What Is Pleurisy?
The pleura are two thin, sheet-like layers of tissue. One covers your lungs. The other 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 layers glide smoothly as you breathe.
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:
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. Besides sudden pleuritic chest pain, you may have:
- Shortness of breath
- Fast breathing
- A rapid heart rate
- Coughing (with or without blood)
- Lightheadedness or fainting
- Anxiety or a feeling of dread
See a doctor right away if you have these symptoms.
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. In worse cases, you may have:
- Low oxygen levels
- Low blood pressure
- A fast heart rate
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 right away.
An autoimmune disease. These conditions 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 pain. Other symptoms include:
- Joint pain
- A fever, facial rash, or dry eyes (for lupus)
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 coronavirus. But much more research is needed.
Other causes. Pleuritic chest pain can also happen because of:
Pleuritic 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."
This kind of chest 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.
Other symptoms of pleurisy. You're likely to notice these things:
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 bacteria, antibiotics can make you better.
- If it’s a fungus, they’ll probably give you an antifungal drug.
- If it’s a virus, you’ll get better on your own in a few days or weeks.
Some people with pleurisy have too much fluid built up between their two layers of pleura. Your doctor may need to remove some of the fluid. They may insert a thin needle into the space between your pleura 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.
You might feel better if you lie on the side that’s causing you pain. As the pain starts to go away, try to breathe more deeply and cough up any phlegm you have.
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.