From the Guidelines
Pleurisy should be diagnosed and treated based on the underlying cause, with a focus on managing symptoms and preventing complications, as outlined in the 2023 British Thoracic Society guideline for pleural disease 1. The diagnosis of pleurisy involves identifying the underlying cause, which can be infectious (bacterial, viral, or fungal) or non-infectious (inflammatory, traumatic, or malignant) in nature.
- Key factors to consider in diagnosis include:
- Clinical presentation (sharp chest pain that worsens with breathing, coughing, or sneezing)
- Radiologic findings (chest X-ray, CT scan)
- Pleural fluid analysis (if present) Treatment of pleurisy focuses on addressing the underlying cause and managing symptoms, with the goal of reducing morbidity, mortality, and improving quality of life.
- For pain relief, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg every 6-8 hours) or naproxen (500mg twice daily) are recommended 1.
- If pain is severe, stronger pain medications may be prescribed temporarily.
- Rest is important during recovery, and taking slow, shallow breaths can help minimize pain.
- The underlying cause must be treated - antibiotics for bacterial infections, antivirals for viral causes, or other specific treatments depending on what's causing the pleurisy 1. It is essential to seek immediate medical attention if symptoms worsen despite treatment or if severe chest pain, shortness of breath, or other concerning symptoms occur, as pleurisy can sometimes indicate serious underlying conditions 1.
From the Research
Diagnosis of Pleurisy
- Pleuritic chest pain is a common presenting symptom of pleurisy, with many potential causes ranging from life-threatening to benign conditions 2
- History, physical examination, and chest radiography are recommended for all patients with pleuritic chest pain to evaluate for significant conditions such as pulmonary embolism, pericarditis, pneumonia, myocardial infarction, and pneumothorax 2
- Electrocardiography is helpful, especially if there is clinical suspicion of myocardial infarction, pulmonary embolism, or pericarditis 2
- Thoracocentesis should be performed for new and unexplained pleural effusions to determine the etiology of the effusion 3
- Laboratory testing, including chemical and microbiological studies, as well as cytological analysis, can provide further information about the etiology of the disease process 3
Treatment of Pleurisy
- Treatment of pleurisy typically consists of pain management with nonsteroidal anti-inflammatory drugs, as well as specific treatments targeted at the underlying cause 2
- Transudative effusions are usually managed by treating the underlying medical disorder, while exudative effusions require management based on the underlying etiology 3
- Malignant effusions are usually drained to palliate symptoms and may require pleurodesis to prevent recurrence 3
- Pleural biopsy is recommended for evaluation and exclusion of various etiologies, such as tuberculosis or malignant disease 3
- Empyemas need to be treated with appropriate antibiotics and intercostal drainage, and surgery may be needed in selected cases where drainage procedure fails to produce improvement or to restore lung function and for closure of bronchopleural fistula 3
Diagnostic Tools
- Medical thoracoscopy is a useful diagnostic tool for evaluating pleural effusions of uncertain etiology, allowing for visualization of the internal pleural surfaces and biopsies of abnormal lesions 4
- Pleuroscopy has high diagnostic accuracy and low complication rates, making it an effective diagnostic tool for identifying the cause of pleural effusion when it is unclear 4
- Cytologic examination of pleural fluid can provide diagnostic clues, such as in the case of rheumatoid pleuritis, which has distinctive cytopathologic features 5