From the Guidelines
Pleurisy should be managed by addressing the underlying cause, with initial drainage of pleural infection undertaken using a small bore chest tube (14F or smaller) as recommended by the British Thoracic Society guideline for pleural disease 1.
Key Considerations
- The management of pleurisy involves treating the underlying cause, which may include infections, autoimmune disorders, or other conditions.
- For symptom relief, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can reduce pain and inflammation.
- In cases of bacterial infection, antibiotics will be prescribed based on the specific pathogen.
- A careful history and physical examination of the patient remains the most important first step when evaluating someone with an undiagnosed pleural effusion 2.
Diagnostic Approach
- Thoracic ultrasound (TUS) should be performed on every patient at their initial presentation and again whenever a pleural procedure is being performed 2.
- If it is not safe to proceed with a pleural aspiration, a CT scan should be obtained as the next step.
- The microbiology of pleural infection is a crucial aspect of management, and knowledge of the likely microbiological cause will influence the required antibiotic therapy 3.
Treatment
- Initial drainage of pleural infection should be undertaken using a small bore chest tube (14F or smaller) 1.
- Antibiotics will be prescribed based on the specific pathogen in cases of bacterial infection.
- For severe pain, prescription pain medications might be necessary temporarily.
- Rest is important during recovery, and breathing exercises may help prevent complications.
From the Research
Definition and Causes of Pleurisy
- Pleurisy refers to the inflammation of the pleura, which is the two-layered membrane surrounding the lungs and lining the chest cavity 4.
- The common causes of pleurisy include differential diagnosis and specific tests are required to confirm the diagnosis 4.
- Pleural effusion, which is an excessive accumulation of fluid in the pleural space, can be related to disorders of the lung or pleura, or to a systemic disorder 5.
Diagnosis and Management of Pleurisy
- To diagnose pleurisy, thoracocentesis should be performed for new and unexplained pleural effusions, and laboratory testing helps to distinguish pleural fluid transudate from an exudate 5.
- Imaging plays an important role in the diagnosis and subsequent management of patients with pleural disease, including the use of CT, MRI, and PET scans 6.
- The treatment of pleurisy depends on the underlying cause, and may include pleurodesis, thoracoscopy, and video-assisted thoracoscopy, as well as the placement of a permanently indwelling pleural catheter 7.
Biopsy and Interventional Techniques
- Biopsies of the lung, pleura, and mediastinum play a crucial role in the workup of thoracic lesions, and percutaneous image-guided biopsy is a relatively safe and noninvasive way to obtain a pathologic diagnosis 8.
- The preprocedural assessment, intraprocedural techniques, and management of complications are important considerations when performing image-guided biopsies of the lung, pleura, and mediastinum 8.