Pleurisy

Inflammation of the pleura

Pleuritis is an acute or chronic inflammation of the pleura, the serous double sheet that covers the inside of the thoracic cavity and surrounds the lungs. Often expression of viral or bacterial insults, pleurisy is normally perceived as a strong pain in the chest, exacerbated by a deep breath and coughing. Pleurisy is synonymous with "pleural thoracic pain", just to highlight the spasm caused by the rubbing of the double inflamed membrane whenever the lungs expand to breathe.

Causes

More often the cause of pleurisy lies in a viral (Adenovirus and influenza virus) or bacterial (tuberculosis and pneumonia) infection. However, infections are not the only factors involved in the etiopathogenesis of pleurisy. Among the other causes that contribute to the inflammation of the pleura we mention: rheumatoid arthritis, pulmonary embolism, lupus erythematosus, asbestos-related diseases, thoracic trauma and pleural cancer. Also a collapse of the lung (typical symptom of pneumothorax) can favor the appearance of pleurisy.

More generally, various diseases of the diaphragm, lung and chest wall may predispose a patient to pleurisy.

Sometimes, patients suffering from pleural effusion also complain of chest pain comparable to that which characterizes pleurisy. However, pleurisy is not an exclusive symptom of pleural effusion.

Pleurisy induced pain due to rubbing and friction between the lung and the lung created during breathing.

Although there is no proven relationship between the onset of pleurisy and smoking behavior, it is known that the so-called "smoker's cough" can aggravate chest pain triggered by inflammation of the pleura.

When it is not possible to identify a specific cause, pleurisy is called "idiopathic".

Symptoms

To learn more: Symptoms Pleurisy

The main symptom of pleurisy is expressed in pain in the chest, described as "stabbing, acute and lancinating", aggravated by coughing. This breathlessness can be felt in any area of ​​the chest, depending on the site of inflammation.

In addition to the omnipresent chest pain, the patient with pleurisy has other prodromes:

• Chills
• Temperature
• Diarrhea
• Sore throat associated with pain and swelling of the joints
• Shortness of breath
• Unwanted weight loss
• Rapid and superficial breathing
• Flu-like symptoms
• Sneezing
• Tachycardia
• Anxious cough, sometimes bloody

Normally, pleurisy does not cause long-term damage, although inflammation can worsen or sometimes lead to lung infections. Among the rare complications, we recall the formation of cicatricial lesions (adhesions) that can hinder breathing.

In principle, it is possible to state that complications do not depend so much on pleurisy itself, but rather on the cause that arises at the beginning.

Diagnosis

The suspicion of pleurisy arises from the perception of a piercing pain, lively and stabbing in the chest. In such circumstances, it is recommended to seek medical attention to ascertain the disorder.

After knowing the patient's medical history, the doctor proceeds with the physical examination using a stethoscope. This medical instrument allows us to perceive the characteristic friction caused by the rubbing of the lungs during breathing and gives an idea of ​​the severity of the condition.

After these routine investigations, you can proceed with more specific tests:

1. Blood tests: help to understand possible pathologies, such as bacterial infections, pneumonia, pulmonary embolism, lupus and rheumatic fever.
2. Control of arterial pressure, heart and respiratory rate, basal temperature
3. Chest X-ray: in addition to highlighting the heart and lungs, this test is useful for identifying possible sites of infection and for ascertaining possible lung collapse, tumor and rib fracture. From the chest radiograph it is also possible to ascertain a pleural effusion, a plausible causal factor of pleurisy. In similar situations we proceed with thoracentesis.
4. Thoracentesis: diagnostic test that allows to obtain a sample of liquid accumulated in the pleural cavity. From the analysis of the samples it is possible to trace the cause that triggered the pleurisy
5. CT (computed tomography): this test is useful to show any accumulation of fluid in the pleural cavity. Through this analysis, the doctor notes any signs of pneumonia, tumor or lung abscess
6. Magnetic resonance: using specific magnets, this exam is able to highlight a neoplastic proliferation or a pleural effusion, possible predisposing factors for pleurisy.
7. Sputum analysis: identifies the pathogen involved in the possible infection involved in pleurisy
8. TAC: the diagnostic investigation analyzes bones, muscles, organs, lungs and blood vessels
9. Cardiac monitoring and electrocardiogram: highlight the functionality of the heart, recording the electrical activity
10. Pulse oximeter: the device measures the amount of oxygen in the blood
11. Biopsy: invasive diagnostic test, used in case of suspected neoplasm or tuberculosis. The exam consists in taking a pleural sample and in the microscopic examination.

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Medications and treatments

To learn more: Pleuritis treatment medications

Most pleurisy has viral origins; in these cases, however annoying, pleurisy tends to self-purify in a few days, without necessarily resorting to specific drugs or treatments.

The main objective of therapy against pleurisy is to remove the pathogen involved in the disease and to resolve - in the case of extra-infectious inflammation - the pathology that arises there.

To alleviate pain during breathing, therapeutic aids (NSAIDs) are available, while antitussives (in particular CODEINE and DESTROMETORPHAN) are indicated to relieve cough.

In the case of proven bacterial pleuritis, the treatment of choice is constituted by antibiotics, such as AMOXICILLINA and moxifloxacin. Cortisonics are also particularly suitable for alleviating severe pleural inflammation.

In the event of a pleural effusion, it is advisable to proceed with thoracentesis which, besides being a valid diagnostic test, proves to be an excellent therapeutic intervention to evacuate the pleural fluid and thus restrict the healing time of pleurisy.