2. INTRODUCTION AND
DEFINITION
• Review anatomy of pleura: parietal Vs visceral
• They are separated by a thin layer of fluid.
• Allows smooth expansion and contraction of lungs during
breathing.
• Pleurisy: inflammation of this sac.
• The inflammation →pain with breathing and effusion.
• May leave scars (adhesions) after healing.
• They then have chronic pain or SOB.
3. TYPES OF PLEURISY
• Two types
o dry and
o wet pleurisy.
• Dry pleurisy: more common
o Inflamed pleurae rub directly against each other.
• Wet pleurisy: fluid oozes from the inflammation
→effusion →compress the lungs →DIB.
• Both may result from respiratory infections complications
(pneumonia, viral, and TB)
4. CAUSES OF PLEURISY
Many causes:
• Infectious: virus, bacteria, fungus, TB, parasites
• Cancer: mesothelioma or metastases
• Collagen vascular disease: SLE, RA, sarcoidosis,
scleroderma
• Trauma: bruised or broken ribs
• GI disease: pancreatitis, peritonitis, liver abscess or
collection of pus under diaphragm
• Drug rxn: methotrexate and penicillin
5. Other Causes
• Uremia
• Blood clot in lung
• Radiotherapy
• SCD
• Chemotherapy drugs
• Asbestos
• HIV
6. CLINICAL FEATURES
Chest Pain
• Most common symptom.
• Sharp, stabbing pain, may also be dull or a burning
sensation.
• Worse on deep breath, cough, or move around.
• Better on shallow breaths or lie on affected side.
• Reason for seeking medical attention.
7. Clinical features…
Cough
• Depends on the cause.
• Dry or productive or haemoptysis.
Shortness of Breath (SOB)
• May be due to underlying cause (blood clot in lungs,
pneumonia)
Fever
• Depending on the cause of the pleurisy.
8. Clinical features…
Signs of Pleurisy
• Pleural rub (each breath in a case of dry pleurisy.
• Tender overlying skin.
• Findings reflect underlying cause (e.g. emphysema,
pneumonia, pneumothorax, lung collapsed etc).
9. MANAGEMENT OF
PLEURISY
• Refer for diagnosis and treatment
• Give pre referral treatment.
Diagnosis
• Dx is made only after R/o other more serious causes
• Diagnostic pleural tap
• Tuberculin test may be done
• CXR: detect the presence of pleural effusion
• ECG
10. Management cont…
Treatment
• Treat underlying infection or disease
• Encourage resting: relieve symptoms.
• Strap chest firmly with an adhesive elastic bandage
sometimes recommended.
o But may prevent deep breathing and coughing up of mucus necessary to clear
respiratory tract.
11. Management cont…
• Anti-inflammatory steroids and NSAIDs are effective in
relieving inflammation and pain
• Less pain if lie on the affected side.
• Avoid exertion or doing anything that would cause to
breathe hard.
• Huge effusion: may need to be drained.
12. PREVENTION
• Most pleurisy are due to infection and is unavoidable.
• Can avoid severe pleuritic CP by early Dx and Rx with
anti-inflammatory drugs.
