Pain in the chest often aggravated during deep breath or cough is main symptom of pleurisy. Pain may be located in the shoulder in few cases. Other symptoms like fever, cough, breathlessness and hemoptysis may be present depending on underlying etiology.

Pleural effusion may follow pleurisy characterized by collection of fluid in pleural cavity which can cause coughing and breathlessness [5]. On examination, restriction to rib movements and pleural rub may be present. Pleural rub may be heard on deep inspiration or around pericardium.

• Fever

  The onset of pleurisy was accompanied by acute fever. [ncbi.nlm.nih.gov]

  Recurrent episodes of fever (one to four days) associated with abdominal, chest, or joint pain or erysipelas-like skin disease Mediterranean descent Family history of familial Mediterranean fever Normal between episodes During episodes: temperature of [aafp.org]

  Pleurisy can cause: Sharp, stabbing pain in the side and lower part of the chest Pain along the shoulders, neck, and belly Pain when you move your chest, such as breathing and coughing A dry cough Fever Rapid heartbeat Rapid and shallow breathing You [health.cvs.com]

• Malaise

  Symptoms Common symptoms are those associated with respiratory illness such as cough, fever and malaise. Localized chest pain may occur in the form of pain with each breath and pain worsened by coughing or deep breathing. [breathebayarea.org]

   Pleural friction rub grating or leathery sounds heard in both phases of respiration; heard low in the axilla or over the lung base posteriorly; may be heard for only a day or so  Evidence of infection; fever, malaise, increased white cell count 6 [slideshare.net]

  Suppression of the inflammatory response in pleural TB could reduce the symptoms and signs associated with the inflammatory process: fever, progression of the pleural effusion, malaise. [cochranelibrary.com]

  days to weeks) Malignancy Rheumatoid arthritis Tuberculosis Recurrent Familial Mediterranean fever Features that are associated with life-threatening causes of pleuritic pain are listed in Table 3. 3 – 5, 8, 9, 21, 22 Other symptoms, such as malaise [aafp.org]

• Pleural Effusion

  BACKGROUND: The differential diagnostic utilities of the levels of soluble interleukin (IL)-12p40 and the IL-2 receptor in sera and pleural effusions were evaluated in patients with exudative pleural effusions. [ncbi.nlm.nih.gov]

  Pleural Effusion The most common cause of a pleural effusion (a buildup of fluid in the pleural space) is heart failure. Lung cancer, LAM, pneumonia, tuberculosis, and other lung infections also can lead to a pleural effusion. [web.archive.org]

• Cough

  Pleurisy The main symptom of pleurisy is a sharp or stabbing pain in your chest that gets worse when you breathe in deeply or cough or sneeze. The pain may stay in one place or it may spread to your shoulders or back. [web.archive.org]

  Codeine-based cough syrup—to treat a painful cough. Pleurisy may be prevented with: Proper care for health problems that can cause pleurisy. Flu shot and pneumonia vaccine may be helpful. It may be most helpful for older adults. [health.cvs.com]

  This pain often occurs when you take a deep breath in or out, or cough. Some people feel the pain in the shoulder. Deep breathing, coughing, and chest movement make the pain worse. Pleurisy can cause fluid to collect inside the chest. [nlm.nih.gov]

• Pleuritic Pain

  Various other lung disorders can also cause a 'pleuritic pain' similar to pleurisy. A pleuritic pain is a chest pain which is typically sharp and 'stabbing' in a part of the chest. The pain is usually made worse when you breathe in or cough. [patient.info]

  C 19 Patients with pleuritic pain should have chest radiography to evaluate for underlying pneumonia. C 9 Nonsteroidal anti-inflammatory drugs should be used to control pleuritic pain. [web.archive.org]

  Pulmonary embolism is the most common potentially life-threatening cause, found in 5 to 20 percent of patients who present to the emergency department with pleuritic pain. [ncbi.nlm.nih.gov]

  Strictly we should reserve pleurisy for the name of the condition, whilst using pleuritic pain for the symptom. Pleurisy typically presents as pleuritic pain, which is typically described as being sharp in nature. [radiopaedia.org]

• Rales

  기타 명시된 순환기계 및 호흡기계를 침습한 증상 및 징후(Other specifiedd symptoms and signs involving the circulatory and respiratory systems) 잡음(동맥성)(Bruit (arterial)) 흉부의 타진음 이상(Abnormal percussion of chest) 흉부의 마찰음(Friction sounds of chest) 흉부의 공명음(Tympany of chest) 수포음(Rales [dic.impact.pe.kr]

  A preliminary physical examination to determine restriction to chest movements, pleural rub, breath sounds, rales, and egophony, third heart sound (S3), blood pressure, pulse rate and temperature should be quickly carried out. [symptoma.com]

  Auscultation gives crepitant and sub-crepitant rales, and later bronchial breathing and no friction sound; and, lastly, there will be no displacement of neighboring organs. [henriettes-herb.com]

  It may also occur in about 4 percent of patients with pneumonia and 4 percent of patients with pulmonary embolism. 28 Additional physical findings on the pulmonary examination may include decreased breath sounds, rales, and egophony, especially in patients [aafp.org]

• Chest Wall Tenderness

  Chest wall tenderness may be present. Occasionally a pleural rub can be heard. Other signs and symptoms will depend on the underlying etiology. [radiopaedia.org]

  More common causes of chest wall tenderness are myofascial pain and muscle strain. It is an inflammation of the outer layer of pleura (parietal pleura) that causes pain [1]. [ehealthstar.com]

• Abdominal Pain

  pain, unspecified Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes. [icd10data.com]

  Specialty General surgery, gastroenterology Symptoms Right upper abdominal pain, nausea, vomiting, fever[1] Duration Short term or long term[2] Causes Gallstones, severe illness[1][3] Risk factors Birth control pills, pregnancy, family history, obesity [en.wikipedia.org]

  Common side effects of these antibiotics include diarrhea, nausea, and abdominal pain. If the patient has tuberculosis, more specialized antibiotics are used for a longer period of time. If the infection is viral, antibiotics will not be effective. [health24.com]

• Hiccup

  […] disfonija, švokštimas English Pulmonary embolism, Pleural effusion, Pulmonary oedema (inc acute), Pulmonary alveolar haemorrhage#, Bronchospasm, Chronic obstructive pulmonary disease*, Hypoxaemia*, Respiratory tract congestion*, Hypoxia, Pleurisy*, Hiccups [mymemory.translated.net]

• Chest Pain

  This is the first report of MAC-SPN occurring with persistent chest pain, suggesting that MAC should be considered in the differential diagnosis of a solitary pulmonary nodule, even for patients who experience persistent chest pain. [ncbi.nlm.nih.gov]

  Pleurisy, or other problems that affect the pleura, can cause a 'pleuritic' chest pain. This is usually a sharp stabbing pain. [patient.info]

  Pleuritis; Pleuritic chest pain Fenster BE, Lee-Chiong TL, Gebhart GF, Matthay RA. Chest pain. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 6th ed. [nlm.nih.gov]

  They include: Chest pain Shortness of breath Respiratory failure A rapid heart rate Anxiety Restlessness Updated: September 21, 2011 [web.archive.org]

• Skin Patch

  The results of the laboratory studies suggested an immunopathogenetic mechanism, but in vitro lymphocyte-proliferation studies and skin patch tests with bromocriptine were negative. Bromocriptine should be considered as a cause of pleurisy. [ncbi.nlm.nih.gov]

• Shoulder Pain

  Some people also experience shoulder pain. Other symptoms accompanying pleurisy include: Bluish discoloration of the skin Coughing Rapid breathing Shortness of breath How Is Pleurisy Treated? The treatment for pleurisy depends on the cause. [newhealthadvisor.com]

  You may also experience shoulder pain, breathing difficulties, fever, chills, unexplained weight loss, and coughing as a result of the condition. Treatment for pleurisy will help relieve these uncomfortable symptoms. [sharecare.com]

  Here are additional symptoms: Problems in breathing Muscle aches Joint pain Headaches Pain in your back and shoulders Pain on one side of your chest Pleurisy can be accompanied with fluid buildup (pleural effusion) that pressurizes your lungs thus preventing [newhealthguide.org]

  This pain can effect the chest cavity in either the front or back of the cavity, and sometimes patient's have back or shoulder pain. [medicinenet.com]

• Back Pain

  Most other causes of back pain don't have this quality, however, for some people back pain will worsen with cough. (As can be seen in spinal disc disease.) Source: Getty Images How is pleurisy diagnosed? The pain of pleurisy is very distinctive. [medicinenet.com]

  Sometimes the pain can spread to the shoulder or back. Pain similar to pleuritic pain can also be a symptom of emergency medical conditions such as a heart attack or pulmonary embolism (blood clot in the lung). [my.clevelandclinic.org]

• Spastic Paraplegia

  A 70-year-old male developed eosinophilic pleurisy fifteen years after dantrolene sodium had been started for his spastic paraplegia due to spinocerebellar degeneration. Drug lymphocyte stimulation test (DLST) for dantrolene was positive. [ncbi.nlm.nih.gov]

A preliminary physical examination to determine restriction to chest movements, pleural rub, breath sounds, rales, and egophony, third heart sound (S3), blood pressure, pulse rate and temperature should be quickly carried out. Chest X-ray along with a complete blood count (CBC) is recommended for all patients with pleuritic chest pain, but normal radiograph does not exclude a pulmonary cause of pleurisy [6].

Further pleurisy often is associated with a pleural effusion identified on a chest radiograph leading to pleural fluid examination. ECG evaluation and/or CT scan of chest is recommended in a case of clinical suspicion of myocardial infarction, pulmonary embolism, or pericarditis. Other diagnostic test could be performed based on expected etiology like connective tissue disorder or drug induced pleurisy.

• Pleural Effusion on Chest X-Ray

  Risk of residual pleural effusion on chest X-ray was reduced by 45% at eight weeks (RR 0.54, 95% CI 0.37 to 0.78; 237 participants, 2 trials, low certainty evidence), and 65% at 24 weeks (RR 0.35, 95% CI 0.18 to 0.66; 237 participants, 2 trials, low certainty [ncbi.nlm.nih.gov]

  Time to resolution of pleural effusion on chest X‐ray Table 7. [cochranelibrary.com]

• Mycobacterium Kansasii

  Cultured samples of the pleural effusions from the two patients, an 80-year-old man and an 87-year-old woman, were ultimately found to contain Mycobacterium intracellulare and Mycobacterium kansasii, respectively. [ncbi.nlm.nih.gov]

• Rickettsia Conorii

  Rickettsia conorii is endemic in Mediterranean area. We describe an unusual sace of R. Conorii infection, which concerns a farmer with clinical, radiological and cytological findings of pleurisy without evidence of malignancy. [ncbi.nlm.nih.gov]

• Multiple Ulcerations

  Multiple ulcers in segmented pattern were noticed in the left hemi-colon using colonoscopy. An UC in active stage was confirmed subsequently by histology. [ncbi.nlm.nih.gov]

• Pleural Effusion

  BACKGROUND: The differential diagnostic utilities of the levels of soluble interleukin (IL)-12p40 and the IL-2 receptor in sera and pleural effusions were evaluated in patients with exudative pleural effusions. [ncbi.nlm.nih.gov]

  Pleural Effusion The most common cause of a pleural effusion (a buildup of fluid in the pleural space) is heart failure. Lung cancer, LAM, pneumonia, tuberculosis, and other lung infections also can lead to a pleural effusion. [web.archive.org]

• Pleural Rub

  On auscultation a loud pleural rub was heard at the left base together with bilateral basal crepitations. The chest radiograph showed hilar enlargement as well as diffuse lung shadowing. [ncbi.nlm.nih.gov]

  Patients present with pleuritic chest pain, often with a pleural rub, but without a pleural effusion. In some cases the pleura remains 'dry' ie there is no subsequent accumulation of pleural fluid. [gpnotebook.co.uk]

  Occasionally a pleural rub can be heard. Other signs and symptoms will depend on the underlying etiology. [radiopaedia.org]

  Diagnosis - Based on symptoms and hearing a pleural rub with a stethoscope. - Chest X-ray often reveals the underlying cause of the pleurisy. - Blood tests and sputum analysis may be necessary, particularly if the condition is severe or does not respond [nursingtimes.net]

  Doctors usually check for a sound caused by pleurisy, often described as a pleural “rub,” by listening for the creaky, scratchy sound of the pleura rubbing together during a breath. [pharmachoice.com]

Primary cause of pleurisy as well the pleuritic chest pain must be treated simultaneously. Pleuritic chest pain could be controlled initially by nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs do not suppress respiratory efforts or cough reflex and are the preferred first-line agent. Narcotic analgesics may be required to relieve severe pleuritic chest pain [7]. Indomethacin (50 to 100 mg orally with food three times per day) has been found to be effective in relieving pleural pain. NSAIDs are first-line therapy for patients with postcardiac injury syndrome. Corticosteroids are reserved for those who are intolerant or experience no response to NSAIDs. Oral corticosteroids are recommended for patients with lupus pleuritis.

Primary cause of pleurisy could be treated based on the underlying condition like causal agent should be discontinued in drug-induced pleuritis, smoking cessation in a case of pleurisy caused by asbestosis and rational chemotherapy based on the suspected underlying organism. In cases of pleuritis with refractory pleural effusions resulting from malignancy or chronic renal failure decortications could be considered. Colchicine is used (1.2 to 2.0 mg orally once per day, or twice per day in divided doses) for treating familial mediterranean fever [8].

Prognosis of pleurisy depends on underlying cause i.e. pulmonary infarction, tuberculosis or bronchial carcinoma which is dependent on response to treatment, recurrence of underlying cause, compliance to treatment.

Viral infection is a commonest cause of pleurisy. In 5 to 20 percent of patients who present to the emergency department with pleuritic pain, pulmonary embolism is the most common potentially life-threatening cause. Whereas, in other cases underlying cause could be bronchial carcinoma, pericarditis, pneumonia, myocardial infarction, pulmonary tuberculosis and pneumothorax [2].

Once a common disease, pleurisy is now quite infrequent due to the development of antibiotics. Pleurisy represents 15.9% of hospitalizations in pneumology department and is more prevalent in men aged of 41 years 55. 60% of cases are associated with serofibrinous exudate, purulent in 25% of cases and hemorrhagic in 15%. 60% of hemorrhagic pleurisy is due to cancer. A serology test for HIV is positive in 56% of cases. Coinfection with HIV is the principal cause of morbidity and mortality [3].

Pleurisy is inflammation of the parietal pleura and depending on the character of exudate it could be serous, fibrinous, serofibrinous, suppurative or hemorrhagic. Parietal pleurae along the ribs and lateral part of each hemidiaphragm are innervated by intercostal nerves. The parietal pleura when inflamed activates somatic pain receptors and somatic nerves that sense pain localized to the cutaneous distribution of those nerves [4]. The phrenic nerve supplies the central part of each hemidiaphragm, when activated, pain is referred to the ipsilateral neck or shoulder.

Prevention of pleurisy depends on prevention underlying cause i.e. pulmonary infarction, tuberculosis, bronchial carcinoma or viral infection. This includes early diagnosis and treatment of deep venous thrombosis, pneumonia, tuberculosis, bronchial carcinoma etc. Smoking cessation and withdrawing drugs which may cause pleurisy may be recommended [9].

Pleurisy is inflammation of the parietal pleura that typically results in characteristic pleuritic pain or pleural rub. It has a variety of possible causes and may be life-threatening to benign. Patients should be evaluated by taking history and performing clinical examination [1]. Chest radiography is recommended for all patients with pleuritic chest pain. Electrocardiography and CT scan of chest are needed if there is clinical suspicion of myocardial infarction, pericarditis or pulmonary embolism. Mainstays of treatment are treatment of underlying cause and relieve pleural pain in order to allow patient to breathe normally or cough efficiently.

Definition

Pleurisy is pain in chest aggravated upon breathing or coughing, as a result of any disease process involving the covering of lungs called pleura.

Cause

Viral infection is a common cause of pleurisy. Other causes include pulmonary embolism, bronchial carcinoma, pericarditis, pneumonia, myocardial infarction, pulmonary tuberculosis and pneumothorax [10].

Symptoms

Pain in the chest often aggravated during deep breath or cough is main symptom of pleurisy. Pain may be located in the shoulder in few cases. Coughing and breathlessness suggests collection of fluid in lung covering.

Diagnosis

A quick preliminary examination including vital signs is followed by chest radiograph and blood test in all cases. Other investigation like ECG and/or CT scan of chest could be suggested depending on suspected underlying cause.

Treatment

Chest pain could be reduced with treatment of nonsteroidal anti-inflammatory drugs (NSAIDs). If pain is severe and not controlled by NSAIDs, narcotic analgesics may be required to relieve severe pleuritic chest pain. Primary cause of pleurisy like pulmonary embolism, bronchial carcinoma, pericarditis, pneumonia, myocardial infarction, pulmonary tuberculosis and pneumothorax must be treated along with control of the pleuritic chest pain.

1. Crum-Cianflone NF. Bacterial, fungal, parasitic, and viral myositis. Clin Microbiol Rev. Jul 2008;21(3):473-94.
2. Aiello M, Chetta A, Marangio E, Zompatori M, Olivieri D. Pleural involvement insystemicdisorders.Curr Drug Targets Inflamm Allergy. 2004;3:441–7.
3. HullR D, Raskob GE, Carter CJ, Coates G, Gill GJ, Sackett DL, et al. Pulmonaryembolismin outpatients with pleuriticchestpain. Arch Intern Med. 1988;148:838–44.
4. Tagarakis GI, Georgios TI, Karangelis D, Dimos K, Tsolaki F, Fani T. Bornholm disease--a pediatric clinical entity that can alert a thoracic surgeon. J Paediatr Child Health. Apr 2011;47(4):242. 
5. Branch WT Jr, McNeil BJ. Analysis of the differential diagnosis and assessment of pleuritic chest pain in young adults. Am J Med. Oct 1983;75(4):671-9.
6. Perrier A, Roy PM, Aujesky D, Chagnon I, Howarth N, Gourdier AL, et al. Diagnosing pulmonary embolism in outpatients with clinical assessment, D-dimer measurement, venous ultrasound, and helical computed tomography: a multicenter management study. Am J Med. 2004;116:291–9.
7. Nolte FS. Case studies in cost effectiveness of molecular diagnostics for infectious diseases: pulmonary tuberculosis, enteroviral meningitis, and BK virus nephropathy. Clin Infect Dis. Dec 1 2006;43(11):1463-7.
8. Conde MB, Loivos AC, Rezende VM, Soares SL, Mello FC, Reingold AL, et al. Yield of sputum induction in the diagnosis of pleural tuberculosis. Am J Respir Crit Care Med. 2003;167:723–5.
9. McEvoy GK. Nonsteroidal Anti-inflammatory Agents. In: AHFS Drug information. Bethesda, Md: American Society of Health-System Pharmacists; 2000.
10. Thomas L, Reichl M. Pulmonary embolism in patients attending the accident and emergency department with pleuritic chest pain. Arch Emerg Med. Mar 1991;8(1):48-51.