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Pleurisy

Pleurisy is the inflammation of the pleura, which are layers of tissue that protect the lungs. It’s usually caused by a viral infection, and can lead to a stabbing chest pain.

  1. Common symptom is stabbing pain in the chest
  2. Often caused by a viral or bacterial infection
  3. Usually just treated with painkillers or NSAIDs

Pleurisy can sometimes be caused by serious conditions, so you should go to a hospital if you experience any pain which is severe. However, if you have mild or moderate symptoms and want to speak to a doctor online, you can do so through our secure video consultation service.

Pleurisy
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Description

Pleurisy is a condition characterised by inflammation of the pleura, a tissue that surrounds the chest cavity and the lungs. In the majority of cases it is caused by a viral infection, but bacterial infections and other conditions can cause it too. Although it can affect anyone, it’s more likely to affect those over 65, as this age group is more susceptible to chest infections.

In the pleura, one layer wraps around the outside of the lungs, whilst the other layer lines the inner chest wall. The space between these two is called the pleural space, and there is usually fluid within it to enable movement of the lungs when breathing. 

There are two layers to the pleura - the visceral and the parietal layers. The parietal pleura has pain receptors which will present symptoms of sharp pain when inflamed, and can become more irritated with deeper breathing.

A viral or bacterial infection can cause an inflammatory response in the pleura. The layers go from a state of smoothness to extremely rough when they are inflamed, causing friction and, in turn, pleuritic pain.

The clearest symptom of pleurisy is a sharp or stabbing pain in the chest, which is exacerbated by deep breathing, coughing or sneezing. It can also spread to the shoulders and the back. The pain is likely to develop into a dull ache. Pleurisy itself doesn’t normally produce other symptoms besides those caused by the illness responsible. For example, someone who has pleurisy caused by flu can also have a fever, a headache and a sore throat.

If you think you may have pleurisy caused by an infection and would like to speak to a doctor online, you can do so through our private consultation service. Our doctors will be able to recommend ways to relieve pain, and also let you know if you should see a clinician in person for a physical examination or further checks.

Sometimes, pleurisy can be caused by something more severe, such as a blood clot in the lung (pulmonary embolism) or an injury to the lung. If pleurisy has a more serious cause, there are a couple of notable symptoms that may indicate this. These include pain that does not ease after a few days, and coughing up blood. If you experience any of these, you should go to hospital for urgent medical attention.

Page last reviewed:  13/03/2020
Diagnosis and treatment

What are the causes of pleurisy?

There are many possible causes of pleurisy. Most of the time it arises from a viral infection (most typically flu), but bacterial infections (streptococcal or staphylococcal), pneumonia, blood clots and injuries to the lungs can be sources of the condition too.

It occurs when the pleura, which are two slender pieces of tissue that sit between the lungs and the ribcage, become inflamed.

How is pleurisy diagnosed?

A doctor will look to ascertain if you have any underlying conditions, and what your patient history is, before conducting a physical examination. This examination will involve a stethoscope placed on the chest to assess the breathing, from which a doctor will be able to surmise whether more serious complications may be present. 

For example, quieter breathing sounds with an increased resonance in the chest may suggest a collapsed lung (which can cause pleurisy), whereas quieter breathing sounds with a low resonance may suggest the presence of water on the lungs (pleural effusion). 

Will I need tests?

There are a number of tests that a doctor may recommend to help rule out other conditions. Increased white blood cells in a blood test can show if an infection is present. An x-ray of the chest can illustrate if the lungs are functioning properly, if they’re inflating sufficiently, or if there is fluid in the pleura. A CT scan is another option that can show if there is a blood clot in the lung, which can sometimes cause pleurisy and lead to a pulmonary embolism.

In some cases, a doctor may decide to undertake a diagnostic procedure to remove some of the fluid in the pleural space, for further assessment. This is called a thoracentesis, and involves inserting a needle in between the ribs and taking out some fluid for analysis.

How is pleurisy managed?

In most cases, pleurisy is managed by relieving the pain caused by the infection, and treating any possible underlying condition. If a bacterial infection is present, antibiotics will be required, whereas a viral infection such as flu simply requires rest and allowing the infection to pass. 

Non-steroidal anti-inflammatory drugs, such as ibuprofen, can be used to relieve pain. In the event of pleural effusion, you may have to have an operation to remove the fluid if the shortness of breath has not cleared up by itself.

Page last reviewed:  13/03/2020
Questions and Answers

How is pleurisy treated?

If pleurisy is caused by a viral infection, it may not require any specific treatment besides rest. Painkillers such as ibuprofen and paracetamol, or NSAIDs, to decrease the effect of the inflammation, may be sufficient. If the cause is bacterial, a course of antibiotics will be necessary. 

You can also have some of the fluid in the pleura removed, if your doctor thinks you may be at risk of developing complications, such as a collapsed lung. This procedure is called a thoracentesis, and you’ll likely require hospital admission for it. 

How long will it take for me to recover?

It depends entirely on what the underlying condition is. Viral infections will usually resolve themselves within a week or two, and perhaps take a few additional days for the symptoms to completely disappear. Bacterial infections may vary, depending on how bad the infection is and when treatment commenced. A simple bacterial infection might only take a week or two, but more severe cases such as pneumonia may take longer.

If pleurisy is as a result of a blood clot, for example, this will have to be treated first with blood thinning medication before symptoms clear. You may need to stay in hospital for a week or two under observation in such circumstances.

Can I consult a doctor about pleurisy online?

If you think you may have pleurisy caused by an infection such as the flu, our video consultation may be able to help you. Our GMC-registered doctors can offer guidance on how to ease symptoms and speed up your recovery. Book an appointment at a time that’s suitable for you. 

If you have a severe pain in the chest, or other symptoms which may indicate a serious health issue, such as coughing up blood or difficulty breathing, you should not use our service and get emergency medical attention at your nearest hospital.

Page last reviewed:  13/03/2020

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