What is Pleurisy?
Pleurisy is an inflammation of the thin membranous tissue that covers the external part of the lungs. Disease may spread to the periphery of the lungs, and set up infection here. This may result in fluid being produced at the lung surface. This can accumulate between the lung and the walls of the thoracic cage, it is termed a pleural emission. If it becomes infected with other invaders, it may turn into pus and become emphysema. A pneumothorax develops if the tuberculosis ruptures into the pleura and air accumulates here, so forming a pocket of air. This can further reduce the capacity of the lungs, and produce its own set of symptoms. These complications are however seen much more rarely than in the past.
A simple dry pleurisy usually has a sudden onset. A sharp, shooting pain, much like a stitch, occurs on the affected side. It is often described “as if a red-hot poker is being pushed through me.” The pain is usually aggravated by respiratory movements, particularly inspiration. Coughing can really seem to tear the body apart, and cause intense pain. Also, simple body movements can aggravate the pain. Breathing tends to become rapid and shallow, chiefly because respiratory movements amplify the discomfort. There may be a dry, nonproductive cough and a mild fever. If the pleura covering the diaphragmatic part of the lung are involved, the pain is usually referred to the shoulder or to the abdomen. In fact, pleurisy in this region has sometimes been incorrectly diagnosed as an acute disorder of the abdomen. The picture will be further complicated by the nature and extent of the underlying disease.
In many viral chest infections, symptoms there may be minimum and the pleurisy may be the chief point of discomfort. Often an effusion will follow on from the pleurisy, but this does not necessarily occur. Diagnosis is often fairly easy to make. However, the doctor may be intent on checking for any serious underlying chest disease, and so may order a chest X-ray to help. With a stethoscope, he or she may hear a typical “pleural rub” as the roughened pleural surfaces slide over each other. This is usually diagnostic of the complaint.
The most common cause of pleurisy is a lung infection such as pneumonia. Any type of pneumonia, whether it be viral, bacterial or due to aspirated foreign material, can rapidly lead to pleurisy. However, it may also occur in relation to other more severe conditions, such as lung cancer, pulmonary infarcts (a major blood vessel of the lung being clotted), pulmonary tuberculosis, bronchitis or usually any other serious lung disease.
It may also be produced by injuries to the lung wall and other external causes. Even a sudden “chill” or getting drenched in a rainstorm may precipitate an attack, as the body cools down and its defenses are temporarily reduced. Fibrin may exude from the blood, causing the adjacent sheets of visceral and parietal pleura to stick together. Later on this may persist in a thickening of the pleura which can be detected on X-ray examination.
In most cases of simple “dry pleurisy” the condition tends to resolve and become normal quite rapidly as the underlying disease is brought under control. However, it sometimes progresses through successive stages. These are given their own particular names.
If the lungs produce fluid and this is pushed into the space between the pleural layers, a “pleural effusion” is said to have taken place. In some conditions, bacterial infection of this fluid occurs and a mass of pus is produced. This is termed a “purulent pleurisy” or “emphysema”. These terms are largely textbook distinctions, for in reality they are merely progressive stages of the same general condition. Once more, it is pointed out that these complications, or advanced stages, are usually governed by the original cause and they will vary in accordance with the underlying basic cause for the initial effusion.
Pain is the usual symptom and is worse with deep breathing or coughing. Usually it affects one side, often at the lower part of the rib cage at the back or side. The pain may be noticed mostly in a shoulder or the abdomen. If severe, the person may breathe less deeply and there may be a grunting noise with expiration.
As with any severe, sharp or stabbing chest pain, prompt medical advice is recommended. Antibiotics prescribed by the doctor will usually cut short the attack, but simple measures will help. Paracetamol elixir for children, or tablets for older ones, will reduce pain and fever. A cough linctus such as Pholcodine will reduce a cough, for coughing aggravates the pain and discomfort. Local heat may help, such as a hot water-bottle, but make certain you don’t burn junior’s skin! Most cases respond well to simple measures. If the child is obviously not responding rapidly, the doctor may suggest an X-ray examination. If there is any underlying cause, or fluid collection, appropriate treatment will be arranged.