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Introduction
Pleurisy is a swelling with inflammation of the layers covering the lung. It is commonly associated with pain which aggravates while breathing.
The pleura consist of two layers; the inner layer i.e. visceral pleura holds the lungs and the outer layer i.e. parietal pleura separates lung from the chest wall and other organs.
Pleurisy occurs as a result of accumulation of extra fluid, in the space between the two layers of pleura. The fluid accumulation is referred as Pleural effusion. Pleurisy can be cured on its own or may need treatment. Scar tissue or adhesions may develop while one is recovering.
Epidemiology:
In younger population, an infection of the respiratory system may trigger pleurisy. Pleurisy normally lasts from 1 to 2 weeks. A distal spread of infection is noted in some individuals.
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Causes & Risk factors
The irritation of the pleura usually causes fluid to accumulate within the pleural cavity. The fluid reduces the friction in 2 layers of the pleura and reduces pain temporarily. But, in long run more fluid actually hampers the breathing process and lung function.
There are various causes of pleurisy as mentioned below.
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Infections in the respiratory systems: Those caused by virus, micro organism, fungus, tuberculosis, or parasites
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Cancers: comparable to mesothelioma, lung cancer, breast cancer etc.
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Drugs like penicillin, methotrexate, hydralazine, Procanbid, Procan, Procan-SR, phenytoin etc. make oneself susceptible to develop pleurisy
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Trauma to ribs
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Gastrointestinal infections like pancreatitis, peritonitis which spread to lung and pleura.
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Collagen vascular illness e.g. rheumatoid arthritis, sarcoid disease, lupus etc.
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Other causes: Uremia which is seen in kidney dysfunction, Blood clot/s in the artery supplying lung, Radiation therapy, Sickle cell anemia, Chemotherapy, Exposure to the Asbestos, HIV and so on.
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Symptoms and signs
Following are the signs and symptoms found with pleurisy.
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Chest pain: Commonly noted symptom, characterized by sharp, stabbing pain sometimes associated with burning sensation. The pain may aggravate while breathing and coughing.
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Dyspnoea or shortness of breath
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Cough: It can be dry or productive and sometimes may be associated with blood in sputum
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Fever: Infection, as commonly associated with fever
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Diagnosis
The cause of inflammation is traced first. The doctor needs to complete a Physical Examination. The infections and inflammatory reactions causing various signs and symptoms are taken into consideration. Risk factors like presence of autoimmune disorder, HIV or breast cancer are assessed.
The vital parameters like heart rate, respiratory arte, blood pressure, body temperature and the oxygen saturation of blood are noted before proceeding with the investigative reports.
Patient is auscultated over chest, with the stethoscope to listen for abnormal heart and breath sounds.
Differential Diagnosis:
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Nephrotic syndrome
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Peritoneal dialysis
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Pleuropneumonia
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pulmonary embolism or secondary infarction
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CSF fluid leakage to the pleural space
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Congestive coronary heart failure
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Post cardiac injury syndrome,
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Post pericardiotomy syndrome
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Post myocardial infarction or Dressler's syndrome
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Cirrhosis with hepatic hydrothorax
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Glomerulonephritis
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Superior vena cava obstruction
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Fontan procedure to cure congenital heart diseases
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Urinothorax
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Hypoproteinemia
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Investigations
Following tests are ordered to arrive at a conclusion.
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Chest X-ray: The chest and lung abnormalities can be studied and cause of pleurisy is traced to some extent.
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Examination of pleural fluid for infections
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Electrocardiogram: The doctor might order electrocardiogram/ECG to rule out cardiac cause.
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Blood test: Blood analysis to rule out different causes of chest pain as well as to know about infection if present.
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Treatment
Medical Treatment:
There are various types of treatments available to treat pleurisy. The choice of treatment depends upon the severity and progression of the disease. Response to the treatment also determines further course.
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Anti-inflammatory drugs: These are started to deal with inflammatory reactions and associated chest pain
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Treatment of underlying disorder like GI problem, HIV, Cancer, pleural fluid accumulation also reduces the symptoms to the great extent
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Antibiotic medications to relieve patient from infection
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Thoracentesis: If you are diagnosed with pleural effusion, your doctor may ask for thoracentesis. The procedure involves suctioning pleural fluid with needle
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Re-accumulation of pleural fluid is prevented by using medical measures known as pleurodesis. The procedure consists of introducing an irritant in a pleural cavity so that the cavity will develop an inflammation and scarring. As scar restricts movement and space, the fluid accumulation is ruled out.
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Pain killing agents: Taken with a Physician’s advice and only if the pain is severe enough to hamper daily activities.
Patient’s Education:
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Many causes of chest pain are serious as well as life-threatening.
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Patient or a keen is counseled for the presence and recurrence of infection. Why the care is essential with appropriate treatment is explained. Pleurisy can cause pneumonia and other illnesses in future, so caution is inevitable. Associated emphysema, heart problems, bronchitis, diabetes and other risk factors worsen the situation.
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References
Lee-Chiong T, Gebhart GF, Matthay RA. Chest pain. In: Mason RJ, Broaddus VC, Martin TR, et al, eds. Murray and Nadel’s Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2010
Chestnutt MS, Prendergast TJ (2007). Pleural diseases section of Lung. In LM Tierney Jr. et al., eds., Current Medical Diagnosis and Treatment, 46th ed., New York: Lang Medical Books/McGraw-Hill. | |