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Pleuritic Chest Pain

Medically Reviewed by Paul Boyce, MD on April 18, 2022

Does it hurt when you breathe in and out? And does the pain get worse when you try to take a deep breath? Doctors call this sharp, stabbing, or burning pain "pleuritic chest pain."

This kind of pain is usually linked to problems with lung membranes called the pleura. But the term can be used to describe any intense chest pain that happens while you breathe, cough, or laugh. Lots of things can cause it, including infections, blood clots, and heart problems.

As with any chest pain, you need to get it checked out. Your doctor may use imaging tests like X-rays, CT scans, and EKGs to find out why you’re hurting. They may also do blood tests. Here are some of the possibilities.

Pleurisy

This condition is the major cause of pleuritic chest pain. Pleurisy may also cause pain in your shoulders or back. It can hurt so much to breathe that you take small, shallow breaths.

The pleura are two thin, sheet-like layers. One covers your lungs. The other lines the inside of your chest wall. There’s a small amount of fluid in the space between the two layers (the pleural space). This helps the layers glide smoothly as you breathe.

The pleura can get irritated and rub painfully against each other. The doctor may listen to your breath and hear the scratchy sound this causes.

Doctors don’t always know what causes pleurisy. It sometimes goes away on its own.

Treatments include:

Pleurisy is often caused by another health problem, like an infection. If so, your doctor will treat that condition, too.

Lung Infection

Bacterial pneumonia and tuberculosis (TB) infections are common causes of pleuritic chest pain. Viruses like the flu or even a fungal infection can trigger infections in your lungs. Other symptoms include:

Your treatment will depend on what kind of infection you have. You'll get:

If it’s a viral infection, it may go away on its own. NSAIDS like ibuprofen and acetaminophen can help you feel better.

Call your doctor if you:

  • Have a cough that doesn't go away
  • Are short of breath
  • Have chest pain and a fever
  • Cough up blood

Blood Clots

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. Besides sudden pleuritic chest pain, you may have:

See a doctor right away if you have these symptoms.

Treatments include:

  • Blood thinners to shrink the size of the clot and stop new ones from forming
  • Medicines that dissolve clots, used when a PE is large or life-threatening

Collapsed Lung (Pneumothorax)

When air gets into the pleural space, the pressure can make your lung fully or partially collapse. This can be caused by:

  • A chest injury
  • Damage from lung disease
  • Some medical procedures

A lung can collapse for no obvious reason, too.

In some cases, a collapsed lung is life-threatening. The main symptoms are sudden chest pain and shortness of breath. In worse cases, you may have:

A minor pneumothorax may heal by itself. Treatment for more serious ones can include:

  • A needle or tube inserted between your ribs to remove the air so your lung can expand
  • Oxygen therapy

Heart Problems

A heart attack is one of the things doctors want to rule out when someone complains of chest pain. But often, a heart attack feels like pressure and moves down one of your arms or into your neck or jaw. You may also:

  • Have nausea
  • Sweat a lot
  • Be short of breath

If you think you could be having a heart attack, call 911 now.

Pericarditishappens when the sac around your heart gets swollen. Pleuritic chest pain comes on suddenly and is usually felt in the front of the chest. You may get a fever, too.

Lots of things can cause pericarditis. An infection is a common reason. The condition is often mild and can go away on its own. Generally, treatment includes:

  • An NSAID medication to relieve pain
  • Rest
  • A medicine called colchicine to bring down swelling and stop the problem from happening again

If doctors know what caused pericarditis, they’ll likely treat that problem too.

Autoimmune Diseases

These conditions happen when your immune system attacks healthy body tissues by mistake. Rheumatoid arthritis and lupus are two common ones that can trigger pleuritic chest pain. Both happen more often to women. Other symptoms include:

Treatment for both conditions includes:

COVID-19

A few research papers and case reports have reported that pleuritic chest pain can be a symptom of COVID-19, the infection caused by the new coronavirus. But much more research is needed. As the story of the pandemic unfolds, researchers will learn more about all the symptoms of COVID-19.

The most common symptoms of COVID-19 are:

  • Coughing
  • Fever
  • Shortness of breath

If you have any of these, get medical help right away:

  • Serious trouble breathing
  • Chest pain or pressure that doesn’t go away
  • Confusion
  • Blue tint to the lips or face

Show Sources

SOURCES:

American Family Physician: "Pleuritic Chest Pain: Sorting Through the Differential Diagnosis," "Pleurisy,” "Pneumonia."

Cleveland Clinic: "Pleurisy," "Pulmonary Embolism: Who’s at Risk?"

Mayo Clinic: "Pleurisy," "Heart Attack," "Rheumatoid Arthritis," "Lupus," "Tuberculosis," "Pneumothorax."

American Lung Association: "What Are the Symptoms of Pneumonia?"

National Organization of Rare Disorders: "Tuberculosis."

American Journal of Roentgenology: "Clinical Features and Chest CT Manifestations of Coronavirus Disease 2019 (COVID-19) in a Single-Center Study in Shanghai, China.”

Harvard Medical School: "Pneumothorax."

UptoDate: "Pericarditis.”

CDC: "Symptoms of Coronavirus."

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