Pleurisy is a relatively common disease. It is an inflammation affecting the pleura, which is a membrane covering the lungs and the chest cavity. There is a minimal space between the pleural and the lung tissue with a minimal amount of fluid and negative pressure, which ensures easy opening of lungs during the inspiration.


The pleurisy may be caused by both viral and bacterial infections and it frequently accompanies bacterial pneumonias. However, there are also non-infectious inflammations of pleura caused by autoimmune diseases (systemic lupus erythematosus, etc.). Similarly, the pleura can be irritated by many other primarily non-infectious diseases such as the lung cancer, mesothelioma, asbestosis and silicosis.


The pleurisy is generally divided into dry and wet. Dry pleurisy is related to pleural chest pain and the wet form causes occurrence of fluid in the chest cavity (pleural effusion). The disease often starts with the dry form, which progresses into the wet pleurisy. The pain in pleurisy is located in the chest on side of the affected pleura. It typically worsens during inspiration and disappears during expiration. In addition, the irritation of pleura causes a nasty dry cough and elevated body temperature. The pleural effusion may compress the lung and cause shortness of breath.


The diagnosis can be stated from the clinical symptoms and listening with the stethoscope. We can hear a characteristic friction rub (dry pleurisy) or muted breathing sounds (wet pleurisy). Imaging methods such as the chest X-ray or computed tomography can show us the thickening of inflamed pleura, pleural effusion and many causative factors (pneumonias, tumors, etc.).


Dry pleurisy is treated with bed rest and administration of anti-inflammatory drugs. This therapy suppresses the pain and decreases the elevated body temperature. When we suspect the presence of a bacterial infection, antibiotics are the medications of choice. When there is the wet pleurisy, it is advisable to aspirate the fluid by a needle or perform a continuous drainage of the affected chest cavity. The procedure is both diagnostic and therapeutic as the fluid can be sent for examination (microbiological, biochemical, cytological) and the intervention eases the feeling of shortness of breath.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources