Pleurisy is an inflammation of the pleura, which is a double-layered membrane that:
- the outside of the lungs,
- separates it from the chest.
The pleura consists of two layers or leaves:
- The outer layer (pleura or parietal pleura) is connected to the rib cage.
- The inner layer (pleura visceralis) covers each lung and covers the neighboring structures such as blood vessels, bronchi and nerves.
The two leaves slide past each other without rubbing.
This is possible because there is a small amount of fluid like a lubricant between them (in the pleural space).
The smooth gliding allows the lungs to function correctly during the breathing process without getting tired.
If the pleura becomes inflamed, the two pleural sheets press against each other. The result is:
- increased friction,
- Pressure on the lungs.
One consequence of pleurisy may be excessive fluid accumulation in the pleural space: pleural effusion.
Usually this disease occurs bilaterally and can affect various pleural zones, for example:
- the upper part (pleurisy apical),
- the lower area (diaphragmal pleurisy).
This condition is most common in the elderly, but can also affect children.
Pleurisy can be serious and if left untreated, it can lead to death.
Classification of pleurisy
Pleurisy can be divided according to the cause:
- Infectious pleurisy: caused by bacteria, viruses and fungal infections.
- Irritant pleurisy: caused by trauma, pulmonary infarction or neoplasms.
- Autoimmune pleurisy: associated with autoimmune diseases such as systemic lupus erythematosus (SLE).
- Idiopathic pleurisy or nonspecific pleurisy: has no clear cause.
Depending on the duration, pleurisy has several forms:
- Acute, which means that it occurs suddenly, develops symptoms and then passes again.
- Chronic, if the symptoms persist or recur over time.
According to fluid occurrences, pleurisy can be divided as follows:
- Fibrinous or dry pleurisy (the most common), there is an accumulation of fibrin between the pleura parietalis (pleura, adhering to the rib cage) and visceralis (pleura, lining the lungs), eliminating all or part of the pleural space. The inflamed pleures rub directly against each other.
- Sero-fibrinous or wet pleurisy, is characterized by fluid filtering (exuding) from the inflamed tissue to the pleural space. If this fluid accumulates in large quantities (pleural effusion), it can compress the lungs and cause breathing difficulties.
Forms of pleurisy by location of occurrence
- Diaphragmatic pleurisy is an inflammation of the pleural lining of the diaphragm (at the base of the lungs). The diaphragm is innervated by the diaphragmatic nerve (phrenic nerve), which originates from the nerve roots of the vertebrae C3-C4-C5.
The result is pain that is reflected into the area that is innervated by the nerves originating at this height: in the upper abdomen and severe transmission pain also in the neck and shoulder.
- Interlobar pleurisy is localized between the lobes of the lungs.
- Pleurisy saccata is localized only on one area of the pleura. Pleurisy saccata usually develops at the tip of the lungs.
Causes of pleurisy
- Infectious diseases caused by viruses, bacteria, fungi and parasites, for example, pneumonia, bronchopneumonia or tuberculosis (tuberculous pleurisy is quite common).
- Tumors: Lung tumors, such as mesothelioma or metastases from other organs (especially breast cancer or breast cancer).
- Autoimmune diseases or rheumatoid diseases such as lupus, rheumatoid arthritis, sarcoidosis or scleroderma.
- Trauma that causes a rib fracture and pneumothorax or contusion.
- Gastrointestinal diseases, for example, pancreatitis, peritonitis or an accumulation of pus under the diaphragm.
- A serious heart condition, such as decompensated heart failure or pericarditis.
- Kidney disease: renal insufficiency, in which case pleurisy is referred to as “uremic pleurisy”.
- Reactions to medicines such as methotrexate, nitrofurantoin and methysergide.
- Pulmonary embolism
- Sickle-cell anaemia
- Asbestosis (due to asbestos)
- Ammonia exposure
- Infection by HIV
Some cases are caused by diseases of the abdominal organs, in particular:
- liver (e.g. liver abscess),
- Pancreas (for example, pancreatitis).
These conditions can inflame the diaphragm (which is the large muscle that divides the chest cavity and abdominal cavity) and the pleural section that covers the diaphragm.
Is pleurisy contagious?
- Pleurisy is not a contagious disease, but the microorganisms that cause the disease can be viruses or bacteria that can be transmitted to others.
- People with weakened immune systems are more likely to develop infection and pleurisy.
- The germs can spread by:
- sneezing, coughing,
- joint use of utensils,
- the handling of infected objects.
Symptoms of pleurisy
Pleurisy can affect people of all ages, but those most at risk are older people over the age of 65. Correctly recognizing the initial symptoms will help to avoid complications. Symptoms are classified as onset or severe depending on the stage of the disease.
- Chest pain when inhaling. The discomfort is felt by a burning sensation in the outer side of the lungs, which is caused by the rubbing of the pleures together.
- Feeling of pain/discomfort in the abdomen, neck and shoulders.
- Dry cough followed by rapid and shallow breathing. The cough can also become productive and have admixtures of mucus and blood.
- Fever, chills, loss of appetite and weight loss.
- Very high fever.
- Feeling of pressure on the chest due to pleural effusion.
- Shortness of breath even at rest.
- fatigue along with tachycardia (high heart rate).
- It comes to a bluish discoloration (cyanosis) of the skin.
Complications of pleurisy
Pleurisy can heal spontaneously or worsen due to fluid accumulation in the pleural cavity (pleural effusion).
Sometimes scar tissue forms after healing, which leads to adhesions and is a consequence of the disease. People with pleural adhesions suffer from:
- frequent pleurisy relapses,
- chronic pain,
- Shortness of breath.
Diagnosis and examination for pleurisy
To diagnose pleurisy, the doctor performs a physical examination, which includes:
- eavesdropping (auscultation) of the lungs,
- Checking whether lymph nodes are enlarged (signs of infection).
The doctor prescribes some examinations, including:
- X-ray of the thorax, a helpful examination to detect lung damage (lung collapse, tumor). The X-ray also indicates the presence of fluid in the lungs (pleural effusion). In this case, you can see a large opacity (white spot).
- Thoracic CT, useful for detecting lung diseases (e.g. pneumonia) or lung cancer.
Blood tests are used to diagnose the following:
- Autoimmune diseases.
Thoracocentesis To get a final confirmation, the doctor can perform a thoracentesis
: a medical procedure for taking some fluid from the pleural cavity for:
- an examination,
- to reduce symptoms in patients with pleural effusion.
Treatment for pleurisy
Viral pleurisy heals without medication.
To relieve symptoms, the doctor prescribes:
- nonsteroidal anti-rheumatic drugs (NSAIDs), such as ibuprofen (Aktren),
- Cough remedies such as codine-based cough blockers (paracodin juice).
With bacterial pleurisy, antibiotics may be needed for treatment. Then doctors often prescribe:
- levofloxacin (Tavanic®),
- Amoxicillin (Clamoxyl).
If the causes of pleurisy are blood clots in the lungs (pulmonary embolism), the doctor prescribes anticoagulants such as warfarin (Coumadin) to “dissolve” them and keep the blood flowing.
In pregnancy, one should consult a doctor before any drug treatment.
In the case of pleural effusion, surgical rehabilitation (thoracocentesis or thoracic drainage) is performed to drain the infected fluid.
Adhesion (adhesions) can cause breathing problems. In severe cases, surgical intervention may be necessary to remove them.
How long does pleurisy last? When is one cured?
The duration of pleurisy depends on the pathogenic agent responsible for the infection.
- If the cause is malignant neoplasia (cancer), measures can be taken to alleviate the severity of symptoms depending on the clinical picture of the individual.
Pleurisy caused by lung cancer or metastases is usually recurrent.
- In infectious bacterial pleurisy, the prognosis is unclear and sufferers may develop complications that can lead to permanent damage.
- Recovery times for viral pleurisy are quite long and take at least two weeks.
It is imperative to diagnose the disease at the first stages and immediately initiate therapy to avoid complications.
In some cases, consequences from previous pleurisy remain. Then the strongly fibrous tissue (adhesions) in the pleural cavity resembles a scar.