Each lung is wrapped in a thin membrane called the visceral pleura. The chest wall is similarly lined (parietal pleura). These two membranes touch and slide across each other while we breathe, lubricated by a slick of fluid. Pleurisy is inflammation of these membranes, commonly caused by upper respiratory tract infections.

There are many germs (or microbes) which may cause lung infections. The two most important types are viruses and bacteria. Most commonly the infecting germ is inhaled, and multiplies in the lining of the bronchi, spreading the infection further down the tubes, or into the tissues themselves.

Pleurisy, also called pleuritis, is an inflammation of the pleura, which is the moist, double-layered membrane that surrounds the lungs and lines the rib cage. The condition can make breathing extremely painful. Sometimes it is associated with another condition called pleural effusion, where excess fluid fills the area between the membrane’s layers.

The outer layer of the pleura lines the inside of the chest wall, and the inner layer covers the lungs. The tiny space between the two layers is called the pleural cavity. This cavity normally contains a small amount of lubricating fluid that allows the two layers to slide over each other when you breathe.

Signs and symptoms

When an accumulation of fluids (pleural effusion) is associated with pleurisy, the pain usually disappears because the fluid serves as a lubricant. However, if enough fluid accumulates, it puts pressure on your lungs and interferes with their normal function, causing shortness of breath. If the fluid becomes infected, the signs and symptoms of dry cough, fever and chills may appear. An infected pleural effusion is called an empyema.

Chest pain: This is the most common symptom. The pain is generally a sharp, stabbing pain, but may also be a dull ache or a burning sensation. It is usually worse when you take a deep breath, cough, or move around. The pain is usually better if you take shallow breaths or lie on the side that hurts. Chest pain is what usually causes people with pleurisy to seek medical attention.

Causes  of Pleurisy

Pulmonary embolism:  blood clot inside the blood vessels to the lungs. These clots sometimes severely reduce blood and oxygen to portions of the lung and can result in death to that portion of lung tissue (termed lung infarction). This, too, can cause pleurisy.

Trauma: rib fractures or irritation from chest tubes used to drain air or fluid from the pleural cavity in the chest

Pneumonia, in those cases in which the infected portion of the lung involves the pleural surface

Autoimmune conditions, such as lupus, rheumatoid arthritis and autoimmune hepatitis

Treatment of Pleurisy

 The most important goal in relieving pleurisy or pleural effusion is treatment of the underlying condition that’s causing your signs and symptoms. For example, if the cause of pleurisy is a bacterial infection of your lung (pneumonia), an antibiotic may control the infection. But, for pleurisy due to a viral infection, antibiotics won’t be effective. Most viral infections run their course without treatment.

When larger amounts of fluid must be removed, a chest tube may be inserted through your chest wall. The doctor injects a local painkiller into the area of your chest wall outside where the fluid is. He or she will then insert a plastic tube into your chest between two ribs. The tube is connected to a box that suctions the fluid out. A chest x ray is taken to check the tube’s position.

Treating the source

The treatment used to cure pleurisy is ultimately defined by the underlying cause. Thus, pleurisy from a bacterial infection can be successfully treated with antibiotics, while no treatment is given for viral infections that must run their course. Specific therapies designed for more chronic illnesses can often cause pleurisy to subside.

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