Pleurisy

Inflammation of the pleura

Pleurisy is an acute or chronic inflammation of the pleura, the double serous sheet that lines the inside of the thoracic cavity and surrounds the lungs. Often an expression of viral or bacterial insults, pleurisy is normally perceived as severe pain in the chest, exacerbated by deep breathing and coughing. Pleurisy is synonymous with "pleural chest pain", precisely to highlight the spasm caused by the rubbing of the inflamed double 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. Other causes that contribute to inflammation of the pleura include: rheumatoid arthritis, pulmonary embolism, lupus erythematosus, asbestos-related diseases, thoracic trauma and tumor of the pleura. A collapse of the lung (a typical symptom of pneumothorax) can also promote the onset of pleurisy.
More generally, various diseases of the diaphragm, lung and chest wall can predispose a patient to pleurisy.
Sometimes, patients with pleural effusion also complain of chest pain comparable to that which characterizes pleurisy. However, pleurisy is not an exclusive symptom of pleural effusion.
The stabbing pain induced by pleurisy results from the friction and friction between lung and lung created during breathing.
Although there is no demonstrated relationship between the onset of pleurisy and smoking, it is known that the so-called "smoker's cough" can aggravate chest pain triggered by inflammation of the pleura.

Main cause of pleurisy

Frequent causes of pleurisy

Minor causes of pleurisy

Viral infection
Bacterial infection (tuberculous-type species) pulmonary embolism
chest injuries
lupus erythematosus
diseases related to asbestos
pneumonia
chest trauma Rheumatoid arthritis
Lung cancer
Pleural cancer
Rib fractures
Fungal and parasitic infections
Collapsed lung (pneumothorax)

When a precise cause cannot be identified, pleurisy is referred to as "idiopathic".

Symptoms

For further information: Symptoms Pleurisy

The main symptom of pleurisy is expressed in chest pain, described as "stabbing, sharp and stabbing", aggravated by coughing. This breathlessness can be felt in any area of ​​the chest, based on the site of inflammation.
In addition to the omnipresent chest pain, the patient suffering from pleurisy reports other prodromes:

• Chills
• Fever
• Diarrhea
• Sore throat associated with pain and swelling of the joints
• Shortness of breath
• Unwanted weight loss
• Fast, shallow breathing
• Flu-like symptoms
• Sneezing
• Tachycardia
• Irritating, sometimes bloody cough

Normally, pleurisy does not cause long-term damage, although inflammation can worsen or sometimes lead to lung infections. Rare complications include the formation of scarring (adhesions) that can obstruct breathing.
Generally speaking, it is possible to state that complications do not depend so much on the pleurisy itself, but rather on the underlying cause.

Diagnosis

The suspicion of pleurisy arises from the perception of a stabbing, lively and stabbing pain in the chest. In such circumstances, it is recommended that you seek medical attention to ascertain the disorder.
After knowing the patient's clinical history, the doctor proceeds with the physical examination using a stethoscope. This medical instrument allows you to perceive the characteristic friction caused by the rubbing of the lungs during breathing and allows you to give an idea of ​​the severity of the disease.
After these routine investigations, it is possible to proceed with more specific tests:

1. Blood tests: help to understand possible diseases, such as bacterial infections, pneumonia, pulmonary embolism, lupus and rheumatic fever.
2. Control of blood 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 a possible lung collapse, tumor and fracture of the ribs.From the chest X-ray 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 fluid 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 for showing any accumulation of fluid in the pleural cavity. With this test, the doctor detects any signs of pneumonia, tumor or lung abscess
6. Magnetic resonance: using specific magnets, this examination is able to highlight a neoplastic proliferation or a pleural effusion, possible predisposing factors for pleurisy.
7. Sputum analysis: identifies the pathogen involved in any infection involved in pleurisy
8. CT scan: the diagnostic investigation analyzes bones, muscles, organs, lungs and blood vessels
9. Cardiac monitoring and electrocardiogram: they 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 cases of suspected cancer or tuberculosis. The examination consists in taking a sample of the pleura and in the microscopic examination.

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Medicines and treatments

For further information: Medicines for the treatment of Pleurisy

Most pleurisy have viral origins; in these cases, however annoying, the pleurisy tends to resolve itself in a few days, without necessarily resorting to drugs or specific 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 at its origins.
Therapeutic aids (NSAIDs) are available to relieve pain during breathing, while antitussives (in particular CODEIN and DEXTROMETORPHAN) are indicated to relieve cough.
In the case of proven bacterial pleurisy, the treatment of choice is constituted by antibiotics, such as AMOXICILLIN and moxifloxacin. Cortisones are also particularly suitable for relieving severe pleural inflammation.
In case of pleural effusion, it is advisable to proceed with thoracentesis which, in addition to being a valid diagnostic test, proves to be an excellent therapeutic intervention to evacuate the pleural fluid and thus reduce the healing time of the pleurisy.