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Medical Author:

George Schiffman, MD, FCCP

George Schiffman, MD, FCCP

Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.

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Medical Editor:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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In this Article

• What is pleurisy?
• What causes pleurisy?
• How does the pleura work?
• What are the symptoms of pleurisy?
• How is pleurisy diagnosed?
• How is pleurisy treated?
• Can pleurisy be prevented?
• Pleurisy At A Glance
• Patient Comments: Pleurisy (Pleuritis) - Treatments
• Patient Comments: Pleurisy (Pleuritis) - Diagnosis
• Patient Comments: Pleurisy - Symptoms
• Find a local Pulmonologist in your town
• Pleurisy Index

The pain of pleurisy is very distinctive. The pain is in the chest and is usually sharp and aggravated by breathing. However, the pain can be confused with the pain of:

• inflammation around the heart (pericarditis), or
  
  
• heart attack (myocardial infarction)

To make the diagnosis of pleurisy, the doctor examines the chest in the area of pain and can often hear (with a stethoscope) the friction that is generated by the rubbing of the two inflamed layers of pleura with each breath. The noise generated by this sound is termed a pleural friction rub. (In contrast, the friction of the rubbing that is heard with pericarditis occurs synchronous with the heartbeat and does not vary with respiration.) With large amounts of pleural fluid accumulation, there can be decreased breath sounds (less audible respiratory sounds heard through a stethoscope) and the chest is dull sounding when the doctor drums on it (termed dullness upon percussion).

A chest X-ray taken in the upright position and while lying on the side is an accurate tool in diagnosing small amounts of fluid in the pleural space. It is possible to estimate the amount of fluid collection by findings on the X-ray. Occasionally, as much as 4-5 liters of fluid can accumulate inside the pleural space.

Ultrasound is also a very sensitive method of detecting the presence of pleural fluid.

A CT scan can be very helpful in detecting trapped pockets of pleural fluid as well as in determining the nature of the tissues surrounding the area.

Removal of pleural fluid with a needle and syringe (aspiration) is essential in diagnosing the cause of pleurisy. The fluid's color, consistency, and clarity are analyzed in the laboratory. The fluid analysis is defined as either an "exudate" (high in protein, low in sugar, high in LDH enzyme, and high white cell count; characteristic of an inflammatory process) or a "transudate" (containing normal levels of these body chemicals).

• Causes of exudative fluid include infections (such as pneumonia), cancer, tuberculosis, and collagen diseases (such as rheumatoid arthritis and lupus).
  
  
• Causes of transudative fluid are congestive heart failure and liver and kidney diseases. Pulmonary emboli can cause either transudates or exudates in the pleural space.

The fluid can also be tested for the presence of infectious organisms and cancer cells. In some cases, a small piece of pleura may be removed for microscopic study (biopsied) if there is suspicion of tuberculosis (TB) or cancer.