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Pleurisy

Pleurisy

Overview
Pleurisy is an inflammation
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...

 of the pleura, the lining of the pleural cavity
Pleural cavity
In human anatomy, the pleural cavity is the potential space between the two pleura of the lungs. The pleura is a serous membrane which folds back onto itself to form a two-layered, membrane structure. The thin space between the two pleural layers is known as the pleural cavity; it normally...

 surrounding the lung
Lung
The lung is the essential respiration organ in many air-breathing animals, including most tetrapods, a few fish and a few snails. In mammals and the more complex life forms, the two lungs are located near the backbone on either side of the heart...

s. Among other things, infections are the most common cause of pleurisy.
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Encyclopedia
Pleurisy is an inflammation
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...

 of the pleura, the lining of the pleural cavity
Pleural cavity
In human anatomy, the pleural cavity is the potential space between the two pleura of the lungs. The pleura is a serous membrane which folds back onto itself to form a two-layered, membrane structure. The thin space between the two pleural layers is known as the pleural cavity; it normally...

 surrounding the lung
Lung
The lung is the essential respiration organ in many air-breathing animals, including most tetrapods, a few fish and a few snails. In mammals and the more complex life forms, the two lungs are located near the backbone on either side of the heart...

s. Among other things, infections are the most common cause of pleurisy.

The inflamed pleural layers rub against each other every time the lungs expand to breathe in air. This can cause severe sharp pain
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...

 with inhalation (also called pleuritic chest pain
Chest pain
Chest pain may be a symptom of a number of serious conditions and is generally considered a medical emergency. Even though it may be determined that the pain is non-cardiac in origin, this is often a diagnosis of exclusion made after ruling out more serious causes of the pain.-Differential...

).

Signs and symptoms


The main symptom of pleurisy is a sharp or stabbing pain in the chest that gets worse with deep breathing, coughing, sneezing or laughing. The pain may stay in one place, or it may spread to the shoulder or back. Sometimes it becomes a fairly constant dull ache.

Depending on its cause, pleurisy may be accompanied by other symptoms:
  • Shortness of breath
  • Cough
  • Fever
    Fever
    Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...

     and chills
  • Rapid, shallow breathing
  • Unexplained weight loss
    Weight loss
    Weight loss, in the context of medicine, health or physical fitness, is a reduction of the total body mass, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue...

  • Sore throat
    Sore throat
    A sore throat or throat pain is a common physical symptom usually caused by acute pharyngitis, or throat inflammation, though it also occurs in a number of other situations, such as post trauma and in diphtheria. It can cause mild to extreme pain....

     followed by pain and swelling in the joints
  • Diarrhea
    Diarrhea
    Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...

  • Ventricular tachycardia
    Ventricular tachycardia
    Ventricular tachycardia is a tachycardia, or fast heart rhythm, that originates in one of the ventricles of the heart...

  • Vomiting blood

Causes


Viral infection is the most common cause of pleurisy. However, many different conditions can cause pleurisy:
  • Pneumothorax
    Pneumothorax
    Pneumothorax is a collection of air or gas in the pleural cavity of the chest between the lung and the chest wall. It may occur spontaneously in people without chronic lung conditions as well as in those with lung disease , and many pneumothoraces occur after physical trauma to the chest, blast...

  • Bacterial infections like pneumonia
    Pneumonia
    Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...

     and tuberculosis
    Tuberculosis
    Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...

  • Autoimmune disorders like systemic lupus erythematosus
    Systemic lupus erythematosus
    Systemic lupus erythematosus , often abbreviated to SLE or lupus, is a systemic autoimmune disease that can affect any part of the body. As occurs in other autoimmune diseases, the immune system attacks the body's cells and tissue, resulting in inflammation and tissue damage...

     (or drug-induced lupus erythematosus
    Drug-induced lupus erythematosus
    Drug-induced lupus erythematosus is an autoimmune disorder caused by chronic use of certain drugs. These drugs cause an autoimmune response producing symptoms similar to those of SLE...

    ) and rheumatoid arthritis
    Rheumatoid arthritis
    Rheumatoid arthritis is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks synovial joints. The process produces an inflammatory response of the synovium secondary to hyperplasia of synovial cells, excess synovial fluid, and the development...

  • Lung cancer
    Lung cancer
    Lung cancer is a disease characterized by uncontrolled cell growth in tissues of the lung. If left untreated, this growth can spread beyond the lung in a process called metastasis into nearby tissue and, eventually, into other parts of the body. Most cancers that start in lung, known as primary...

     and lymphoma
    Lymphoma
    Lymphoma is a cancer in the lymphatic cells of the immune system. Typically, lymphomas present as a solid tumor of lymphoid cells. Treatment might involve chemotherapy and in some cases radiotherapy and/or bone marrow transplantation, and can be curable depending on the histology, type, and stage...

  • Other lung diseases like Cystic Fibrosis
    Cystic fibrosis
    Cystic fibrosis is a recessive genetic disease affecting most critically the lungs, and also the pancreas, liver, and intestine...

    , sarcoidosis
    Sarcoidosis
    Sarcoidosis , also called sarcoid, Besnier-Boeck disease or Besnier-Boeck-Schaumann disease, is a disease in which abnormal collections of chronic inflammatory cells form as nodules in multiple organs. The cause of sarcoidosis is unknown...

    , asbestosis
    Asbestosis
    Asbestosis is a chronic inflammatory and fibrotic medical condition affecting the parenchymal tissue of the lungs caused by the inhalation and retention of asbestos fibers...

    , lymphangioleiomyomatosis
    Lymphangioleiomyomatosis
    Lymphangioleiomyomatosis is a rare lung disease that results in a proliferation of disorderly smooth muscle growth throughout the lungs, in the bronchioles, alveolar septa, perivascular spaces, and lymphatics, resulting in the obstruction of small airways and lymphatics...

    , and mesothelioma
    Mesothelioma
    Mesothelioma, more precisely malignant mesothelioma, is a rare form of cancer that develops from the protective lining that covers many of the body's internal organs, the mesothelium...

  • Pulmonary embolism
    Pulmonary embolism
    Pulmonary embolism is a blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream . Usually this is due to embolism of a thrombus from the deep veins in the legs, a process termed venous thromboembolism...

    , a blood clot in the blood vessels that go into the lungs
  • Inflammatory bowel disease
    Inflammatory bowel disease
    In medicine, inflammatory bowel disease is a group of inflammatory conditions of the colon and small intestine. The major types of IBD are Crohn's disease and ulcerative colitis.-Classification:...

  • Familial Mediterranean fever
    Familial Mediterranean fever
    Familial Mediterranean fever is a hereditary inflammatory disorder. FMF is an autoinflammatory disease caused by mutations in MEFV, a gene which encodes a 781–amino acid protein denoted pyrin....

    , an inherited condition that often causes fever and swelling in the abdomen or lung
  • Infection from a fungus
    Fungus
    A fungus is a member of a large group of eukaryotic organisms that includes microorganisms such as yeasts and molds , as well as the more familiar mushrooms. These organisms are classified as a kingdom, Fungi, which is separate from plants, animals, and bacteria...

     or parasite
  • Heart surgery, especially coronary artery bypass grafting
  • High blood pressure
  • Chest injuries
  • Aortic dissection
    Aortic dissection
    Aortic dissection occurs when a tear in the inner wall of the aorta causes blood to flow between the layers of the wall of the aorta and force the layers apart. The dissection typically extends anterograde, but can extend retrograde from the site of the intimal tear. Aortic dissection is a medical...

  • Can occur with no illness or infection

Some cases of pleurisy are idiopathic
Idiopathic
Idiopathic is an adjective used primarily in medicine meaning arising spontaneously or from an obscure or unknown cause. From Greek ἴδιος, idios + πάθος, pathos , it means approximately "a disease of its own kind". It is technically a term from nosology, the classification of disease...

, meaning the cause cannot be determined.

Diagnosis


A diagnosis of pleurisy or another pleural condition is based on medical histories, physical exams, and diagnostic tests. The goals are to rule out other sources of the symptoms and to find the cause of the pleurisy so the underlying disorder can be treated.

Physical exam


A doctor uses a stethoscope
Stethoscope
The stethoscope is an acoustic medical device for auscultation, or listening to the internal sounds of an animal body. It is often used to listen to lung and heart sounds. It is also used to listen to intestines and blood flow in arteries and veins...

 to listen to the breathing. This detects any unusual sounds in the lungs. A person with pleurisy will have inflamed layers of the pleura that make a rough, scratchy sound as they rub against each other during breathing. This is called pleural friction rub
Pleural friction rub
A pleural friction rub, or simply pleural rub, is a medical sign, audible by listening to the internal sounds of the body, usually using a stethoscope on the lungs, that is used in the diagnosis of pleurisy and other conditions affecting the chest cavity....

, and it is a likely sign of pleurisy.

Diagnostic tests


Depending on the results of the physical exam, diagnostic tests are sometimes performed.

Chest x-ray
A chest x-ray
Chest X-ray
In medicine, a chest radiograph, commonly called a chest X-ray , is a projection radiograph of the chest used to diagnose conditions affecting the chest, its contents, and nearby structures...

 takes a picture of the heart and lungs. It may show air or fluid in the pleural space. It also may show what's causing the pleurisy –for example; pneumonia, a fractured rib, or a lung tumor.

Sometimes an x-ray is taken while lying on the painful side. This may show fluid that did not appear on the standard x-ray taken while standing.

Computed tomography (CT) scan
A CT scan provides a computer-generated picture of the lungs that can show pockets of fluid. It also may show signs of pneumonia, a lung abscess, or a tumor.

Ultrasound
Ultrasonography uses sound waves to create an image. It may show where fluid is located in the chest. It also can show some tumors. Although ultrasound may detect fluid around the lungs, also known as a pleural effusion, sounds beams cannot penetrate through air or bone. Therefore, an actual picture of the lungs cannot be obtained with ultrasonography.

Magnetic resonance imaging (MRI)
Magnetic resonance imaging
Magnetic resonance imaging
Magnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...

 (MRI), also called nuclear magnetic resonance
Nuclear magnetic resonance
Nuclear magnetic resonance is a physical phenomenon in which magnetic nuclei in a magnetic field absorb and re-emit electromagnetic radiation...

 (NMR) scanning, uses powerful magnets to show pleural effusion
Pleural effusion
Pleural effusion is excess fluid that accumulates between the two pleural layers, the fluid-filled space that surrounds the lungs. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during ventilation.-Pathophysiology:...

s and tumors.

Blood tests
Blood test
Blood test
A blood test is a laboratory analysis performed on a blood sample that is usually extracted from a vein in the arm using a needle, or via fingerprick....

s can detect bacterial or viral infection, pneumonia
Pneumonia
Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...

, rheumatic fever
Rheumatic fever
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection, such as strep throat or scarlet fever. Believed to be caused by antibody cross-reactivity that can involve the heart, joints, skin, and brain, the illness typically develops two to three weeks after...

, a pulmonary embolism
Pulmonary embolism
Pulmonary embolism is a blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream . Usually this is due to embolism of a thrombus from the deep veins in the legs, a process termed venous thromboembolism...

, or lupus
Lupus
Lupus most commonly refers to the disease systemic lupus erythematosus.Lupus may also refer to:-Medicine:* Lupus erythematosus, a chronic autoimmune disease with several different forms...

.

Arterial blood gas
In arterial blood gas sampling, a small amount of blood is taken from an artery
Artery
Arteries are blood vessels that carry blood away from the heart. This blood is normally oxygenated, exceptions made for the pulmonary and umbilical arteries....

, usually in the wrist. The blood is then checked for oxygen
Oxygen
Oxygen is the element with atomic number 8 and represented by the symbol O. Its name derives from the Greek roots ὀξύς and -γενής , because at the time of naming, it was mistakenly thought that all acids required oxygen in their composition...

 and carbon dioxide
Carbon dioxide
Carbon dioxide is a naturally occurring chemical compound composed of two oxygen atoms covalently bonded to a single carbon atom...

 levels. This test shows how well the lungs are taking in oxygen.

Thoracentesis

Once the presence and location of fluid is confirmed, a sample of fluid can be removed for testing. The procedure to remove fluid in the chest is called thoracentesis
Thoracentesis
Thoracentesis , also known as thoracocentesis or pleural tap, is an invasive procedure to remove fluid or air from the pleural space for diagnostic or therapeutic purposes. A cannula, or hollow needle, is carefully introduced into the thorax, generally after administration of local anesthesia...

. The doctor inserts a small needle or a thin, hollow, plastic tube through the ribs in the back of the chest into the chest wall and draws fluid out of the chest.

Thoracentesis can be done in the doctor's office or at the hospital. Ultrasound is used to guide the needle to the fluid that is trapped in small pockets around the lungs.

Thoracentesis usually does not cause serious complications. Generally, a chest x-ray is done after the procedure to evaluate the lungs. Possible complications of thoracentesis include the following:
  • Pneumothorax
    Pneumothorax
    Pneumothorax is a collection of air or gas in the pleural cavity of the chest between the lung and the chest wall. It may occur spontaneously in people without chronic lung conditions as well as in those with lung disease , and many pneumothoraces occur after physical trauma to the chest, blast...

    , or buildup of air in the pleural space, with a collapsed or partially collapsed lung. Sometimes air comes in through the needle or the needle makes a hole in the lung. Usually, a hole will seal itself. But sometimes air can build up around the lung and make it collapse. A chest tube can remove the air and let the lung expand again.
  • Pain.
  • Bleeding
    Bleeding
    Bleeding, technically known as hemorrhaging or haemorrhaging is the loss of blood or blood escape from the circulatory system...

     and bruising where the needle went in. In rare cases, bleeding may occur in or around the lung. The doctor can use a chest tube to drain the blood. In some cases, surgery is needed.
  • Infection where the needle went in.
  • Rarely, liver
    Liver
    The liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion...

     or spleen
    Spleen
    The spleen is an organ found in virtually all vertebrate animals with important roles in regard to red blood cells and the immune system. In humans, it is located in the left upper quadrant of the abdomen. It removes old red blood cells and holds a reserve of blood in case of hemorrhagic shock...

     injury.


The fluid removed by thoracentesis is examined under a microscope. It is evaluated for the presence of chemicals and for its color, and texture. The clearness of the fluid is an indicator of infection, cancer, or other conditions that may be causing the buildup of fluid or blood in the pleural space.

Biopsy
If tuberculosis or cancer is suspected, a small piece of the pleura may be examined under a microscope to make a definitive diagnosis. This is called a biopsy
Biopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...

.

Several approaches to taking tissue samples are available
  1. Insertion of a needle through the skin on the chest to remove a small sample of the outer layer of the pleura.
  2. Insertion of a small tube with a light on the end (endoscope) into tiny cuts in the chest wall in order to visualize the pleura. Small pieces of tissue can be biopsied though the endoscope.
  3. remove a sample of the pleura through a small cut in the chest wall. This is called an open pleural biopsy. It is usually done if the sample from the needle biopsy is too small for an accurate diagnosis.

Treatment


Treatment has several goals:
  • Remove the fluid, air, or blood from the pleural space
  • Relieve symptoms
  • Treat the underlying condition

Procedures


If large amounts of fluid, air, or blood are not removed from the pleural space, they may put pressure on the lung and cause it to collapse.

The surgical procedures used to drain fluid, air, or blood from the pleural space are as follows:
  • During thoracentesis, a needle or a thin, hollow, plastic tube is inserted through the ribs in the back of the chest into the chest wall. A syringe is attached to draw fluid out of the chest. This procedure can remove more than 6 cups (1.5 litres) of fluid at a time.
  • When larger amounts of fluid must be removed, a chest tube may be inserted through the chest wall. The doctor injects a local painkiller into the area of the chest wall outside where the fluid is. A plastic tube is then inserted into the chest between two ribs. The tube is connected to a box that suctions the fluid out. A chest x-ray is taken to check the tube's position.
  • A chest tube also is used to drain blood and air from the pleural space. This can take several days. The tube is left in place, and the patient usually stays in the hospital during this time.
  • Sometimes the fluid contains thick pus or blood clots, or it may have formed a hard skin or peel. This makes it harder to drain the fluid. To help break up the pus or blood clots, the doctor may use the chest tube to put certain medicines into the pleural space. These medicines are called fibrinolytics. If the pus or blood clots still do not drain out, surgery may be necessary.

Medications


A couple of medications are used to relieve pleurisy symptoms:
  • Paracetamol
    Paracetamol
    Paracetamol INN , or acetaminophen USAN , is a widely used over-the-counter analgesic and antipyretic . It is commonly used for the relief of headaches and other minor aches and pains and is a major ingredient in numerous cold and flu remedies...

     (acetaminophen) or anti-inflammatory agents to control pain and decrease inflammation. Only indomethacin (brand name Indocin) has been studied with respect to relief of pleurisy.
  • Codeine
    Codeine
    Codeine or 3-methylmorphine is an opiate used for its analgesic, antitussive, and antidiarrheal properties...

    -based cough syrups to control a cough


There may be a role for the use of corticosteroids (for tuberculous pleurisy), tacrolimus
Tacrolimus
Tacrolimus is an immunosuppressive drug that is mainly used after allogeneic organ transplant to reduce the activity of the patient's immune system and so lower the risk of organ rejection...

 (Prograf) and methotrexate
Methotrexate
Methotrexate , abbreviated MTX and formerly known as amethopterin, is an antimetabolite and antifolate drug. It is used in treatment of cancer, autoimmune diseases, ectopic pregnancy, and for the induction of medical abortions. It acts by inhibiting the metabolism of folic acid. Methotrexate...

 (Trexall, Rheumatrex) in the treatment of pleurisy. Further studies are needed.

Lifestyle changes


The following may be helpful in the management of pleurisy:
  • Lying on the painful side may be more comfortable
  • Breathing deeply and coughing to clear mucus as the pain eases. Otherwise, pneumonia
    Pneumonia
    Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...

     may develop.
  • Getting rest

Treating the cause


Ideally, the treatment of pleurisy is aimed at eliminating the underlying cause of the disease.
  • If the pleural fluid is infected, treatment involves antibiotics and draining the fluid. If the infection is tuberculosis or from a fungus, treatment involves long-term use of antibiotics or antifungal medicines.
  • If the fluid is caused by tumors of the pleura, it may build up again quickly after it is drained. Sometimes antitumor medicines will prevent further fluid buildup. If they don't, the doctor may seal the pleural space. This is called pleurodesis
    Pleurodesis
    Pleurodesis is a medical procedure in which the pleural space is artificially obliterated. It involves the adhesion of the two pleura.- Uses :Pleurodesis is done to prevent recurrence of pneumothorax or recurrent pleural effusion...

    . Pleurodesis involves the drainage of all the fluid out of the chest through a chest tube. A substance is inserted through the chest tube into the pleural space. This substance irritates the surface of the pleura. This causes the two layers of the pleura to squeeze shut so there is no room for more fluid to build up.
  • Chemotherapy
    Chemotherapy
    Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....

     or radiation treatment also may be used to reduce the size of the tumors.
  • If congestive heart failure
    Congestive heart failure
    Heart failure often called congestive heart failure is generally defined as the inability of the heart to supply sufficient blood flow to meet the needs of the body. Heart failure can cause a number of symptoms including shortness of breath, leg swelling, and exercise intolerance. The condition...

     is causing the fluid buildup, treatment usually includes diuretics and other medicines.


The most common and known treatment for pleurisy is generally to carry on as normal, ibuprofen and amoxicilin being common treatments prescribed by doctors. Milder forms of Pleurisy can be noticed by less inflammatres of the arms and legs. If this is the case Pleurisy will clear of all symptoms within two weeks.

Alternative treatments


A number of alternative or complementary medicines are being investigated for their anti-inflammatory properties, and their use in pleurisy. At this time, clinical trials of these compounds have not been performed.

Extracts from the Brazilian folk remedy Wilbrandia ebracteata ("Taiuia") have been shown to reduce inflammation in the pleural cavity of mice.
The extract is thought to inhibit the same enzyme, cyclooxygenase-2 (COX-2), as the non-steroidal anti-inflammatory drug
Non-steroidal anti-inflammatory drug
Nonsteroidal anti-inflammatory drugs, usually abbreviated to NSAIDs or NAIDs, but also referred to as nonsteroidal anti-inflammatory agents/analgesics or nonsteroidal Anti-inflammatory medicines , are drugs with analgesic and antipyretic effects and which have, in higher doses, anti-inflammatory...

s.
Similarly, an extract from the roots of the Brazilian Petiveria alliacea
Petiveria alliacea
Petiveria alliacea is a species of flowering plant in the pokeweed family, Phytolaccaceae, that is native to Florida and the Lower Rio Grande Valley of Texas in the United States, Mexico, Central America, the Caribbean, and tropical South America. Introduced populations occur in Benin and Nigeria...

 plant reduced inflammation in a rat model of pleurisy.
The extract also reduced pain sensations in the rats. An aqueous extract from Solidago chilensis has been shown to reduce inflammation in a mouse model of pleurisy.

Related problems


Pleurisy is often associated with complications that affect the pleural space.

Pleural effusion


In some cases of pleurisy, excess fluid builds up in the pleural space. This is called a pleural effusion
Pleural effusion
Pleural effusion is excess fluid that accumulates between the two pleural layers, the fluid-filled space that surrounds the lungs. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during ventilation.-Pathophysiology:...

. The buildup of fluid usually forces the two layers of the pleura apart so they don't rub against each other when breathing. This can relieve the pain of pleurisy. A large amount of extra fluid can push the pleura against the lung until the lung, or a part of it, collapses. This can make it hard to breathe.

In some cases of pleural effusion, the extra fluid gets infected and turns into an abscess
Abscess
An abscess is a collection of pus that has accumulated in a cavity formed by the tissue in which the pus resides due to an infectious process or other foreign materials...

. This is called an empyema
Empyema
Pleural empyema is an accumulation of pus in the pleural cavity. Most pleural empyemas arise from an infection within the lung , often associated with parapneumonic effusions. There are three stages: exudative, fibrinopurulent and organizing. In the exudative stage, the pus accumulates...

.

Pleural effusion involving fibrin
Fibrin
Fibrin is a fibrous, non-globular protein involved in the clotting of blood. It is a fibrillar protein that is polymerised to form a "mesh" that forms a hemostatic plug or clot over a wound site....

ous exudates in the fluid may be called fibrinous pleurisy. It sometimes occurs as a later stage of pleurisy.

A person can develop a pleural effusion in the absence of pleurisy. For example, pneumonia, heart failure, cancer, or a pulmonary embolism can lead to a pleural effusion.

Pneumothorax


Air or gas also can build up in the pleural space. This is called a pneumothorax
Pneumothorax
Pneumothorax is a collection of air or gas in the pleural cavity of the chest between the lung and the chest wall. It may occur spontaneously in people without chronic lung conditions as well as in those with lung disease , and many pneumothoraces occur after physical trauma to the chest, blast...

. It can result from acute lung injury or a lung disease like emphysema
Emphysema
Emphysema is a long-term, progressive disease of the lungs that primarily causes shortness of breath. In people with emphysema, the tissues necessary to support the physical shape and function of the lungs are destroyed. It is included in a group of diseases called chronic obstructive pulmonary...

. Lung procedures, like surgery, drainage of fluid with a needle, examination of the lung from the inside with a light and a camera, or mechanical ventilation, also can cause a pneumothorax.

The most common symptom is sudden pain in one side of the lung and shortness of breath. A pneumothorax also can put pressure on the lung and cause it to collapse.

If the pneumothorax is small, it may go away on its own. If large, a chest tube is placed through the skin and chest wall into the pleural space to remove the air.

Hemothorax


Blood also can collect in the pleural space. This is called hemothorax
Hemothorax
A hemothorax is a condition that results from blood accumulating in the pleural cavity.-Cause and presentation:Its cause is usually traumatic, from a blunt or penetrating injury to the thorax, resulting in a rupture of the serous membrane either lining the thorax or covering the lungs...

. The most common cause is injury to the chest from blunt force or surgery on the heart or chest. Hemothorax also can occur in people with lung or pleural cancer.

Hemothorax can put pressure on the lung and force it to collapse. It also can cause shock, a state of hypoperfusion in which an insufficient amount of blood is able to reach the organs.

Prognosis


Pleurisy and other disorders of the pleura can be serious, depending on what caused the inflammation in the pleura.

If the condition that caused the pleurisy or other pleural disorders isn't too serious and is diagnosed and treated early, one usually can expect a full recovery.

Notable cases

  • Flavius Constantius III
    Constantius III
    Flavius Constantius , commonly known as Constantius III, was Western Roman Emperor for seven months in 421. A prominent general and politician, he was the power behind the throne for much of the 410s, and in 421 briefly became co-emperor of the Western Empire with Honorius.- Early life and rise to...

    , Joint Emperor of the Western Roman Empire, died of pleurisy on 2 September 421 AD.
  • Charlemagne
    Charlemagne
    Charlemagne was King of the Franks from 768 and Emperor of the Romans from 800 to his death in 814. He expanded the Frankish kingdom into an empire that incorporated much of Western and Central Europe. During his reign, he conquered Italy and was crowned by Pope Leo III on 25 December 800...

    , known as the father of Europe for reuniting much of the Roman Empire, died in 814 of pleurisy.
  • Benjamin Franklin
    Benjamin Franklin
    Dr. Benjamin Franklin was one of the Founding Fathers of the United States. A noted polymath, Franklin was a leading author, printer, political theorist, politician, postmaster, scientist, musician, inventor, satirist, civic activist, statesman, and diplomat...

     died from the disease at the age of 84.
  • Mahatma Gandhi
    Mahatma Gandhi
    Mohandas Karamchand Gandhi , pronounced . 2 October 1869 – 30 January 1948) was the pre-eminent political and ideological leader of India during the Indian independence movement...

     suffered from pleurisy during the First World War, while he was in London.
  • Juan O'Donoju
    Juan O'Donojú
    Juan O'Donojú y O'Rian was a Spanish military officer and jefe político superior of New Spain from July 21, 1821 to September 28, 1821, during Mexico's war of independence...

    , last viceroy of the Spanish colony of New Spain
    New Spain
    New Spain, formally called the Viceroyalty of New Spain , was a viceroyalty of the Spanish colonial empire, comprising primarily territories in what was known then as 'América Septentrional' or North America. Its capital was Mexico City, formerly Tenochtitlan, capital of the Aztec Empire...

     (Mexico
    Mexico
    The United Mexican States , commonly known as Mexico , is a federal constitutional republic in North America. It is bordered on the north by the United States; on the south and west by the Pacific Ocean; on the southeast by Guatemala, Belize, and the Caribbean Sea; and on the east by the Gulf of...

    ), died of pleurisy on October 8, 1821.
  • Francis Scott Key
    Francis Scott Key
    Francis Scott Key was an American lawyer, author, and amateur poet, from Georgetown, who wrote the lyrics to the United States' national anthem, "The Star-Spangled Banner".-Life:...

     died in 1843 at the home of his daughter Elizabeth Howard in Baltimore from pleurisy.
  • Carson McCullers
    Carson McCullers
    Carson McCullers was an American writer. She wrote novels, short stories, and two plays, as well as essays and some poetry. Her first novel The Heart Is a Lonely Hunter explores the spiritual isolation of misfits and outcasts of the South...

    , author of The Heart is a Lonely Hunter
    The Heart Is a Lonely Hunter
    The Heart Is a Lonely Hunter is the debut 1940 novel by American author Carson McCullers. Written in Charlotte, North Carolina, in houses on Central Avenue and East Boulevard, it is about a deaf man named John Singer and the people he encounters in a 1930s mill town in the US state of Georgia...

    , was diagnosed with pleurisy in 1944.
  • Erik Satie
    Erik Satie
    Éric Alfred Leslie Satie was a French composer and pianist. Satie was a colourful figure in the early 20th century Parisian avant-garde...

    , French composer, died from pleurisy at l'Hôpital St. Joseph on 1 July 1925.
  • Ringo Starr
    Ringo Starr
    Richard Starkey, MBE better known by his stage name Ringo Starr, is an English musician and actor who gained worldwide fame as the drummer for The Beatles. When the band formed in 1960, Starr was a member of another Liverpool band, Rory Storm and the Hurricanes. He became The Beatles' drummer in...

    , former Beatles drummer, had chronic-pleurisy at age 13 in 1953.
  • William Wordsworth
    William Wordsworth
    William Wordsworth was a major English Romantic poet who, with Samuel Taylor Coleridge, helped to launch the Romantic Age in English literature with the 1798 joint publication Lyrical Ballads....

    , the English poet, died of pleurisy at age 80 on 13 April 1850.

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