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Key Features

  • Irritation of the parietal pleura causes the pain associated with pleuritis

Clinical Findings

  • Pain

    • Localized, sharp, and fleeting

    • Worsened by cough, sneeze, movement, or deep breathing

  • Pain may be referred to the shoulder when there is irritation of the central portion of the ipsilateral diaphragmatic pleura

Diagnosis

  • The setting in which pain occurs can often narrow the broad list of potential causes

  • In young, healthy individuals, pleuritis is usually due to a viral respiratory infection

  • Pleural effusion, pleural thickening, or pneumothorax require additional diagnostic and therapeutic measures

  • Simple rib fracture can cause severe pleurisy

Treatment

  • Treatment is directed at the underlying disease

  • NSAIDs (indomethacin, 25 mg two or three times daily) may help pain relief

  • Codeine (30–60 mg three times daily) or other opioids may control cough

  • Intercostal nerve blocks are occasionally helpful

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