Pleuritic Chest Pain
The heart and lungs have two different types of lining, visceral and parietal. Visceral pleura directly cover the lungs and serve as a type of protection. Parietal pleura cover the chest wall and help to mobilize the lungs and prevent them from moving around in the chest cavity. There exists some fluid between the two pleura to lubricate during movements such as breathing. The pleural can become inflamed due to various medical complications. This inflammation can lead to pain of varying severity during breathing, exertion, and especially coughing. The medical term for chest pain due to inflammation of the pleura is pleurisy.
Causes of Pleurisy
Pleurisy most often results from a disease that affects the pleura directly, such as infections, blood clots, cancer, or connective tissues disease. These complications can block blood vessels, leading to increased pressure decreasing the rate at which pleural fluid is removed from the inter-pleural space, which can cause inflammation.
Individuals who exhibit pleurisy, there is most often underlying medical conditions that cause the discomfort. Many times, these individuals have a pre-existing lung disease or respiratory infection.
In healthy individuals, infections that result spontaneously, without other medical complications, are usually the culprit of chest pain. Pneumonia is the most common infection causing pleurisy in health persons.
Aside from infections, there are a number of issues that can cause pleurisy. Injury to the area around the chest, including broken or fractured ribs, cancer, inflammation of surrounding organs (such as that caused by pancreatitis, cirrhosis, or heart failure), and drug reactions are common causes of chest pain leading to pleuritic chest pain diagnosis.
Classifications of Pleurisy
Pleurisy can either be classified as effusion or dry. To understand effusion pleurisy one must understand the anatomy of the chest.
As noted early, the heart and lungs have two different lining that serve to anchor these crucial organs to the body and to also protect them from stress and damage. There exists some fluid between the two pleura to lubricate during movements such as breathing. An effusion is a build up of too much fluid; a pleural effusion is the accumulation that occurs between the visceral and parietal pleural; and a pulmonary effusion is that build that occurs in the pleural of the lungs. An effusion results when fluid cannot be removed fast enough to keep a fluid balance. Pleural effusion is the most common type of pleurisy, and is the least painful. In this case, the pleural linings are forced apart.
Dry pleurisy is inflammation that occurs without fluid build-up between the membrane surfaces. While this type of pleurisy is the most painful, it does not result in as many additional medical complications caused by pleural effusion.
The most prominent symptom is having shortness of breath or other breathing difficulty. In the case of pleural effusion increased fluid between the pleura there is limited space available for the lungs to expand during breathing. This limited space forces individuals to take many short breaths instead of normal deep breathes. Cyanosis, a physical sign of having breathing difficulty resulting in bluish coloration of the skin, can result of extreme breathing difficulties persist. Because a common causes of pleurisy is infection, many of the symptoms associated with pleurisy are identical to that of having an infection, including fever, chills, and fatigue.
The first sign that would signal possibly having pleurisy is persistent chest pain. It is important to report to your physician when chest pain begins, how frequently it is experienced, and any activity that increasing the pain. If you are not constantly communicating this pain with your physician, record the information to discuss with your physician immediately. Without knowing the full extent and persistence of the pain, your physician might not make the connection of you possibly having pleurisy. Given that pleurisy is due to an underlying medical complication, this main source needs to be identified to alleviate the chest pain. Diagnosis of the underlying cause is often difficult, as one would need to know which type of pleurisy an individual has, pleural effusion or dry pleurisy.
Diagnosis of pleural effusion requires proper medical judgment. On an x-ray a pleural effusion is noted as white area. With the proper amount of pleural fluid the area is not generally detected on x-rays. The increased fluid causes a greater density to exist in the pleural space and thus shows as white on scans. Once your physician confirms that you have a pleural effusion they will attempt to identify the cause. Analyzing the type of fluid that has accumulated is the only way to do this. Thoracentesis is the procedure in which fluid is removed from the pleural space. The procedure involves the insertion of a needle between the sixth, seventh, or either intercostal space to then remove fluid. This procedure will help identify the cause type of fluid present and from the cause of the effusion.
In the case of dry pleurisy or when the analysis of fluid from pleural effusion is inconclusive, a biopsy of the pleura may be acquired. The sample will be obtained by the use of a biopsy needle or throacoscope. This microscopic analysis will help determine the underlying cause of pleurisy.
The first main treatment method is pain management. The pain sensation experienced with pleurisy is extremely difficult to tolerate while conducting every day activities. Typical anti-inflammatory drugs are prescribed such as acetaminophen and ibuprofen. These are often prescribed in dosages stronger than can be purchases over the counter. While cough syrups may be suggested to assist in the pain from coughing, it is often recommended to cough as often as you feel necessary to clear your throat from any congestion. Without coughing out the congestion, pneumonia might result, leading to further complications.
Aside from pain management, treatment of the main cause of the pleurisy is the only way to have complete relief of pain. Thoracentesis might result in immediate pain relief, however, may not stop fluid from accumulating in the case of pleural effusion.
Prognosis and Prevention
Prognosis varies based on the main cause of the chest pain. However, with treatment individuals who do not present with chronic lung and heart conditions will usually have relief of pain once the main cause is treated.
Typically, treatment for respiratory infection and avoidance of toxic substances (i.e. asbestos) are good preventative measures against pleurisy.