Pleurisy And Pleural Effusion

What Is It?

Pleurisy means inflammation of the pleura, the membrane that covers the lungs and lines the inside of the chest cavity. Depending on its cause, pleurisy can be associated with an accumulation of fluid in the space between the lungs and chest wall called a pleural effusion, or it can be dry pleurisy, which has no fluid accumulation.

Pleurisy can develop many ways, including:

  • Lung infection — In industrialized nations, bacterial pneumonia (lung infection) resulting from staphylococci, pneumococci, Haemophilus influenzae or other organisms is a frequent cause of pleurisy. In developing nations where tuberculosis is common, pulmonary tuberculosis is another important cause. When pleurisy is caused by a bacterial lung infection, it can be associated with a pus-filled pleural effusion. Viral lung infections, especially epidemic pleurodynia (an infection usually caused by coxsackieviruses or echoviruses), also can cause pleurisy.

  • Pulmonary embolism — A pulmonary embolism is a blood clot that has floated through the bloodstream and lodged in the lungs. In people with pulmonary embolism, symptoms of pleurisy tend to occur when the pulmonary embolism is fairly small and has lodged in a part of the lungs near the pleura.

  • Lung cancer — Pleurisy can develop in people with lung cancer. When pleurisy occurs because of lung cancer, a bloody pleural effusion is common.

  • Rheumatic fever — Rheumatic fever, an inflammatory condition that sometimes occurs after a streptococcal infection, can cause pleurisy, as well as inflammation in other parts of the body, including the heart and joints.

  • Connective tissue disorders — Systemic lupus erythematosus (SLE or lupus) and other connective tissue disorders can cause inflammation of the pleura.

  • Rare causes — Radiation therapy (for cancer), a collapsed lung (pneumothorax) and pericarditis (as with severe kidney failure or following a heart attack) all can be associated with pleurisy.

  • No identifiable cause — Pleurisy can develop for no clear reason despite extensive investigation. These cases are rare, and usually are presumed to be caused by a viral infection.

Symptoms

Pleurisy typically causes a sharp chest pain (pleuritic chest pain) that worsens with breathing in or coughing. The pain may start and remain in one specific area of the chest wall, or it may spread to the shoulder or back. To ease chest pain from pleurisy, a person with pleurisy often lies on the affected side as a way of limiting movement of the chest wall. In rare cases, the chest pain of pleurisy is a fairly constant, dull ache.

Depending on the specific cause of pleurisy, other symptoms may be present. For example, a person with pneumonia may have a high fever, shortness of breath and a cough that produces thick, yellow or dark sputum (mucus). A pulmonary embolus may be associated with shortness of breath, a low-grade fever and a cough that brings up small amounts of blood. A person with lung cancer may have unexplained weight loss and cough and a strong history of smoking. People with rheumatic fever may have pain and swelling in several joints that follow a sore throat.

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