Pleurisy is inflammation of the visceral (inner) and parietal (outer) pleural membranes that envelop each lung. The saclike membrane enveloping each lung and lining the adjacent portion of the thoracic cavity or the pleura of one or both lungs may be affected. The two layers are lubricated with pleural fluid. The condition may be either primary or secondary and is often associated with pleural effusion.
Primary pleurisy is caused by infection of the pleura by bacteria, fungus, parasites, or viruses. It can be the result of inhaled toxins or chemical fumes. The condition is often secondary to pneumonia, heart failure, pulmonary infarction, neoplasm, systemic lupus erythematosus, pulmonary embolism, and chest trauma.
Signs and Symptoms
The lung’s pain fibers are located in the pleura, so when the tissue becomes inflamed, the sharp stabbing pain can be so severe that it limits movement on the affected side when breathing. Clients often believe they are having a heart attack. Other symptoms may include coughing, fever and chills, and chest pain that is greater during inspiration. Dyspnea also may occur.
Chest auscultation reveals a pleural friction rub (“squeaky leather” or grating sound) during respiration. Additional information can be obtained from a chest x-ray, ultrasound, and CT scan if necessary.
Treatment is aimed at the underlying cause but is otherwise symptomatic. Such treatment may include the use of strong analgesics and antiinflammatory agents. Bed rest is usually indicated.
Thoracentesis (removing chest fluid) can relieve the pain and shortness of breath, but caution should be exercised because it can temporarily worsen the pleurisy if the two inflamed pleural surfaces rub directly on each other.
Treatment of the underlying cause is essential, along with natural analgesics and anti-inflammatory agents.
Stress the importance of bed rest, and encourage clients to apply firm pressure at the site of the pain during coughing to minimize pain.
Prognosis is dependent on etiology but is usually good. Pleural effusion, a collection of fluid in the pleural space, may develop.
Early treatment of any respiratory diseases is the best prevention.