Pleuritis

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