What is Pleurisy
Pleurisy is inflammation of the linings around the lungs (the pleura). There are two layers of pleura: one covering the lung (termed the visceral pleura) and the other covering the inner wall of the chest (the parietal pleura). These two layers are lubricated by pleural fluid.

Pleurisy is frequently associated with the accumulation of extra fluid in the space between the two layers of pleura. This fluid is referred to as a pleural effusion. Pleurisy is also referred to as pleuritis.

The pain fibers of the lung are located in the pleura. When this tissue becomes inflamed, it results in a sharp pain in the chest that is worse with breathing in, aka pleurisy. Other symptoms of pleurisy can include cough, chest tenderness, and shortness of breath.

What are the symptoms of pleurisy?

• Pain in the chest that is aggravated by breathing

• Shortness of breath

• "Stabbing" sensation

The most common symptom of pleurisy is pain that is generally aggravated by inspiration (breathing in). Although the lungs themselves do not contain any pain nerves, the pleura contains abundant nerve endings. When extra fluid accumulates in the space between the layers of pleura, the pain usually is a less severe form of pleurisy. With very large amounts of fluid accumulation, the expansion of the lungs can be limited, and shortness of breath can worsen.

How is pleurisy treated?
External splinting of the chest wall and pain medication can reduce the pain of pleurisy. Treatment of the underlying disease, of course, ultimately relieves the pleurisy. For example, if a heart, lung, or kidney condition is present, it is treated. Removal of fluid from the chest cavity (thoracentesis) can relieve the pain and shortness of breath. Sometimes fluid removal can make the pleurisy temporarily worse since now the two inflamed pleural surfaces can rub directly on each other with each breath.

If the pleural fluid shows signs of infection, appropriate treatment involves antibiotics and drainage of the fluid. If there is pus inside the pleural space, a chest drainage tube should be inserted. This procedure involves placing a tube inside the chest under general anesthesia. The tube is then connected to a sealed chamber that is connected to a suction device in order to create a negative pressure environment. In severe cases, in which there are large amounts of pus and scar tissue (adhesions), there is a need for "decortication." This procedure involves examining the pleural space under anesthesia with a special scope (thoracoscope). Through this pipelike instrument, the scar tissue, pus, and debris can be removed. Sometimes, an open surgical procedure (thoracotomy) is required for more complicated cases.

In cases of pleural effusion that result from cancer, the fluid often reaccumulates. In this setting, a procedure called pleurodesis is used. This procedure entails instilling an irritant, such as bleomycin, tetracycline, or talc powder, inside the space between the pleural layers in order to create inflammation. This inflammation, in turn, will tack the two pleura together as scarring develops. This procedure thereby obliterates the space between the pleura and prevents the reaccumulation of fluid.