urgent healthcare immediately. 

Summary

To summarise, pleurisy is inflammation of the pleura, two layers of tissue that line the lungs. There are different causes of pleurisy, ranging from viral infections to lung cancer. 

The main symptom of pleurisy is pain in the chest that worsens with deep breathing. Pleurisy is usually diagnosed by a GP, but sometimes additional tests are needed.  

Painkillers are the main treatment for pleurisy, but other interventions may be needed to treat the underlying cause. It’s very important to get immediate medical attention if you are experiencing chest pain.