Pleurisy

Alternative Name :Pleuritis

Definition:
Pleurisy  is an inflammation of the pleura,  the lining of the pleural cavity surrounding the lungs. Among other things, infections are the most common cause of pleurisy.

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The inflamed pleural layers rub against each other every time the lungs expand to breathe in air. This can cause severe sharp pain with inhalation (also called pleuritic chest pain).

Symptoms:
The main symptom of pleurisy is a sharp or stabbing pain in the chest that gets worse with deep breathing, coughing, sneezing or laughing. The pain may stay in one place, or it may spread to the shoulder or back. Sometimes it becomes a fairly constant dull ache.

Depending on its cause, pleurisy may be accompanied by other symptoms:

*Chest pain when you inhale and exhale (between breaths, you feel almost no pain)
*Shortness of breath
*Dry cough
*Fever and chills
*Rapid, shallow breathing
*Unexplained weight loss
*Sore throat followed by pain and swelling in the joints
*Diarrhea
*Ventricular tachycardia
*Erectile dysfunction
*Vomiting blood
*Vaginal discharge
*Loss of appetite

The sharp, fleeting pain in your chest that pleurisy causes is made worse by coughing, sneezing, moving and breathing, especially deep breathing. In some cases, pain may extend from your chest to your shoulder. You may find relief from pain when you hold your breath or when you apply pressure over the painful area.

When an accumulation of fluids (pleural effusion) is associated with pleurisy, the pain usually disappears because the fluid serves as a lubricant. However, if enough fluid accumulates, it puts pressure on your lungs, compressing and interfering with their normal function, causing shortness of breath. If the fluid becomes infected, the signs and symptoms of dry cough, fever and chills may appear. An infected pleural effusion is called an empyema.

Causes:
Viral infection is the most common cause of pleurisy. However, many different conditions can cause pleurisy:

*Pneumothorax
*Bacterial infections like pneumonia and tuberculosis
*Autoimmune disorders like systemic lupus erythematosus (or drug-induced lupus erythematosus) and rheumatoid arthritis
*Lung cancer and lymphoma
*Other lung diseases like Cystic Fibrosis, sarcoidosis, asbestosis, lymphangioleiomyomatosis, and mesothelioma
*Pulmonary embolism, a blood clot in the blood vessels that go into the lungs
*Inflammatory bowel disease
*Familial Mediterranean fever, an inherited condition that often causes fever and swelling in the abdomen or lung
*Infection from a fungus or parasite
*Heart surgery, especially coronary artery bypass grafting
*High blood pressure
*Chest injuries
*Aortic dissection
*Can occur with no illness or infection
*Some cases of pleurisy are idiopathic, meaning the cause cannot be determined.

Complications:
*Breathing difficulty
*Collapsed lung due to thoracentesis
*Complications from the original illness

Diagnosis:
Tests to diagnose the underlying cause of  symptoms may include:

*Medical history and physical exam. Doctor will ask detailed questions about your medical history, including other health problems, medications and your recent signs and symptoms. Your doctor may want to examine your chest with a stethoscope. If he or she hears a “snow crunching” sound over the area of your pain, that may be enough to diagnose pleurisy. You may even be able to feel the crunching with your hand. This sign isn’t always present with pleurisy, however.

*Blood tests. A blood test may tell your doctor if you have an infection and, if so, what type of infection you have. Other blood tests also may detect an autoimmune disorder, such as rheumatoid arthritis or lupus, in which the initial sign is pleurisy.

Doctor may also order imaging tests or diagnostic procedures.

Imaging tests
Imaging tests to diagnose the underlying cause of pleurisy may include:

*Chest X-ray. A chest X-ray may show an area of inflammation in your lungs that indicates pneumonia. Sometimes doctors want a special type of chest X-ray in which you lie on your side where the pleurisy is to see if there’s any fluid that doesn’t appear on a standard chest X-ray. This type of X-ray is called a decubitus chest X-ray.

*Computerized tomography (CT) scan. Your doctor will want to investigate any unexplained abnormality seen on chest X-rays with additional imaging, usually beginning with a computerized tomography (CT) scan. In a CT scan, a computer translates information from X-rays into images of thin sections (slices) of your chest, producing more-detailed images.

*Ultrasound. This imaging method uses high-frequency sound waves to produce precise images of structures within your body. Your doctor may use ultrasound to determine whether you have a pleural effusion.

*Magnetic resonance imaging (MRI) . Magnetic resonance imaging (MRI), also called nuclear magnetic resonance (NMR) scanning, uses powerful magnets to show pleural effusions and tumors.

*Arterial blood gas :In arterial blood gas sampling, a small amount of blood is taken from an artery, usually in the wrist. The blood is then checked for oxygen and carbon dioxide levels. This test shows how well the lungs are taking in oxygen.

 

Diagnostic procedures :-
In some cases,  doctor may remove fluid and tissue from the pleural space for testing. Procedures may include:

*Thoracentesis. To remove fluid for laboratory analysis, your doctor may suggest a procedure called thoracentesis. In this procedure, your doctor first injects a local anesthetic between your ribs to the area where fluid was seen on your imaging studies. Next your doctor then inserts a needle through your chest wall between your ribs to remove fluid for laboratory analysis. If only a small amount of fluid is present, your doctor may insert the needle with the help of ultrasound guidance over the site of the fluid.

*Pleural biopsy. If tuberculosis or lung cancer is a suspected cause of your condition,  doctor may perform thoracentesis with pleural biopsy — removal of a sample of tissue to be examined in a pathology laboratory. The biopsy needle has a small hook on the end that lifts away a small piece of tissue. Your doctor may use ultrasound guidance for this procedure as well.

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*Thoracoscopy. This procedure, performed while you’re under a general anesthetic, allows a surgeon to see inside your chest and obtain a sample of pleural tissue. First, the surgeon makes one or more small incisions between your ribs. A tube with a tiny video camera is then inserted into your chest cavity – a procedure sometimes called video-assisted thoracoscopic surgery (VATS). Tools designed for this type of surgery allow your surgeon to cut away tissue for testing.
Treatment:
Treatment has several goals:

*Remove the fluid, air, or blood from the pleural space
*Relieve symptoms
*Treat the underlying condition

Procedures:
If large amounts of fluid, air, or blood are not removed from the pleural space, they may put pressure on the lung and cause it to collapse.

The surgical procedures used to drain fluid, air, or blood from the pleural space are as follows:

*During thoracentesis, a needle or a thin, hollow, plastic tube is inserted through the ribs in the back of the chest into the chest wall. A syringe is attached to draw fluid out of the chest. This procedure can remove more than 6 cups (1.5 litres) of fluid at a time.

*When larger amounts of fluid must be removed, a chest tube may be inserted through the chest wall. The doctor injects a local painkiller into the area of the chest wall outside where the fluid is. A plastic tube is then inserted into the chest between two ribs. The tube is connected to a box that suctions the fluid out. A chest x-ray is taken to check the tube’s position.

*A chest tube also is used to drain blood and air from the pleural space. This can take several days. The tube is left in place, and the patient usually stays in the hospital during this time.

*Sometimes the fluid contains thick pus or blood clots, or it may have formed a hard skin or peel. This makes it harder to drain the fluid. To help break up the pus or blood clots, the doctor may use the chest tube to put certain medicines into the pleural space. These medicines are called fibrinolytics. If the pus or blood clots still do not drain out, surgery may be necessary.

Medications:
A couple of medications are used to relieve pleurisy symptoms:

*Paracetamol (acetaminophen) or anti-inflammatory agents to control pain and decrease inflammation. Only indomethacin (brand name Indocin) has been studied with respect to relief of pleurisy.

*Codeine-based cough syrups to control a cough

There may be a role for the use of corticosteroids (for tuberculous pleurisy), tacrolimus (Prograf) and methotrexate (Trexall, Rheumatrex) in the treatment of pleurisy. Further studies are needed.

Alternative Treatmewnt:
A number of alternative or complementary medicines are being investigated for their anti-inflammatory properties, and their use in pleurisy. At this time, clinical trials of these compounds have not been performed.

Extracts from the Brazilian folk remedy Wilbrandia ebracteata (“Taiuia”) have been shown to reduce inflammation in the pleural cavity of mice.  The extract is thought to inhibit the same enzyme, cyclooxygenase-2 (COX-2), as the non-steroidal anti-inflammatory drugs. Similarly, an extract from the roots of the Brazilian Petiveria alliacea plant reduced inflammation in a rat model of pleurisy.  The extract also reduced pain sensations in the rats. An aqueous extract from Solidago chilensis has been shown to reduce inflammation in a mouse model of pleurisy

Lifestyle changes:
The following may be helpful in the management of pleurisy:

*Lie on your painful side. This may actually lessen your pain.

*Take OTC medicines such as ibuprofen (Advil, Motrin, others) as needed to relieve pain and inflammation.

*Breathing deeply and coughing to clear mucus as the pain eases. Otherwise, pneumonia may develop.

*Get plenty of rest. Even when you start to feel better, be careful not to overdo it.

Prognosis:
Pleurisy and other disorders of the pleura can be serious, depending on what caused the inflammation in the pleura.

If the condition that caused the pleurisy or other pleural disorders isn’t too serious and is diagnosed and treated early, one usually can expect a full recovery.

Prevention:
Early treatment of bacterial respiratory infections can prevent pleurisy.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Pleurisy
http://www.mayoclinic.com/health/pleurisy/DS00244
http://www.nlm.nih.gov/medlineplus/ency/article/001371.htm
http://www.bbc.co.uk/health/physical_health/conditions/pleurisy.shtml

http://www.webmd.com/lung/understanding-pleurisy-basics

http://www.nhlbi.nih.gov/health/dci/Diseases/pleurisy/pleurisy_whatare.html

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