An amebic infection can cause pus to enter the pleural space. An amebic infection is an infection caused by amoebae. Amoebae are very tiny parasites made of a single cell. A parasite is any organism that lives in or on another living being, gains an advantage by doing so, but causes disadvantage to the being it is living on. Pus is a yellow or green creamy substance sometimes found at the site of infections.

Infections, poisonous substances, and abnormally developed cells can travel to the pleura via the bloodstream or lymphatic system. The lymphatic system is a system of vessels that drain lymph from all over the body back into the blood. Lymph is a milky fluid that contains proteins, fats, and white blood cells (which help the body fight off diseases).

Other causes of pleurisy include cancer of the lungs, a pulmonary embolism, rheumatoid arthritis, and systemic lupus erythematosus (SLE). Cancer is an abnormal growth of new tissue characterized by uncontrolled growth of abnormally structured cells that have a more primitive form. A pulmonary embolism is a blockage of an artery (a type of blood vessel that carries blood away from the heart) that goes from the heart to the lungs.

Rheumatoid arthritis is a disorder in which the body's defense system attacks its own tissues, causing inflammation of bone joints. A joint is a place where two bones contact each other. SLE is a long-term disease in which the connective tissues throughout the body are inflamed because the body's defense system attacks these tissues as if they were foreign substances.

Carcinoma of the bronchial tubes is another possible cause of pleurisy. A carcinoma is any malignant cancer that arises from cells in the covering surface layer or membrane (outer covering) that lines an organ of the body. When describing cancer, malignant means that the newly formed tissues are made of abnormally structured and primitive-looking cells that grow uncontrollably, spread throughout the body, and invade surrounding tissues. The bronchial tubes are airways that connect that windpipe to the lungs.

Heart failure, drug reactions, and abscesses of the chest wall or lungs can also cause pleurisy. An abscess is an opening containing pus that is surrounded by inflammation. Trauma to the chest and/or ribs (such as a rib fracture) can also lead to pleurisy if the injury damages the pleura.

A pulmonary infarction can lead to pleurisy. A pulmonary infarction is dead tissue in part of a lung caused by blockage in a branch of a lung artery. Uremia is another condition that can cause pleurisy. Uremia is a condition in which substances build up in the blood that are normally passed out of the body when one pees.

Diseases caused by asbestos can lead to pleurisy. Asbestos is a material found in many homes and buildings that helps resist heat and provide insulation. Asbestos can be inhaled accidentally and can reach the pleura by traveling through the airways. When asbestos reaches the pleura, inflammation can result.

Kidney and liver disease can lead to pleurisy. The kidneys are two organs located on each side of the spine, behind the stomach. The kidneys filter (remove) wastes from the blood and remove them from the body through urine (pee). The liver is the largest organ in the body and is responsible for filtering (removing) harmful chemical substances, producing important chemicals for the body, and other important functions.

Rarely, a buildup of fluid in the pleural space is due to certain medications. This can lead to pleurisy. Sometimes, a cause of pleurisy cannot be found. When this happens, it is known as idiopathic pleurisy. Pleurisy can still be treated, regardless of whether the cause is known.

WHAT IS THE DIFFERENCE BETWEEN PRIMARY & SECONDARY PLEURISY?

Primary pleurisy is when pleurisy is due to a cause (such as an infection) that originated within the pleura. Secondary pleurisy is when pleurisy is an added effect from a cause that originated outside of the pleura. See the last section for the many possible causes of pleurisy. The signs and symptoms of primary and secondary pleurisy can be exactly the same, with only the cause being different.

WHAT ARE THE SIGNS AND SYMPTOMS OF PLEURISY?

The signs and symptoms of pleurisy varies from patient to patient. Patients suspecting they have pleurisy should contact their doctor immediately. The most common symptom of pleurisy is a sudden and sharp chest pain (usually in the lower chest). The pain is usually characterized by a stabbing sensation, but sometimes it is only a vague discomfort. The chest pain is common over the site of inflammation.

The pain is worse when breathing in (especially when taking deep breaths), coughing, sneezing, or moving the chest. This is because the pleura of the lungs and chest cavity can become stiff and swollen and rub against each other like sandpaper. Sometimes, the pain can be felt with every breath. The pain usually goes away between breaths.

Pain can occur that is due to inflammation of the diaphragmatic pleura. The diaphragmatic pleura is part of the parietal pleura (see first section) that covers the top surface of the diaphragm. The diaphragm is a muscular-fibrous area that separates the chest and abdomen (belly). Pain is usually felt on one side of the belly. Patients are usually able to point to the exact location of the pain.

Certain portions of the diaphragmatic pleura have nerves that enter them from different areas of the body. Because of this, irritation of these different portions of the pleura causes pain in different areas of the body. For example, if the back and side portions of the diaphragmatic pleura are irritated, it can cause pain in the lower chest wall or belly. If the central portion of the diaphragmatic pleura is irritated, the pain can be experienced in the neck and shoulder. The chest pain sometimes travels to the tip of the shoulder on the side of the body where the lung is affected.

Chest pains can lead to a restriction in breathing and can cause the chest to go into spasms on the side that is affected. A spasm is a sudden, involuntary muscle movement. Only the pleura that lines the lungs feels pain. This is mainly due to nerves that sense pain which enter this pleura from spaces between the ribs. The pleura that lines the chest cavity does not feel pain. Other signs and symptoms of pleurisy include uncomfortable breathing, fevers, a general ill feeling, weakness, loss of appetite, chills, and rapid pulse.

During a physical examination, the doctor may be able to detect a pleural friction rub when listening to the person breath in and out (often with a stethoscope). A pleural friction rub is an abnormal, coarse, grating, creaking, and/or scratchy sound heard when the membranes from the lungs and chest cavity rub against each other. Although a pleural friction rub is the characteristic sign of pleurisy, it occurs infrequently. A pleural friction rub is usually accompanied by pain.

Other abnormal sounds in the chest that can be heard in patients with pleurisy are rales and rhonchi. Rales are noises that sound like crackling, clicking, rattling, or bubbling. Rhonchi are noises that resemble snoring. These noises are heard when the patient breathes in and out. Sometimes sounds can be heard if the pleura lining the lungs rub against the membrane surrounding the heart and roots of the great blood vessels. These sounds are known as pleuropericardial rubs.

Sometimes, pleurisy is associated with extensive inflammation, which can cause the formation of large amounts of exudate in pleural spaces (see above) and on the surface of the pleura. Exudate refers to fluids, cells, or other substances that have been slowly discharged from damaged blood vessels into a tissue or onto a tissues surface.

The type of blood vessels that are usually damaged are known as capillaries. Capillaries are types of small blood vessels. Capillaries act as an exchange system that connects the smallest veins (known as venules) with the smallest arteries (known as arterioles). Veins are blood vessels that carry blood to the heart. Arteries are blood vessels that carry blood away from the heart to the rest of the body. Venules and arterioles are other types of small blood vessels.

Blood and lymph often make up much of the exudates. Lymph is a milky fluid that contains proteins, fats, and white blood cells (which help the body fight off diseases). A chest injury with bleeding can be another source of the fluid.

The collection of fluid can separate the pleura of the lungs from the pleura of the chest wall. This can cause the chest pain to disappear because the pleura from the lungs and chest wall will no longer rub against each other (since they are separated by the fluid). In such a case, even though the pain is disappearing, the condition can actually be getting worse. The condition can be getting worse because the buildup of fluid in the pleural space can lead to a great deal of pressure on the lungs.

Excessive pressure on the lungs decreases the ability of the lungs to move freely. The lungs will not be able to hold as much air, which causes shortness of breath. Shortness of breath is also likely if the muscles that help breathe in air are diminished in function. This usually happens when the rib cage in the chest area has been expanded.

Shortness of breath is especially likely if lung disease is present and if the mediastinum shifts to the side that is opposite of the diseased lung. The mediastinum is the space between the lungs and the structures (such as the heart, windpipe, and esophagus) within that space.

The lungs may not expand to their normal size after the fluid has been reabsorbed. This is because the pleura can become thickened after the fluid has been reabsorbed, making less room for the lungs to expand. The buildup of fluid can also move the heart and lungs out of its normal position.

Fluid that is relatively clear may give the person little trouble and is usually reabsorbed in time. In some cases, the fluid is not clear because it becomes infected and turns into pus. Pus is a yellow or green creamy substance sometimes found at the site of infections. When pleurisy occurs with a buildup of fluid in the pleural spaces, it is known as wet pleurisy or pleurisy with effusion. In rare cases, pleural effusion can be caused by certain medications. When pleurisy occurs without any detectable exudates, it is known as dry pleurisy or fibrous pleurisy.

Wet pleurisy can turn into dry pleurisy if the fluid dries up. Dry pleurisy can be very painful because there is no fluid buildup to prevent to pleura from the lungs and chest from rubbing against each other. It is like sandpaper rubbing against sandpaper. Dry pleurisy can lead to dry coughing.

The buildup of fluid in the pleural space that causes difficulties breathing (shortness of breath and rapid breathing) can lead to coughing. Retraction of the chest can also occur. Retraction of the chest is a visible sinking of the soft tissues of the chest between and around the more firm tissue of the ribs. Cyanosis can also occur. Cyanosis is a bluish color of the skin caused by too much hemoglobin or problems with the structure of the hemoglobin. Hemoglobin is a substance in the blood that carries oxygen to the cells in the body from the lungs.

When the doctor listens for sounds in the lungs when there is a buildup of fluid in the pleural space, he/she will no longer hear a pleural friction rub. This is because the excess fluid is preventing the pleura that lines the lungs and chest wall from rubbing against each other.

If there is a buildup of fluid in the pleural space, when the doctor taps the chest area to listen for sounds, the doctor will be able to tell by the sound he/she hears that there is a buildup of fluid. Besides listening to sounds produced after tapping the chest, the doctor will also be able tell if there is a buildup of fluid in the pleural spaces if he/she does not feel a vibration on his/her hand. Breath sounds may be decreased or absent in the presence of fluid.

The doctor may notice egophony when listening to a patient with fluid in the pleural space. Egophony is a peculiar, broken quality of the voice that sounds like the bleating of a goat. Egophony is heard at the upper level of the fluid in patients with fluid in the pleural space. The greater the amount of fluid in the pleural space, the greater are the signs described in this paragraph and the last paragraph.

Pleurisy can lead to permanent adhesions between the pleura and the surfaces next to it. Adhesions are bands of scar tissue that cause surfaces on the body to stick together that are normally separated. Adhesions can form when dry pleurisy heals. The adhesions are located between the lungs and chest wall, which causes these two structures to stick together.

The adhesions can be so extensive that restrict the movement of the lungs. It is as if someone put glue between the lungs and chest wall. The formation of adhesions can lead to soreness. However, this soreness usually goes away as the adhesions stretch out more. The doctor should be made aware of any of the above signs or symptoms.

DOES PLEURISY USUALLY BEGIN SUDDENLY OR SLOWLY?

Pleurisy can occur suddenly or slowly, but usually begins suddenly. Pleurisy that occurs suddenly is known as acute pleurisy. Pleurisy that occurs slowly over time in known as chronic pleurisy. Chronic pleurisy tends to remain present and recur often.

HOW IS PLEURISY DIAGNOSED?

When the characteristic pain of pleurisy occurs, the condition be diagnosed by the doctor. Relief of pain by applying pressure to the chest wall or belly can help confirm a diagnosis of pleurisy. If the doctor hears the characteristic pleural friction rub (see signs and symptoms section), this noise can only be caused by pleurisy. Thus, the presence of a pleural friction rub makes it easy to diagnose pleurisy.

If a pleural friction rub is not present, the doctor will also look for other signs and symptoms consistent with pleurisy, such as shortness of breath. Evidence of a breathing problem will help the doctor differentiate between pleurisy that causes pain in the belly versus a disease in the belly. An absence of nausea and vomiting can also help make this distinction.

Chest X-rays (which show pictures of the lungs and heart) can also help the doctor make the distinction mentioned above, but they are of limited value because the condition does not always show up on x-rays. In addition to chest X-rays, people with pleurisy may be asked to get an ultrasound of the chest, thoracentesis, and a complete blood count (CBC). An ultrasound is a procedure that uses types of sound waves to produce images of the body.

Thoracentesis is a procedure in which a needle is pushed through the chest wall to withdraw fluid for diagnostic or treatment purposes. The chest area is numbed before inserting the needle. The CBC is a blood test that shows the number of various types of red and white blood cells. Red blood cells help carry oxygen in the blood. White blood cells help the body fight against infections. The CBC test is performed to see if an infection is present. If an infection is present, certain types of white blood cells will be abnormally increased in number.

The doctor may ask the patient to provide a sample of the liquid that is coughed up. The liquid can then be tested, which may help diagnose the type of infection that is present. Identification of the type of infection helps the doctor determine what the best medication is for treatment.

To tell if any injury or damage has occurred to the heart, the doctor may have the patient undergo an electrocardiogram (abbreviated ECG and EKG). An electrocardiogram is a test that provides information about the electrical activity that occurs before a heartbeat.

HOW IS PLEURISY TREATED?

Pleurisy is treated by attacking whatever caused it to occur. Thus, if the cause of pleurisy is an infection, it is the infection that is treated. Although there are many antibiotic medications available to treat infections caused by bacteria, there are more limited treatment options for infections causes by viruses. However, infections caused by a virus normally go away without treatment.

Painkillers (such as acetaminophen) are used to treat the pain associated with pleurisy, which will help the person breathe easier. NSAIDs (non-steroidal anti-inflammatory drugs) are another type of pain medication that is often effective when treating pleurisy. An example of an NSAID is aspirin.

Significant pain may require the use of narcotics by mouth. Narcotics are strong types of substances or drugs that relieve pain and cause feelings of pleasure. One problem with taking narcotics is that they can decrease the ability to cough. For this reason, doctors often recommend that patients using narcotics breathe deeply and cough when the pain relief is at its best.

If the pain is severe, a procedure known as a nerve block may be done to prevent painful nerve impulses in the chest. The nerve impulse is blocked by injecting a medication that causes a loss of sensation. In people with pleurisy, the injection is done in the nerves that serve the chest muscles.

Resting in bed (often on a firm surface) is sometimes recommended to treat pleurisy. Doctors tell patients to avoid lying flat and to use a few pillows to sit up a little. This helps improve breathing. The doctor may suggest lying on the side in a special way to prevent pain by decreasing the stretching of the pleura. Lying down on the side that hurts has helped ease pain in some patients.

Some doctors recommend holding a pillow tightly against the chest while coughing to ease the pain. Loosely wrapping a 6-inch elastic ace bandage around the chest has also been helpful to some patients. The bandage is removed several times a day. A cold towel or a heating pad (set on low) can help reduce pain if it is placed on the area that hurts.

Due to difficulties breathing, patients may be administered oxygen through the mouth and nose. The amount of oxygen in the blood is measured by a device called a pulse oximeter (also known as a pulse ox) that is attached to a finger, toe, or ear

Fluid buildup can be removed by thoracentesis (see last section) and evaluated for signs of infection. If pus is present, this will need to be removed as well. Sometimes, the pus breaks through the lungs and into the air passages, allowing it to be coughed up. The timing of fluid removal is important because the fluid can come back if it is removed too soon. However, if the fluid is not removed in time, thick adhesions (see previous section) can form, which may lead to permanent breathing difficulty.

Doctors generally recommend that patients with pleurisy quit smoking, since smoking can irritate the lungs. Coughing after 2 or 3 deep breaths helps keep the lungs free of infection. Doctors usually recommend doing this several times a day. If coughing up thick liquids, the goal is to thin the liquid so they can be coughed up more easily. This is done by drinking 8 to 10 soda can size glasses of water each day. Drinks that thicken the liquid being coughed up (such as milk) are avoided. Placing a humidifier in the room that one is in can help keep the air moist and can thin the liquid that is coughed up.

WHAT IS THE PROGNOSIS?

The prognosis of people with pleurisy depends on what is causing the pleurisy and how the cause responds to treatment. In general, most people recover from pleurisy if it is caused by an infection. However, the prognosis is worse for more serious causes of pleurisy, such as cancer. Some cases of pleurisy clear up without treatment. In most patients, however, pleurisy gets worse without treatment.

WHAT ELSE IS PLEURISY KNOWN AS?

Pleurisy is also known as pleuritis.

WHAT IS THE ORIGIN OF THE TERM, PLEURISY?

Pleurisy comes from the Greek word "pleura" meaning "side," and the Greek word "itis" meaning "inflammation." Put the words together, and you have "side inflammation."