OVERVIEW

What is the pleura?

The pleura is a membrane located between the lungs and the chest wall, consisting of two layers: the outer parietal pleura and the inner visceral pleura. The enclosed space formed by these two layers is called the pleural cavity.

Normally, the two layers of the pleura are closely adhered, and the pleural cavity contains a small amount of physiological fluid (approximately 0.3 mL/kg body weight) for lubrication.

Since the pleura and pleural cavity in healthy individuals are not directly connected to the external environment, external pathogens cannot directly contact the pleura to cause disease. Pathogenic factors often invade the pleura through the lungs. Therefore, pleural diseases are often related to lung diseases.

What is pleurisy?

Pleurisy refers to inflammatory changes in the pleura caused by various factors. Common causes include:

Tuberculosis, pneumonia, pulmonary infarction, lung cancer, metastatic cancer, pleural mesothelioma, rheumatoid arthritis, systemic lupus erythematosus, parasitic infections (e.g., amebiasis), pancreatitis, trauma (e.g., rib fractures), drug allergies (e.g., hydralazine, procainamide, isoniazid, phenytoin, chlorpromazine), and lipid metabolism disorders.

Treatment primarily involves identifying and addressing the underlying cause.

Is pleurisy common?

Pleurisy is not a rare condition, with tuberculous pleurisy being the most common type.

What are the types of pleurisy?

• Based on the cause, pleurisy can be classified as: tuberculous pleurisy, parapneumonic effusion, purulent pleurisy, neoplastic pleurisy, connective tissue disease-related pleurisy, fungal pleurisy, cholesterol pleurisy, traumatic pleurisy, etc.

• Based on the presence or absence of fluid accumulation in the pleural cavity, pleurisy can also be divided into: exudative pleurisy (with fluid accumulation) and dry pleurisy (without fluid accumulation).

SYMPTOMS

What are the possible symptoms of pleurisy?

Common symptoms of pleurisy include chest pain, difficulty breathing, coughing, fever, etc.

• Chest pain: Typically sharp, stabbing pain, most noticeable on the side of the chest, caused by friction between the two layers of the pleura. The pain may worsen with coughing or deep breathing and may ease when lying on the affected side.
  The pain may also radiate to the same-side shoulder or upper abdomen. When pleural effusion occurs, the chest pain may lessen.

• Difficulty breathing: This refers to a sensation of insufficient air or labored breathing. Both exudative pleurisy and dry pleurisy can cause difficulty breathing.

• Exudative pleurisy: When a significant amount of fluid accumulates in the pleural cavity, it can impede lung expansion, leading to difficulty breathing, along with chest tightness, shortness of breath, and palpitations.
  Patients with large pleural effusions may even struggle to lie flat and may be forced to sit upright to breathe, with possible cyanosis due to hypoxia.

• Dry pleurisy: Since deep breathing worsens the pain, patients often avoid taking deep breaths, resulting in shallow, rapid breathing and difficulty with both inhalation and exhalation.

• Cough: Mostly presents as an irritating dry cough.

What are the dangers of pleurisy?

Severe cases of pleurisy may lead to respiratory failure, heart failure, and life-threatening complications.

Does pleurisy leave any sequelae?

If treatment is incomplete or inadequate, pleurisy can result in sequelae:

• Pleural adhesion: This occurs when the visceral and parietal pleura stick together, impairing lung function and causing difficulty breathing. It can be treated with fibrinolytic drugs injected into the pleural cavity.

• Pleural thickening: This refers to the thickening of the visceral or parietal pleura. Mild thickening does not affect daily life.
  Severe visceral pleural thickening can restrict lung expansion and contraction, impairing respiratory function. Severe parietal pleural thickening may limit chest movement and, in extreme cases, lead to chest collapse and deformity, further affecting breathing. Surgical treatment may be required.

CAUSES

What conditions can cause pleurisy?

Infections (bacterial, viral, fungal, parasitic, etc.), tumors, drug allergies, connective tissue diseases, and chest trauma can all cause pleurisy.

Is pleurisy contagious?

Tuberculous pleurisy may be contagious, but it depends on the specific situation:

• Tuberculous pleurisy without pulmonary tuberculosis has very low contagiousness.

• Tuberculous pleurisy with pulmonary tuberculosis is more contagious, especially in patients with positive sputum tuberculosis smear results, who are the most contagious.

Other types of non-infectious pleurisy are not contagious.

DIAGNOSIS

How is pleurisy diagnosed?

Clinical manifestations such as chest pain, cough, and difficulty breathing; physical examination reveals reduced breath sounds and respiratory movement, dull percussion, and weakened vocal fremitus in cases of significant pleural effusion. Diagnosis can be confirmed with imaging studies like chest X-ray, CT, or ultrasound indicating pleural effusion.

Etiological diagnosis of pleuritis requires pleural effusion analysis via thoracentesis, pleural biopsy, thoracoscopy, or even systemic disease-specific tests.

What tests are needed to confirm pleurisy?

• Blood tests: Complete blood count, C-reactive protein, erythrocyte sedimentation rate, PPD test, tuberculosis antibody, etc.

• Imaging tests: Chest X-ray, ultrasound, or CT to assess the presence of pleurisy, pleural effusion volume, and other cardiopulmonary conditions.

• Pleural biopsy: Can definitively diagnose pleurisy.

• Thoracentesis: Extracting pleural fluid for analysis to identify the cause of pleurisy, guiding targeted treatment.

TREATMENT

Which department should patients with pleurisy visit?

Respiratory medicine or cardiothoracic surgery.

Can pleurisy be cured?

The treatment outcomes vary depending on the type of pleurisy:

• Infectious pleurisy: Generally curable, provided there is standardized treatment and timely drainage.

• Pleurisy caused by connective tissue diseases: Depends on the treatment of the underlying disease. If the primary condition is well-controlled, pleurisy can also be cured. Poor control of the primary disease may lead to recurrent pleurisy.

• Neoplastic pleurisy: Since most malignant tumors are difficult to treat, neoplastic pleurisy is also challenging to cure.

• Parapneumonic effusion: The treatment outcome is poorer if pleural drainage of pus is delayed or if the patient has complications like diabetes or empyema.

How is pleurisy treated?

• Addressing the cause: Treat the underlying disease with medication or surgery.

• Symptom relief: For excessive pleural effusion, thoracentesis drainage may be performed based on the condition. Oxygen therapy for dyspnea, analgesics for chest pain, and antipyretics for fever may also be used.

• Supportive care: Rest, avoid overexertion, maintain a balanced diet, and ensure adequate protein and vitamin intake.

• Preventing complications: Fibrinolytic drugs may be injected into the pleural cavity to prevent pleural adhesions.

Pleurisy is very painful. How can the pain be relieved?

While actively treating the underlying disease, analgesics may be used as needed. Additionally, lying on the affected side and minimizing movement of that side can help alleviate pain.

When do pleurisy patients require surgery?

Surgery is often necessary for pleural adhesions, pleural thickening with effusion, or when medical treatment is ineffective. Common procedures include intrapleural fibrinolytic therapy, pleurectomy, or pleurodesis.

What is pleurodesis?

Pleurodesis, also known as pleural adhesion or fixation, involves injecting a sclerosing agent into the pleural cavity after draining the effusion. This causes the pleural layers to adhere, preventing fluid recurrence.

Pleurodesis is mainly used for malignant tumor patients with refractory pleural effusion. While it does not prolong survival, it improves quality of life.

What is pleurectomy?

Pleurectomy is an open-chest surgery that removes all fibrous tissue from the pleura and drains pleural effusion, facilitating lung expansion.

It is primarily performed for pleurisy patients with significant pleural thickening and impaired lung function.

DIET & LIFESTYLE

What should pleurisy patients pay attention to in daily life?

• Get adequate rest and avoid overexertion.

• Maintain a balanced diet and increase protein and vitamin intake appropriately.

• Adhere to thorough and consistent treatment.

• After recovery, engage in moderate physical exercise to strengthen immunity and prevent recurrence.

What dietary precautions should pleurisy patients take?

Pleurisy patients have no specific dietary restrictions, but a healthy, balanced diet is recommended.

• Use less salt, oil, and high-sodium seasonings while cooking. Avoid pickled vegetables and meats.

• Replace refined grains with whole grains, legumes, potatoes, or pumpkin for some staple foods.

• Balance meat and vegetables. Prefer white meat like chicken, duck, or fish over fatty cuts. Eggs and milk are important sources of protein and nutrients.

• Vegetarians can consume more beans and soy products for protein.

• Eat plenty of fresh fruits and vegetables.

• Quit smoking and limit alcohol.

PREVENTION

Can pleurisy be prevented?

• Maintain a healthy and regular routine, ensure adequate sleep and rest, and avoid excessive fatigue.

• Pay attention to diet, maintain balanced nutrition, eat less greasy and spicy irritating foods, and focus on light meals.

• Frequently breathe fresh air, keep indoor spaces well-ventilated, and create a good breathing environment.

• Maintain a positive and optimistic attitude.

• Engage in appropriate exercise to strengthen the body and improve physical fitness.