Pleurisy

– An inflammation of the visceral and parietal pleurae that envelop the lungs.

Causes and Incidence

Pleurisy arises from a pleural injury, which may be caused by an underlying lung disease (e.g., pneumonia, asbestosis, or infarction); an infectious agent, neoplastic cells, or irritants that invade the pleural space (e.g., amebic empyema, tuberculosis, pleural effusion, systemic lupus erythematosus, pleural carcinomatosis, rheumatoid disease); or pleural trauma (e.g., rib fracture).

Disease Process

The pleura becomes edematous and congested, cellular infiltration ensues, and fibrinous exudate forms on the pleural surface as plasma proteins leak from damaged vessels. This causes the visceral and parietal pleural surfaces to rub together rather than sliding over each other during respiration. The pleura becomes increasingly inflamed and stretched, causing pain on each breath.

Symptoms

The primary symptom is sudden onset of pain in the chest or abdominal wall that may vary from vague to an intense stabbing sensation. The pain is aggravated by breathing and coughing. Respirations are rapid and shallow, with guarding and decreased motion on the affected side.

Potential Complications

Permanent adhesions that restrict lung expansion may develop.

Diagnostic Tests

Auscultation reveals a friction rub, along with the characteristic presentation of pain. A chest x-ray may reveal pleural effusion.

Treatments

Surgery
None.

Drugs
Narcotic analgesic to relieve pain during deepbreathing and coughing exercises; analgesics and antipyretics.

General
Treatment of underlying disease; positioning and splinting of chest; coughing and deep breathing to prevent atelectasis and infection.