pleurisy
Meaning of pleurisy: Pain that arrives with the breath and stops when breathing stops is the signature, and it points at the lining rather than the lung.
Definition of pleurisy
Pleurisy is inflammation of the pleura, the double-layered membrane covering the lungs and lining the inside of the chest wall. The two layers normally glide over one another on a thin film of fluid. When inflamed they roughen and drag instead, producing a sharp chest pain that stabs with every breath in, every cough and every sneeze.
Why does it hurt to breathe?
The lung itself carries no pain fibers. The pleura does, at least in the outer layer lining the chest wall, which is supplied by the same nerves as the ribs and muscles above it. Every breath slides the two layers across each other. Inflamed surfaces lose their slipperiness and catch, and that friction registers as a sharp, well-localized, usually one-sided pain, worse with a deep breath, a cough or a sneeze, and easier when breathing is kept shallow. A creaking sound like bending leather, called a pleural rub, can sometimes be heard over the painful area.
What causes it?
| Group | Examples |
|---|---|
| Infection | Viral illness, bacterial chest infection, tuberculosis |
| Clot in the lung | An embolus lodging near the lung surface |
| Autoimmune disease | Lupus, rheumatoid arthritis |
| Injury and irritation | Broken rib, chest surgery, inhaled mineral fibers |
| Tumor | Deposits on the pleural surface, mesothelioma |
Viral infection is the commonest reason and settles by itself. The cause that matters most to identify is a clot travelling into the lung, because it is life threatening while producing pain indistinguishable from the harmless version. Exposure to asbestos long in the past is another route, since those fibers reach the pleural surface and provoke thickening, plaques and inflammation decades later.
How is it different from fluid around the lung?
The two are stages of one process rather than alternatives. Inflammation frequently makes the pleura leak, and fluid then gathers between the layers as a pleural effusion. Once enough fluid separates the surfaces they no longer rub together, so the sharp pain fades while breathlessness grows as the collection presses on the lung. Pain easing in that way therefore does not always mean the process is settling. Pneumonia is the illness that most often runs through both stages, and pleurisy names a pattern of symptoms with many possible causes rather than a diagnosis in its own right.
Also known as
Used in a sentence
Pleurisy was recorded as the presenting complaint alongside a productive cough.
Good to know
Pleuritic pain beginning suddenly alongside breathlessness can reflect a clot in the lung circulation, which the pain alone cannot distinguish from far more benign causes, and pain that fades while breathlessness increases may indicate fluid separating the inflamed surfaces.
Word origin
Where “pleurisy” comes from
Pleurisy descends from the Greek pleura, meaning the side or rib, by way of the Latin pleuritis for inflammation of that membrane.