From the Guidelines
Pleurisy is primarily caused by infections, particularly viral respiratory infections like influenza and bacterial pneumonia, as well as other conditions such as autoimmune disorders, pulmonary embolism, and certain cancers that affect the pleura, as stated in the most recent guideline by the British Thoracic Society 1. The causes of pleurisy can be categorized into several groups, including:
- Infections, such as viral respiratory infections like influenza and bacterial pneumonia
- Autoimmune disorders, such as lupus and rheumatoid arthritis
- Pulmonary embolism, or blood clot in the lung
- Certain cancers that affect the pleura
- Trauma to the chest, including rib fractures or surgical procedures
- Pneumothorax, or collapsed lung
- Asbestos exposure
- Certain medications The condition develops when the pleura, the thin membrane surrounding the lungs, becomes inflamed, causing the normally smooth pleural surfaces to become rough and rub against each other during breathing, resulting in the characteristic sharp chest pain that worsens with breathing. According to the British Thoracic Society guideline for pleural disease, the management of pleural infection should involve a respiratory physician or thoracic surgeon, and the use of chest tube drainage and antibiotics may be necessary in some cases 1. It's also worth noting that the diagnosis of pleural infection can be challenging, and the use of diagnostic tests such as pleural fluid analysis and imaging studies can help guide management, as discussed in the BTS guidelines for the management of pleural infection 1. However, the most recent and highest quality study, the British Thoracic Society guideline for pleural disease, should be prioritized when making a definitive recommendation, as it provides the most up-to-date and evidence-based guidance on the management of pleural disease 1.
From the Research
Causes of Pleurisy
The causes of pleurisy, which is the inflammation of the pleura, can be varied and range from life-threatening to benign conditions 2. Some of the common causes include:
- Pulmonary embolism, found in 5 to 20 percent of patients who present to the emergency department with pleuritic pain 2
- Pericarditis
- Pneumonia
- Myocardial infarction
- Pneumothorax
- Viral pleurisy, which is among the most common causes of pleurisy 2
- Neoplastic diseases, such as malignant mesothelioma and lung cancer, which account for 55.9% of pleurisy cases 3
- Infectious diseases, including tuberculosis, parapneumonic pleural effusion, empyema, and nontuberculous mycobacteriosis, which account for 24.0% of pleurisy cases 3
- Collagen vascular diseases, such as rheumatoid arthritis, immunoglobulin G4-related diseases, and systemic lupus erythematosus, which account for 2.8% of pleurisy cases 3
Immunological and Molecular Mechanisms
The immunological and molecular mechanisms underlying pleural disorders are complex and involve the infiltration of various types of immune cells, such as neutrophils, eosinophils, and lymphocytes 4. Mesothelial cells also play a role in pleural inflammation by releasing various mediators and proteins, including platelet-derived growth factor, interleukin-8, and monocyte chemotactic peptide 4. The presence of these mediators and the sequence of events leading to pleural loculation, pleural adhesion, or repair are not yet fully understood and require further research.
Systemic Autoimmune Disorders
Systemic autoimmune diseases, such as rheumatoid arthritis and systemic lupus erythematosus, can affect the pleura and cause pleurisy 5. Other systemic autoimmune disorders, such as scleroderma, polymyositis/dermatomyositis, mixed connective tissue disease, ankylosing spondylitis, Sjogren's syndrome, and Wegener's granulomatosis, can also involve the pleura, although the prevalence and natural history of pleural involvement in these conditions are not well defined 5.