9-35: Pleuritis

Pleuritic pain due to inflammation of the parietal pleura is generally localized, sharp, and fleeting; it is made worse by coughing, sneezing, deep breathing, or movement. When the central portion of the diaphragmatic parietal pleura is irritated, pain may be referred to the ipsilateral shoulder. There are numerous causes of pleuritis. The setting in which pleuritic pain develops helps narrow the differential diagnosis. In young, otherwise healthy individuals, pleuritis is usually caused by viral respiratory infections or pneumonia (including tuberculosis in endemic regions), while PE, inflammatory disorders (serositis), malignancy, and drug reactions may also be considered in the proper context. The presence of pleural effusion, pleural thickening, or air in the pleural space requires further diagnostic and therapeutic measures.

Treatment of pleuritis consists of treating the underlying condition. Anti-inflammatory analgesic medications are often helpful for pain relief. Opioids may be used if NSAIDs are ineffective or are contraindicated, provided retention of airway secretions is not a concern.