Pleurisy (Pleuritis)

  • Medical Author:
    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.

  • Medical Editor: Melissa Conrad Stöppler, MD
    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.

Understanding COPD

How is pleurisy treated?

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. For example, if a heart, lung, or kidney condition is present, it is treated. Removal of fluid from the chest cavity (thoracentesis) can relieve the pain and shortness of breath. Sometimes fluid removal can make the pleurisy temporarily worse because without the lubrication of the fluid, the two inflamed pleural surfaces can rub directly on each other with each breath.

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. This procedure involves placing a tube inside the chest under local anesthesia. The tube is then connected to a sealed chamber that is connected to a suction device in order to create a negative pressure environment. In severe cases, in which there are large amounts of pus and scar tissue (adhesions), there is a need for "decortication." This procedure involves examining the pleural space under general anesthesia with a special scope (thoracoscope). Through this pipelike instrument, the scar tissue, pus, and debris can be removed. Sometimes, an open surgical procedure (thoracotomy) is required for more complicated cases.

In cases of pleural effusion that result from cancer, the fluid often reaccumulates. In this setting, a procedure called pleurodesis is used. This procedure entails instilling an irritant, such as bleomycin, tetracycline, or talc powder, inside the space between the pleural layers in order to create inflammation. This inflammation, in turn, will adhere or tack the two layers of pleura together as scarring develops. This procedure thereby obliterates the space between the pleura and prevents the reaccumulation of fluid.

Can pleurisy be prevented?

Some cases of pleurisy can be prevented, depending on the cause. For example, early intervention in treating pneumonia may prevent the accumulation of pleural fluid. In the case of heart, lung, or kidney disease, management of the underlying disease can help prevent the fluid collection. Continue Reading

Reviewed on 8/3/2015
References
REFERENCE:

Fauci, Anthony S., et al. Harrison's Principles of Internal Medicine. 17th ed. United States: McGraw-Hill Professional, 2011.

IMAGES:

1. iStock

2. MedicineNet

3. "Pleurisy and pneumothorax" by National Heart Lung and Blood Institute

4. "2313 The Lung Pleurea" by OpenStax College - Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013.. Licensed under CC BY 3.0 via Wikimedia Commons

5. iStock

6. Getty Images

7. "Thoracentesis" by National Heart, Lung and Blood Institute - Thoracentesis. Licensed under Public Domain via Wikimedia Commons

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