Pleurisy (Pleuritis)

Medically Reviewed by Poonam Sachdev on April 03, 2024
Written by WebMD Editorial Contributors
6 min read

Pleurisy (pronounced PLUR-uh-see) is a type of chest pain. It affects a part of your body called the pleura. You have two pleurae, one for each lung.

Each pleura consists of two thin, sheet-like layers of tissue. The inner layer covers your lung. The other layer lines the inside of your chest wall. They fit snugly within your chest. There's a small amount of fluid in the space between the two layers (the pleural space). This helps the pleurae glide smoothly as you breathe.

These layers keep your bare lungs from rubbing against the wall of your chest cavity every time you breathe in. 

When the pleurae are swollen and inflamed, they rub against each other in a painful way each time your lungs expand. When you inhale deeply, cough, sneeze, or laugh, you’ll probably feel a sharp, stabbing pain in the area that’s affected.

Most of the time, pleurisy happens because of an infection. If your doctor treats your infection, that can make it, and the pain, go away.

Things that can cause pleurisy include:

Lung infections. Bacterial infections such as pneumonia often cause pleurisy. It can also be caused by a virus such as the flu or by a fungus.

A blood clot in your lung. A pulmonary embolism (PE) is a clot that blocks blood flow to your lungs. It can be life-threatening. Usually, the clot forms in a deep vein (like in your lower legs), breaks free, and travels to your lungs. 

Collapsed lung (pneumothorax). When air gets into the pleural space, the pressure can make your lung fully or partially collapse. The main symptoms are sudden chest pain and shortness of breath.

An autoimmune disease. These diseases happen when your immune system attacks healthy body tissues by mistake. There are many different types. Rheumatoid arthritis and lupus are two common ones that can trigger pleuritic chest tightness. 

COVID-19. A few research papers and case reports have reported that pleuritic pain can be a symptom of COVID-19, the infection caused by the coronavirus. But much more research is needed. 

Other causes. Pleuritic chest pain can also happen because of:

  • A chest injury
  • Lung cancer
  • Other types of cancer that affect your lungs or pleura
  • Sickle cell anemia
  • Mesothelioma (a rare but aggressive cancer that affects the pleura; caused by inhaling asbestos)
  • Chemotherapy
  • HIV or AIDS

Is pleurisy contagious?

It's not contagious, but some of the bacteria and viruses that cause pleurisy can be contagious.

Pleurisy and pneumonia

Pneumonia is an infection that can inflame the air sacs in your lungs and fill them with pus. It's caused by bacteria, a virus, or fungi. Having pneumonia is a common risk factor for pleurisy.

Pleurisy and lupus

Pleurisy is the most frequent lung problem that people with lupus have. Lupus is an autoimmune disease that causes pain and inflammation in any part of the body. Lupus can cause pleurisy via a lung infection or through causing blood clots to form that go to the lungs.

Symptoms of pleurisy may include the following:

Chest pain. Does it hurt when you breathe in and out? And does the pain get worse when you try to take a deep breath, so you have to take small, shallow breaths? This sharp, stabbing, or burning feeling may be what doctors call "pleuritic chest pain."

Pain in other body parts.  When pleurisy happens in certain parts of the lungs, you can feel the pain in other parts of the body such as the neck, shoulder, back, or belly.

A cough (in some cases)

Fever and chills(in some cases)

Pleurisy back pain

Although pleurisy most often affects the chest, if you move your upper body, the pain can spread to your back. It may feel like a constant dull ache. 

 

Your doctor will ask you to describe the type of pain you feel when you breathe or cough, and they’ll ask whether it gets better or worse as the day goes on. They’ll listen to your lungs with a stethoscope to see if they’re making any strange noises. (Doctors often can hear the pleurae rubbing against each other.)

You may also need to have tests, such as:

  • Imaging. If your doctor wants to rule out other problems, they may send you for an X-ray, a CT scan, or an ultrasound. These images can show if pleurisy is causing your pain.
  • Blood tests. These may show if an infection is the culprit. It may also reveal if you have an autoimmune disease like lupus or another problem.
  • EKG. An electrocardiogram of your heart might show that your chest pain is caused by a heart problem, not pleurisy.
  • Thoracentesis. A technician looks at a sample of your pleural fluid under a microscope for problems like infections or cancer.
  • Thoracoscopy. Your doctor uses a thin, flexible tube called a thoracoscope to look inside your chest cavity.

In order to treat your pleurisy the right way, your doctor needs to know what’s causing it:

  • If it’s a virus, you should get better on your own in a few days or weeks. Most often, pleurisy is caused by a virus, like the flu virus.
  • If it’s bacteria (like thestreptococcal bacteria), antibiotics can make you better. 
  • If it’s a fungus, you'll probably get an antifungal drug.

Some people with pleurisy have too much fluid built up between their two layers of pleurae. Your doctor may need to remove some of the fluid. They may insert a thin needle into the space between your pleura layers to do this.

Painkillers and steroid medications can help while you’re getting better.

If coughing hurts too much, your doctor might prescribe medication (codeine) that can make you cough less.

How long does pleurisy last?

That depends on the cause. If your pleurisy is due to a bacterial infection and you get antibiotics, it should go away in a few days. If it's caused by lung cancer or a condition like lupus, the chest pain may linger for several weeks.

Complications of pleurisy can be serious. They include:

  • Lungs that are blocked or can’t expand the way they should (atelectasis)
  • Pus in your pleural cavity (empyema)
  • A sudden drop in blood flow (shock)
  • A dangerous reaction to infection (sepsis)

Inflammation can also make fluid build up in your pleural cavity. This is called pleural effusion. You might have less pain, but it can be hard for you to breathe. Your doctor might give you medications like diuretics, or you might have a procedure to drain the fluid.

Normally, pleurisy doesn't last very long. But here's some advice on home remedies for pleurisy:

  • Take any medication prescribed for treating it. If it's antibiotics, be sure to finish the whole course and not stop when you feel better.
  • Take an over-the-counter anti-inflammatory pain reliever, like ibuprofen, to manage any pain and inflammation.
  • Get plenty of rest.
  • Don't smoke, as this can further irritate your lungs.

How to sleep with pleurisy

Surprisingly, you might feel better if you lie on the side that’s causing you pain. Prop your head up with pillows rather than lying flat. Some people also add a pillow between their legs. As the pain starts to go away, try to breathe more deeply and cough up any phlegm you have.

What not to do with pleurisy

  • Don't do anything that will cause rapid breathing or too much coughing.
  • Don't stop coughing completely. Coughing brings up phlegm, and that helps prevent pneumonia. But if it's excessive, use a cough syrup.
  • Don't be in too much of a hurry to resume daily activities and exercising. Rest and take it easy until your symptoms are gone.

Pleurisy is a type of chest pain that affects your lungs. Most of the time, it's caused by a viral infection that will go away on its own in a few days. But if it's caused by bacteria, you may be given antibiotics. Be sure to get plenty of rest and take pain relievers while recovering.

Can pleurisy go away on its own?

Yes, if it's caused by a viral infection, it may go away on its own. If it's caused by bacteria, you'll need antibiotics to get better. If it's caused by a fungus, you'll probably be given antifungal medication. 

Is pleurisy worse when lying down?

Actually, lying down on the side of your chest that hurts may make you feel better. Coughing, sneezing, and moving around all make the pain worse.