Pleurisy (Pleuritis)

Do you experience chest pain when you breathe? Does it feel sharp, like a stabbing sensation that worsens with each deep breath or cough? You might have pleurisy, a condition that affects the lungs.

At Banner Health, we help you understand what pleurisy is, what might cause it and how to treat it. With prompt care, you can find relief from your symptoms and breathe more comfortably.

What is pleurisy?

Pleurisy, also known as pleuritis, is an inflammation of the pleura. The pleura are two thin layers of tissue that surround your lungs and line the inside of your chest wall. The space between them (pleural space) is filled with fluid that allows the pleura to slide smoothly over each other when you breathe.

When one or both layers become inflamed or swollen, they rub against each other instead. When inflamed, the tissues become sensitive and can feel sticky or rough. This friction causes the sharp chest pain that is a hallmark of pleurisy.

In some cases, fluid can build up between the linings of the lung and chest wall. This is called a pleural effusion and can make it harder to breathe.

Common symptoms of pleurisy

The most common symptom is chest pain (pleuritic pain) that feels sharp, stabbing or knife-like. It worsens when you breathe deeply, cough or sneeze.

You might notice:

• Pain on one side of your chest: It may stay in one place or spread to your shoulder or back.
• Pain that gets better with shallow breaths: You might try to avoid deep breathing to reduce discomfort.

Additional symptoms can include:

• Shortness of breath
• Dry cough
• Fever or chills (especially if there's an infection)
• Fatigue (feeling very tired all the time)

What causes pleurisy?

Pleurisy is often caused by a chest infection. Chest infections can be caused by a virus (such as influenza) or bacteria (such as pneumonia). 

Pleurisy can also result from one of the following: 

• A pulmonary embolism: A blood clot in the lung can cause sudden pleuritic chest pain.
• An autoimmune disorder: Conditions such as lupus, rheumatoid arthritis or Sjogren's disease can lead to ongoing inflammation. 
• A chest injury: Trauma to your rib or chest wall can trigger pleurisy.
• A pneumothorax: A collapsed lung can cause air to leak into the pleural space
• Lung or pleural disease: Lung cancer, tuberculosis, mesothelioma or asbestosis may cause inflammation and fluid buildup.
• Certain medications: Although these reactions are rare, some drugs can trigger pleural inflammation as a side effect.
• Heart problems: Heart attacks and pericarditis (inflammation of the heart’s outer covering) can cause pleurisy.

Pleurisy vs. other causes of chest pain

Chest pain can vary depending on the cause. Here is a quick way to compare pleurisy with other common conditions.

• Pleurisy: Sharp, stabbing pain that worsens when you breathe, cough or sneeze. The pain is often on one side of your chest.
• Pulmonary embolism: This type of blood clot happens when a clot breaks free and travels to the lungs, blocking some or all of the blood supply. It can cause chest pain with sudden shortness of breath. You may also feel lightheaded or have a rapid heartbeat.
• Pneumonia: Chest pain along with cough, fever and signs of infection. You might also feel tired or have difficulty breathing.
• Heart-related chest pain: Pressure, tightness or squeezing pain that can spread to your arm, neck or jaw. This type of pain may be linked to conditions like a heart attack and requires immediate medical attention.

When should you see a doctor?

Chest pain should always be taken seriously. Call your health care provider if you have:

• A high fever
• Unexplained weight loss
• Fast heartbeat
• Chest pain that doesn’t go away after treatments

Call 911 or have someone take you to the nearest ER if you have:

• Sudden and severe chest pain
• Trouble breathing or wheezing
• Coughing up blood
• A high fever
• Pain that spreads to your arm, neck or jaw
• Skin or lips that turn blue, purple or gray

How is pleurisy diagnosed?

Your health care provider will examine you and ask about your symptoms and medical history. They may listen to your lungs for a rubbing sound called a pleural friction rub. 

Your provider might also want to order imaging and other tests. Possible tests include:

• Imaging tests: chest X-ray, CT scan and ultrasound
• Blood tests
• Electrocardiogram (EKG or ECG)
• Pleural fluid testing (thoracentesis)

A chest X-ray can’t directly show pleurisy. But it can identify the presence of blockages or fluids creating pressure. 

How is pleurisy treated?

Treatment depends on the underlying cause of the pleurisy. Severe conditions are managed in the hospital. You may need medications to reduce inflammation, treat an infection and relieve pain and other symptoms caused by the condition.

Your treatment options might include:

• Fluid drainage
• Medications for infection (antibiotics or antifungal drugs)
• Blood thinners for a pulmonary embolism
• Over-the-counter (OTC) medications like ibuprofen
• Prescription anti-inflammatory drugs
• Corticosteroids

How long does pleurisy last?

Recovery depends on the cause. If a virus causes pleurisy, it can go away on its own as you recover from the illness. Bacterial infections may take longer and require treatment. More serious underlying causes, such as cancer or chronic conditions, need to be treated before pleurisy gets better. 

Can pleurisy cause complications?

Yes, but complications depend primarily on the cause of the pleurisy itself. 

• Inadequately treated pleural effusion (fluid around the lungs) can cause scar tissue to form around the lung preventing it from expanding all the way, resulting in a “trapped lung”.
• An untreated pneumothorax (collapsed lung) can result in worsening lung collapse, which can be life threatening.
• Ongoing infection or inflammation that goes untreated can cause further damage to the lung. This damage may lead to lung abscess (pocket of pus in the lung), necrotic lung (dead lung tissue) or even systemic sepsis (a dangerous infection that spreads throughout the body). 
• An acute pulmonary embolism (sudden blood clot) can be fatal without immediate treatment.  While chronic untreated pulmonary embolism can cause pulmonary hypertension (high blood pressure in the lungs).

What can you do at home?

Along with medical treatment, you can take steps to feel more comfortable: 

• Rest when you need to
• Take medication as directed
• Use a pillow to support your chest when coughing
• Try lying on the painful side to reduce movement
• Stay hydrated

How can you lower your risk?

You cannot always prevent pleurisy but you can reduce your risk by:

• Getting recommended vaccines, including flu and pneumonia vaccinations
• Treating respiratory infections early
• Avoiding smoking
• Managing chronic health conditions

Frequently asked questions

Is pleurisy serious?

It can be. Most cases, however, are caused by viral infections that go away on their own without treatment.  Some causes are mild but others require urgent care. It is important to get checked.

Is pleurisy the same as pneumonia?

No. Pneumonia is an infection in the lungs, while pleurisy is inflammation of the lining around the lungs. Pneumonia can lead to pleurisy.

Can lupus cause pleurisy?

Yes, autoimmune diseases such as lupus can cause inflammation of the pleura.

Is pleurisy the same as pleural effusion? 

No. Pleurisy is inflammation; pleural effusion is fluid buildup that occurs in the space between the lung and the chest wall.

Can pleurisy go away on its own?

Yes, especially if it is caused by a virus. But you should still see a provider to rule out more serious conditions.

Does pleurisy affect both sides of the chest?

It can affect one or both sides, depending on the cause.

Get care at Banner Health

Banner Health provides expert diagnosis and treatment for pleurisy. We offer a comprehensive range of services from imaging and lab testing to specialty care in pulmonology and cardiology so you can get answers quickly.

If your symptoms are sudden or severe, do not wait. Seek emergency care immediately.

For ongoing or less urgent symptoms, schedule an appointment with a Banner Health provider. Early treatment can help relieve your pain, address the underlying cause and protect your lung health so you can breathe easier.