Pleurisy

Pleurisy, also known as pleuritis, is a condition characterized by inflammation of the pleura, the thin layers of tissue that cover the lungs and line the chest cavity. This inflammation causes sharp chest pain that worsens with breathing, coughing, or sneezing.

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Causes

Pleurisy can result from various underlying conditions, including:

1. Infections:
   • Viral infections (e.g., influenza, respiratory syncytial virus)
   • Bacterial infections (e.g., pneumonia, tuberculosis)
   • Fungal infections (e.g., histoplasmosis)
2. Autoimmune Disorders:
   • Rheumatoid arthritis
   • Systemic lupus erythematosus
3. Other Medical Conditions:
   • Pulmonary embolism
   • Lung cancer or metastasis to the pleura
   • Pleural effusion (fluid buildup in the pleural space)
   • Pneumothorax (collapsed lung)
   • Chest trauma
4. Medications or Procedures:
   • Certain drugs, like procainamide or hydralazine, can induce pleuritis.
   • Chest surgery or procedures, such as thoracentesis.

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Symptoms

The hallmark symptom of pleurisy is pleuritic chest pain, which has the following characteristics:

• Sharp, stabbing pain that worsens with:
  • Deep breathing
  • Coughing
  • Sneezing
  • Laughing
• Pain may be localized to one side of the chest but can radiate to the shoulder or back.

Other associated symptoms may include:

• Shortness of breath (due to pain while breathing)
• Dry cough
• Fever and chills (if caused by infection)
• Fatigue or malaise

If pleurisy leads to complications like pleural effusion, symptoms may change:

• Dull chest pain (due to fluid reducing friction)
• Significant shortness of breath

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Diagnosis

Diagnosing pleurisy involves a combination of clinical evaluation and diagnostic tests:

1. Medical History and Physical Exam:
   • Listening for a pleural rub: A distinctive friction sound heard with a stethoscope during breathing.
2. Imaging Tests:
   • Chest X-ray: To detect infections, tumors, or pleural effusion.
   • CT scan: For detailed imaging of the chest structures.
   • Ultrasound: To identify and locate fluid in the pleural space.
3. Blood Tests:
   • To detect infections or autoimmune markers.
4. Thoracentesis:
   • Aspiration of pleural fluid for analysis to determine the cause of the inflammation.
5. Other Tests:
   • Tuberculosis skin test or sputum culture (if TB is suspected).

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Treatment

Treatment focuses on addressing the underlying cause and alleviating symptoms:

1. Treating the Underlying Cause:
   • Infections:
     • Antibiotics for bacterial infections.
     • Antivirals for certain viral infections (rarely needed).
     • Antifungals for fungal causes.
   • Autoimmune Conditions:
     • Corticosteroids or immunosuppressive drugs.
   • Pulmonary Embolism:
     • Anticoagulants to prevent further clots.
2. Symptom Management:
   • Pain Relief:
     • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to reduce pain and inflammation.
     • Acetaminophen or opioids for severe pain.
   • Cough Suppressants: To ease dry cough and associated pain.
3. Drainage Procedures (if pleural effusion develops):
   • Thoracentesis: To remove excess fluid and relieve pressure.
   • Chest tube placement in severe cases.

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Complications

If left untreated, pleurisy can lead to complications such as:

• Pleural Effusion: Fluid accumulation that can compress the lungs and cause breathing difficulties.
• Empyema: Infection of pleural fluid.
• Fibrosis or Scarring: Chronic thickening of the pleura, reducing lung expansion.

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Prevention

• Vaccination: Immunizations against pneumonia, influenza, and tuberculosis can reduce the risk of infections that may cause pleurisy.
• Prompt Treatment: Early management of respiratory infections and other underlying conditions.
• Lifestyle Choices:
  • Avoid smoking or exposure to secondhand smoke.
  • Practice good hygiene to reduce respiratory infections.

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Prognosis

• The outlook for pleurisy depends on its cause. Viral pleurisy often resolves on its own within a few days to weeks.
• Recovery from bacterial or other causes may take longer and may require targeted treatment.
• Early diagnosis and appropriate treatment generally lead to a favorable outcome.