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 typically involves a combination of physical examination, medical history, and diagnostic tests such as chest X-rays, computed tomography (CT) scans, and pleural fluid analysis.
- Key factors to consider in the diagnosis and treatment of pleurisy include:
- The severity of symptoms, such as chest pain and shortness of breath
- The presence of underlying medical conditions, such as bacterial or viral infections
- The results of diagnostic tests, such as pleural fluid analysis and imaging studies Treatment for pleurisy usually involves addressing the underlying cause, such as:
- Antibiotics for bacterial infections
- Antivirals for viral causes
- Other specific treatments depending on the diagnosis The initial drainage strategy should be based on the best predictor of clinical outcomes, as determined by the 2023 British Thoracic Society guideline 1. For pain relief, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen are recommended, with dosages and frequencies tailored to the individual patient's needs, as guided by the most recent clinical evidence 1. Rest and taking slow, shallow breaths can help minimize pain during recovery. It is essential to seek immediate medical attention if severe chest pain, shortness of breath, or high fever occur, as these could indicate serious complications or conditions requiring urgent care.
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, 4
- 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 3
Specific Causes of Pleurisy
- Viral pleurisy is among the most common causes of pleurisy 2
- Rheumatoid arthritis can cause pleuritis, which may have distinctive cytopathologic features in pleural fluid cytology 5
- Immune checkpoint inhibitors, such as atezolizumab, can cause pleural complications, including chronic pleuritis and recurrent pleural effusion 6
- Malignant pleurisy is associated with advanced oncological disease, and pleurodesis is the preferred palliative and supportive treatment option 4