Pleurisy rarely occurs alone, but is usually a consequence of pneumonia or another infection. It is often accompanied by severe, stabbing chest pain and shortness of breath. All about causes, symptoms and treatment options.
Pleurisy is an inflammation of the lining of the chest, the so-called pleura. The term pleurisy is also often heard. Doctors speak of pleurisy or pleural infection. The pleura lines the inside of the chest cavity and primarily serves to protect the sensitive lungs. In earlier times, the disease was known as “side sickness” because it usually caused severe pain in the chest and the patient held the affected side. It often occurs as a complication of delayed respiratory infections .
What is pleurisy?
The two lungs lie in the chest under the ribs, protected by two thin, superimposed membranes. The inner skin that directly encloses the lungs is called the pleura (visceral or pulmonary pleura). The outer skin is called the pleura (pleura parietalis). It lies directly above the first and is connected to the thorax. The inner and outer layers of the pleura together form the pleura. It packs the lungs airtight, maintaining the negative pressure that keeps the lungs from separating from the chest and collapsing. Between the two layers of the pleura there is a space, the pleural gap, which is always filled with a little liquid so that the two membranes can slide against each other during breathing.
Normally, the surface of the two layers of the pleura is smooth. However, if pleurisy occurs, a sticky (fibrinous) coating develops and the two leaves rub against each other. Since the outer pleura in particular is rich in sensitive nerves, this leads to extreme pain with every breath and every movement of the chest. Usually only one side of the chest is affected, since the two pleural cavities are completely separated from each other by the mediastinum. In the course of a rib infection, there can be an increased accumulation of fluid in the gap between the two pleural layers, one then speaks of a pleural effusion or “wet” pleurisy (pleurisy exudativa).
Pleurisy: What are the causes behind it?
There are many causes of pleurisy, as this inflammation can be associated with many different diseases. Only in very rare cases does it occur without previous illnesses, as “primary pleurisy”.
Most often, pleurisy occurs as a result of acute inflammation in the chest such as bronchitis or pneumonia (pneumonia) or a delayed viral infection. The causative agents of flu ( influenza ), mumps and glandular fever ( Epstein-Barr virus) play an important role here). There are also a number of viruses and bacteria that can cause inflammation that can spread to the pleura. Spreading of the infection in pneumonia is relatively common. Around 20 to 50 percent of those affected subsequently develop pleurisy with pleural effusion. Doctors also say that the pleura always “cries” with inflammation in the chest cavity.
The most common causes of pleurisy are:
- pneumonia
- Acute bronchitis
- pulmonary infarction
- pulmonary embolism
- tuberculosis
- Inflammation in the upper abdomen such as inflammation of the pancreas (pancreatitis) or inflammation of the kidneys (nephritis)
- lung cancer
- Abscesses or tumors in the upper abdomen
- Rheumatic diseases
- As a result of a heart attack
Pleuritis tuberculosa also occurs as part of tuberculosis, sometimes it is also a symptom of an autoimmune disease such as rheumatoid arthritis or lupus erythematosus . It also occurs when an HIV infection ( AIDS ) breaks out. Pleurisy can also occur after heart surgery. Rare triggers are cancers of the lungs. In some cases, no causes can be found, then one speaks of idiopathic pleurisy.
Pleurisy: Typical symptoms of pleurisy
There are two forms of pleurisy, each characterized by typical symptoms and classic courses: dry pleurisy (pleuritis sicca) and wet pleurisy (pleurisy exudative) with pleural effusion.
Pleuritis sicca – sharp pains when breathing in
In dry or fibrinous pleurisy, there is a characteristic sharp, stabbing pain in the chest and back when breathing. They are caused by the rubbing of the glued layers of the pleura during inhalation and exhalation. They are accompanied by crackling, rattling breathing noises that sound like leather creaks when you listen to them.
Depending on the location of the inflammation, the pain can be more localized on the side of the chest, in the front of the breastbone or on the back. It is usually particularly violent when inhaling. Many of those affected have little or no pain between breaths, so some patients try to relieve the symptoms by holding their breath or breathing movements as little as possible.
Often the patient will hold or lie on the painful side with their arm, as pressure brings relief. In most cases, pleuritis sicca causes only a slight to moderate fever , often none at all.
The main symptoms of dry pleurisy at a glance :
- Severe chest pain or back pain
- Dry tickly cough
- Rattling breath sounds
- gentle breathing
- protective posture
- No fever or only slightly elevated temperature
Exudative pleurisy – chest pressure and fever
Exudative pleuritis, wet pleurisy, usually develops from the dry form. The patient then initially feels relief as the extreme pain during breathing subsides. However, the cause lies in the increasing accumulation of fluid in the pleural space, so that the two sheets no longer stick and rub against each other. De facto, it is therefore a matter of an aggravation of the finding. The symptoms depend on the size of the pleural effusion and can range from a feeling of pressure in the chest to shortness of breathsufficient if the lungs are restricted in their function. Sometimes there is also pain that radiates into the shoulder if the effusion presses on the phrenic nerve (Nervus phrenicus). The body temperature usually rises due to the progressive inflammation, sometimes there is a persistent fever.
Symptoms of pleurisy with pleural effusion:
- shortness of breath
- feeling of pressure on the chest
- pain in the shoulder
- Elevated temperature to high fever
Depending on the cause of the pleurisy, patients sometimes also have symptoms such as malaise, weight loss , night sweats or joint pain .
Warning signs of pleurisy
Severe, persistent or sudden chest pain should be evaluated by a doctor. Acute shortness of breath or shortness of breath and blue discoloration of the skin are also reasons to see a doctor as soon as possible, high fever is another. Because the symptoms mentioned can also hide serious illnesses such as a heart attack , pneumonia caused by bacteria or a blockage of a pulmonary vessel.
Diagnosis of pleuritis: How to recognize pleurisy
Diagnosing pleurisy can involve a variety of tests because the causes of pleurisy are so varied.
At the beginning of the diagnosis, as with other diseases, there is a detailed questioning of the patient by the doctor ( anamnesis ). The doctor asks exactly about the patient’s existing symptoms, for example how long they have existed, whether they came on suddenly or gradually, which makes them worse. Other aspects of the anamnesis are existing illnesses, regular intake of medication, recent long-distance trips and others.
This is followed by a thorough physical examination of the patient with a special focus on the chest, especially the painful region. These include listening to the lungs, tapping and palpating the chest.
First step in diagnosis: chest X-ray
A chest x-ray is usually done in people who suspect they have pleurisy . This allows air accumulations, fluid in the pleural space or signs of pneumonia to be detected. A pleural effusion can also be made visible by means of an ultrasound examination (sonography). Further imaging procedures such as computed tomography , which show the corresponding body region in layers or sections, enable a precise examination of certain changes in the chest.
Laboratory tests can help diagnose pleurisy
Blood analyzes are further measures that can support the diagnosis of pleurisy. They may provide clues to inflammation or certain diseases, such as rheumatoid arthritis . If there is an effusion in the pleural space, fluid can be extracted from it and examined in the laboratory. In this way it can be determined whether the effusion contains pus or blood, for example. The procedure used to collect the fluid is called a pleural puncture. The doctor first numbs the relevant region by injecting an anesthetic on site. He then inserts a needle through the chest wall between the ribs and draws out the fluid. Sometimes the doctor uses the ultrasound to control the process.
Depending on the (suspected) cause of the symptoms, further examinations may be considered. This includes, for example, an electrocardiogram ( EKG ), with which the electrical heart currents are derived in order to detect possible changes in the heart.
Therapy for pleurisy: treatments at a glance
The treatment of pleurisy has two main goals. On the one hand, the underlying disease and, on the other hand, the often very severe pain must be treated.
Treating causes of pleurisy
If pneumonia caused by bacteria is the triggering disease for pleurisy, antibiotics are the drug of choice. However, if viruses are behind the symptoms, antibiotics do not do much. Viral inflammation can heal without medication and is often only treated symptomatically. However, there are also active ingredients that act specifically against viruses (antivirals).
If drugs are the triggers, they should be discontinued as far as possible. However, it is imperative that you consult your doctor. If pleurisy is associated with diseases such as rheumatoid arthritis, the treatment of the original disease is of primary importance.
Relieve pain from pleurisy
In order to relieve the sometimes very severe pain associated with pleurisy, those affected can resort to painkillers . These include, for example, non-steroidal anti-inflammatory drugs (NSAIDs) such as the active ingredients ibuprofen or indomethacin, which also act against the inflammation.
Therapy for pleural effusion
Removal of the accumulation of fluid between the leaves is useful if the pleural effusion is pressing on the lungs or even pushing the heart to one side. Possible procedures are pleural puncture or pleural drainage. However, a pleural effusion can also be caused by other serious diseases such as inflammation of the pericardium, a heart attack or a blockage of a pulmonary artery. These usually require immediate treatment.
Home remedies can relieve symptoms of pleurisy
Pleurisy always belongs in the hands of the doctor. Nevertheless, there are a few things you can do yourself to relieve the pain and support healing:
- A lot of rest is important so that the body can activate its self-healing powers.
- You should also make sure you drink enough fluids , especially if the pleurisy is accompanied by fever.
- Warm chest wraps are an effective home remedy for pleurisy and can relieve pain. They relax the muscles and promote blood circulation and thus healing. However, be sure to remove the chest wrap as soon as it cools.
- After pleurisy, breathing exercises help to stretch and activate the respiratory muscles again, which are often restricted afterwards due to the slow breathing. Breathe consciously and deeply into the tips of your lungs and out again several times a day.