Pleuritis is characterized by inflammation of the pleura, which is the membrane that covers the lungs and the inside of the chest. This condition is associated with symptoms such as pain in the chest and ribs, which can worsen when breathing deeply, fever, coughing and difficulty breathing.
Pleuritis, also called pleurisy, can be caused by infections, trauma to the chest or autoimmune diseases. It may also lead to an accumulation of fluid between the two layers of the pleura, also known as a pleural effusion.
Pleuritis is treated by a lung specialist or family doctor, and can treatment can vary depending on the underlying cause. Anti-inflammatory drugs may be prescribe to reduce discomfort or promote drainage of excess fluid from the pleura.
Common symptoms
The main symptoms of pleuritis are:
- Severe and constant pain in the chest or ribs;
- Pain that worsens when taking a deep breath, coughing or sneezing;
- Shortness of breath;
- Constant cough;
- Persistent fever.
It is also quite common for the pain to radiate to the shoulders or back, depending on the inflamed area of the pleura and the extent of the injury.
Whenever any of these symptoms appear, it is important to seek medical attention, especially if you have had a previous respiratory problem.
Confirming a diagnosis
A pleuritis diagnosis is initially confirmed through an evaluation of the patient's symptoms, health history and physical examination.
The doctor may also order bloodwork and imaging tests like a chest X-ray, CT scan, MRI or ultrasound.
In addition, an electrocardiogram and a blood troponin test may also be ordered to rule out a possible heart problem, especially if the patient presents with symptoms of chest pain or pain on the left side of the chest.
Is pleuritis serious?
Pleuritis is not usually life-threatening, however, it may be a sign that treatment for a respiratory problem is not being effective. It can be life-threatening if left untreated, however.
Therefore, if there is any suspicion for this condition, it is important to consult a doctor to review the current treatment plan.
Possible causes
The main causes of pleuritis are:
- Viral or bacterial pneumonia
- Lung cancer, mesothelioma or metastases in the pleura
- Autoimmune diseases, such as lupus and rheumatoid arthritis
- Spontaneous or traumatic pneumothorax
- Pulmonary embolism or tuberculosis
- Endometriosis in the chest
Pleuritis can also be caused by trauma to the chest wall, acute coronary syndrome or acute pericarditis.
It is important to identify the cause of pleuritis, so that the most appropriate treatment can be started.
Treatment options
Treatment for pleuritis should be guided by a lung specialist or general practitioner and will vary depending on the cause and severity of symptoms.
The main treatments for pleuritis are:
1. Medications
Medications for pleuritis, such as ibuprofen, may be prescribed by the doctor to reduce pain and relieve discomfort.
Depending on the cause of pleuritis, the doctor may also prescribe antibiotics, immunosuppressants, anticoagulants and/or oxygen therapy.
2. Rest
It is recommended to rest and avoid heavy exertion that could increase respiratory rate, like running or climbing stairs.
3. Thoracocentesis
If the presence of fluid in the pleural space is detected, the doctor may recommend thoracocentesis. This is a procedure that involves aspiration of the fluid with a needle. The fluid is then sent to the lab for analysis, which can provide insight into the underlying cause.
4. Respiratory physiotherapy
Respiratory physiotherapy may also be indicated for pleuritis. In these sessions, lung exercises are used to recover full respiratory capacity once the pleura is less inflamed.
5. Hospital admission
Hospital admission is recommended in cases of acute coronary syndromes, acute pericarditis, pulmonary embolism or pneumothorax, as these are medical emergencies that require immediate treatment and can be life-threatening.
In the case of heart problems, treatment should be guided by a cardiologist, who may indicate the use of medication, oxygen therapy, angiography or coronary artery bypass graft surgery.
In cases of pneumothorax, the lung specialist will remove excess air with a needle inserted between the ribs or perform a thoracotomy and place a chest tube to drain the air.