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

• Usually caused by viral respiratory infections or pneumonia (including tuberculosis in endemic regions)

• Other causes to consider include

  • Pulmonary embolism

  • Inflammatory disorders (serositis)

  • Malignancy

  • Drug reactions

• 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

Treatment

• Treatment is directed at the underlying disease

• Anti-inflammatory analgesic medications are often helpful for pain relief

• Opioids may be used if nonsteroidal anti-inflammatory medications are ineffective or are contraindicated, provided retention of airway secretions is not a concern