Pleurisy (Pleuritis): Causes, Symptoms, Diagnosis & Treatment Guide

Definition

Pleurisy = inflammation of the pleura (visceral + parietal layers lining lungs/chest wall). Inflamed surfaces rub → sharp, breathing-related chest pain.

Etiology

Category	Examples
Infection	Viral (flu, COVID), bacterial (pneumonia, TB), fungal, parasitic
Autoimmune	SLE, RA, vasculitis, Still's disease
Malignancy	Lung CA, mesothelioma, metastatic disease
Pulmonary Embolism	Infarction → pleural inflammation (often + effusion)
Trauma/Surgery	Rib fracture, thoracotomy, chest tube
Drug-Induced	Nitrofurantoin, hydralazine, procainamide, methotrexate
Other	Pancreatitis, renal failure (uremic pleuritis), Familial Mediterranean Fever

Classic Symptoms

Pleuritic chest pain: Sharp, stabbing, worse with inspiration/cough/sneeze/laugh. May radiate to shoulder (diaphragmatic irritation).
Dyspnea (splinting → shallow breathing).
Dry cough.
Fever (if infectious).
Pericardial friction rub (if pericarditis coexists).

Diagnostic Workup

History + exam (friction rub = pathognomonic).
CXR: May show effusion, infiltrate, or be normal.
CT chest: Better for PE, malignancy, subtle effusion.
Thoracentesis (if effusion): Light's criteria (exudate vs transudate), cytology, cultures, ADA, pH.
Autoimmune panel (ANA, RF, ANCA) if indicated.

Treatment

Treat underlying cause: Antibiotics, antivirals, immunosuppressants, anticoagulation (PE), chemo.
Symptomatic: NSAIDs (indomethacin, ibuprofen) – first-line for pain/inflammation. Opioids if severe (avoid splinting → atelectasis).
Thoracentesis: Therapeutic if large effusion causing compromise.
Hospitalization: For hypoxia, large effusion, hemodynamic instability, diagnostic uncertainty.

Prevention

Vaccination (flu, pneumococcal, COVID), smoking cessation, treat underlying conditions, avoid asbestos/silica.