The signs and symptoms of pleurisy may include:

• Chest pain when you inhale and exhale (between breaths, you feel almost no pain)
• Shortness of breath
• Dry cough
• Fever and chills, depending on the cause

The sharp, fleeting pain in your chest that pleurisy causes is made worse by coughing, sneezing, moving and deep breathing. In some cases, pain may extend from your chest to your shoulder. You may find relief from pain when you hold your breath or when you apply pressure over the painful area.

When an accumulation of fluids (pleural effusion) is associated with pleurisy, the pain usually disappears because the fluid serves as a lubricant. However, if enough fluid accumulates, it puts pressure on your lungs and interferes with their normal function, causing shortness of breath. If the fluid becomes infected, the signs and symptoms of dry cough, fever and chills may appear. An infected pleural effusion is called an empyema.

When to see a doctor
Call your doctor if you experience any of the following:

• Intense, persistent chest pain
• Shortness of breath
• High fever

These signs and symptoms point to a problem with your lungs or pleura, and may also indicate an underlying illness for which you need prompt medical care.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

A double layer of membranes called pleura separate your lungs from your chest wall. One layer of the pleura overlies each lung. The other layer lines the inner chest wall. The layers are like two pieces of smooth satin rubbing against each other with almost no friction, allowing your lungs to expand and contract when you breathe without any resistance from the lining of the chest wall.

When inflamed, the two layers of the pleural membrane in the affected side of your chest rub against each other like two pieces of sandpaper, producing the pain of pleurisy when you inhale and exhale.

The underlying medical conditions that can cause pleurisy are numerous. Pleurisy causes include:

• An acute viral infection, such as the flu (influenza)
• Pneumonia, in those cases in which the infected portion of your lung involves the surface of the pleura
• Autoimmune conditions, such as lupus, rheumatoid arthritis and autoimmune hepatitis
• Tuberculosis and other infections
• A clot in an artery of your lungs (pulmonary embolism)

Pleurisy can also occur as a result of trauma to your chest or after heart surgery. Rib fractures also may cause pleurisy. It's possible to fracture a rib in the absence of trauma, such as from a severe cough. In some cases, the cause of pleurisy is unknown (idiopathic).

Cancer in the lung rarely causes pleurisy. There's no relationship between smoking and pleurisy, but a "smoker's cough" will aggravate the pain of this condition.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

You're likely to start by first seeing your family doctor. However, when you call to set up your appointment, you may be urged to seek immediate medical care if you are experiencing severe, lasting chest pain or difficulty breathing.

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance.
• Write down any symptoms you've been experiencing, and for how long. Be prepared to describe your chest pain to your doctor and to pinpoint where it starts and how far it spreads.
• Write down key personal information, including recent travel abroad and major life changes, both positive and negative. Your doctor may also be interested in your work history, including possible environmental exposure to asbestos over the past 20 years or longer.
• Make a list of your key medical information, including other conditions you're being treated for and the names of any medications, vitamins and supplements that you're taking. Also note whether any family members or close friends have recently been ill.
• Take a family member or friend along, if possible. With pleurisy, the pain you're experiencing may be too intense to safely drive. In addition, it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out.

For pleurisy, some basic questions to ask your doctor include:

• What do you think is the underlying cause of my symptoms?
• Are there any other possible causes for my symptoms?
• What kinds of diagnostic tests or procedures do I need?
• What treatment approach do you recommend?
• How soon after I begin treatment can I expect to feel better?
• Are there self-care steps I can take to improve my discomfort?
• Do you recommend that I stay home from work or school? For how long?
• Will it help if I stop smoking?
• If the people I live with smoke, will it aggravate my condition?
• Am I at risk of long-term complications from this condition?
• Is the underlying cause of my symptoms contagious? How can I reduce the risk of passing my illness to others?
• I have these other health conditions. How can I best manage them together?
• Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
• What should I do if the pain doesn't get any better?
• Is there a generic alternative to the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your doctor may ask:

• How would you describe your symptoms?
• When did you first begin experiencing these symptoms?
• Where is your chest pain located? Does it spread to your arms, shoulders or jaw?
• Is your chest pain constant, or does it come and go?
• What, if anything, makes your chest pain better? What makes it worse?
• Do your symptoms include other types of pain, such as a sore throat or joint pain?
• Have you been experiencing difficulty breathing?
• Have you been experiencing fever or night sweats?
• Have you lost weight without trying?
• How does your current energy level compare to what's normal for you?
• Have you been diagnosed with or treated for any other health conditions?
• What medications are you currently taking?
• Have you recently had any medical procedures?
• Have you recently traveled to another country? Did anyone who traveled with you get sick?
• Have you been involved in any work, projects or hobbies over the years that might have exposed you to asbestos?
• Do or did you smoke? For how long?

What you can do in the meantime
While you wait for your appointment, over-the-counter pain relievers such as ibuprofen (Advil, Motrin, others) and acetaminophen (Tylenol, others) may make you more comfortable. Tylenol with codeine, available by prescription only, helps control both a cough and pain. Get plenty of rest. You may find that lying on the painful side of your body eases your discomfort.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Your doctor may make a diagnosis based on your signs and symptoms. When examining you and listening to your chest, your doctor may hear a "friction rub" that may sound like the crunching sound of walking on very dry snow.

Your doctor might also use the following procedures to determine the underlying cause of pleurisy:

• Imaging. A chest X-ray may show an area of inflammation in your lungs that indicates pneumonia. Your doctor will want to investigate an unexplained abnormality seen on an X-ray with additional imaging, usually beginning with a computerized tomography (CT) scan. In a CT procedure, a computer translates information from X-rays into images of thin sections (slices) of your chest. CT scans produce more-detailed images of your internal organs than do conventional X-ray studies. Sometimes doctors want a special type of chest X-ray in which you lie on your side where the pleurisy is to see if there's any fluid that doesn't appear on a standard chest X-ray. This type of X-ray is called a decubitus chest X-ray. Your doctor may also use ultrasound to determine whether you have a pleural effusion.
• Blood test. A blood test may tell your doctor if you have an infection and, if so, what type of infection you have. Other blood tests also may detect an autoimmune disorder, such as rheumatoid arthritis or lupus, in which the initial sign is pleurisy.
• Thoracentesis. To remove fluid for laboratory analysis, your doctor may suggest a procedure called thoracentesis. In this procedure, your doctor first injects a local anesthetic, then inserts a needle through your chest wall between your ribs to remove fluid. In addition, a sample of tissue (pleural biopsy) for microscopic analysis may be obtained if your doctor is concerned that the fluid collection may be caused by tuberculosis or cancer. If only a small amount of fluid is present, your doctor may insert the needle with the help of ultrasound guidance over the site of the fluid.
• Thoracoscopy. This procedure allows a surgeon to see inside your chest and obtain a sample of pleural tissue. First, the surgeon makes one or more small incisions between your ribs. A tube with a tiny video camera is then inserted into your chest cavity — a procedure sometimes called video-assisted thoracoscopic surgery (VATS). Special surgical tools allow your surgeon to cut away tissue for testing.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

The most important goal in relieving pleurisy or pleural effusion is treatment of the underlying condition that's causing your signs and symptoms. For example, if the cause of pleurisy is a bacterial infection of your lung (pneumonia), an antibiotic may control the infection. But, for pleurisy due to a viral infection, antibiotics won't be effective. Most viral infections run their course without treatment.

Over-the-counter or prescription nonsteroidal anti-inflammatory drugs (NSAIDs) may help relieve some of the signs and symptoms of pleurisy. Prescription codeine may help control a cough as well as the pain. If you have a large buildup of fluid, you may need to stay in the hospital to have the fluid drained over a period of several days through a tube inserted into your chest.

The outcome of pleurisy treatment may depend on the seriousness of the underlying disease.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.