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Pleurisy
(Pleuritis)

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Pleurisy (Pleuritis)

Pleurisy Treatment: A Little Complicated

External splinting of the chest wall and pain medication can reduce the pain of pleurisy. Treatment of the underlying disease, of course, ultimately relieves the pleurisy.

If the pleural fluid shows signs of infection, appropriate treatment involves antibiotics and drainage of the fluid. If there is pus inside the pleural space, a chest drainage tube should be inserted.

What is pleurisy?

Pleurisy describes the chest pain syndrome characterized by a sharp chest pain that worsens with breathing.

Pleurisy is caused by inflammation of the linings around the lungs (the pleura), a condition also known as pleuritis. There are two layers of pleura: one covering the lung (termed the visceral pleura) and the other covering the inner wall of the chest (the parietal pleura). These two layers are lubricated by pleural fluid.

Pleurisy is frequently associated with the accumulation of extra fluid in the space between the two layers of pleura. This fluid is referred to as a pleural effusion.

The pain fibers of the lung are located in the pleura. When this tissue becomes inflamed, it results in a sharp pain in the chest that is worse with breathing. Other symptoms of pleurisy can include cough, chest tenderness, and shortness of breath.

What causes pleurisy?

Pleurisy can be caused by any of the following conditions:

  • Infections: bacterial (including those that cause tuberculosis), fungi, parasites, or viruses

  • Inhaled chemicals or toxic substances: exposure to some cleaning agents like ammonia

  • Collagen vascular diseases: lupus, rheumatoid arthritis

  • Cancers: for example, the spread of lung cancer or breast cancer to the pleura

  • Tumors of the pleura: mesothelioma or sarcoma

  • Congestion: heart failure

  • 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.

  • Obstruction of lymph channels: as a result of centrally located lung tumors

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

  • Certain drugs: drugs that can cause lupus-like syndromes (such as hydralazine [Apresoline], Procan [Pronestyl, Procan-SR, Procanbid - these brands no longer are available in the U.S.], phenytoin [Dilantin], and others)

  • Abdominal processes: such as pancreatitis, cirrhosis of the liver, gallbladder disease, and damage to the spleen.

  • Pneumothorax: air in the pleural space, occurring spontaneously or from trauma.

How does the pleura work?

The pleura is composed of two layers of thin lining tissue. The layer covering the lung (visceral pleura) and the parietal pleura that covers the inner wall of the chest are lubricated by pleural fluid. Normally, there is about 10-20 ml of clear liquid that acts as a lubricant between these layers. The fluid is continually absorbed and replaced, mainly through the outer lining of the pleura. Pressure inside the pleura is negative (as in sucking) and becomes even more negative during inspiration (breathing in). The pressure becomes less negative during exhalation (breathing out). Therefore, the space between the two layers of pleura always has a negative pressure. The introduction of air (positive pressure) into the space (such as from a knife wound) will result in a collapse of the lung.

Picture of pleural effusion in the pleural space



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