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Pain in the lungs

Oct 28, 2010

Pleurisy:

Pleurisy is the inflammation of the tissues in the lung and is accompanied by sharp pain in the chest.

Pleurisy derives its name from the pleura, or the lining around the lungs which is lubricated by pleural fluid and made up of two layers:

  • Visceral Pluera – covers the lungs
  • Paritel Pleura - covers the inner wall of the chest

The illness is associated with the accumulation of extra fluid between the layers of the pleura, also known as pleural effusion. Symptoms may include coughing, soreness in the chest and shortness of breath.

Bangkok Hospital Pleurisy Lungs

Functions:

The inner and the outer layers of the lungs contain approximately 10-20 ml of clear pleural lubricant which is continuously absorbed and replenished by the outer lining. The space between the two types of lining functions in a negative pressure volume (such as when air is inhaled).

Causes:

  • Infections of the airway passage: bacterial (including infections that cause tuberculosis), fungi, parasites, or viruses
  • Inhaled chemicals or toxic substances: exposure to some cleaning agents like ammonia
  • Collagen vascular diseases such as lupus or rheumatoid arthritis
  • Cancers that affects the lungs and breasts and spreads to the pleura including tumors of the pleura or tumors of the lung that obstructs the lymph channels.
  • Congestion such as heart failure
  • Pulmonary embolism: blood clots inside the blood vessels to the lungs can severely reduce blood and oxygen to portions of the lung and cause lung infarction (failure of the tissue portion of the lungs)
  • Pneumothorax: the presence of air in the pleural space, occurring spontaneously or from trauma (rib fractures causing punctures to the lungs)

Symptoms:

When extra fluid is accumulated between the spaces of the pleura, it causes pain and shortness of breath due to the lung’s limited capacity to expand.

  • Sharp, increasing sensation of pain that is aggravated when breathing
  • Shortness of breath

The painful and sharp sensation of pleurisy is quite distinct although the symptoms can sometimes mimic other complications, such as inflammation of the heart or heart attack.

Specialists will examine the level of friction caused by the two inflamed layers of pleura during each breath with a stethoscope. When excess amounts of fluid are present, the audible respiratory sound is less obvious and the chest-thumping diagnosis reveals a dull reverberation.

Further diagnosis may include:

  • Chest X-ray and ultrasound to reveal small to large amounts of fluid present in the pleural space
  • CT scan to detect trapped pockets of fluid in the pleural space and in the surrounding tissues

Upon confirmation of the fluid’s presence in the pleural space, extraction of the fluid is important to enable the doctors to analyze the cause of the illness and to determine the levels of infectious organisms, including in-depth diagnosis for tuberculosis or cancer.

Treatments:

General treatment:

  • Splinting of the chest wall and medication to reduce pain
  • Removal of fluid from the chest cavity to relieve pain and enable lung capacity for better breathing

If pleural fluid reveals infection, treatment may include:

  • Drainage of fluid and prescription of antibiotics
  • Thoracotomy procedures for more complicated cases

If pleural fluid accumulates from cancer, treatment may include:

  • Tacking the two layers of the pleura to prevent accumulation of fluid

Prevention:

Pleurisy can be prevented by early detection and treatment, depending on the severity of each case. Pneumonia and other underlying illness of heart, lung or kidney disease should be diagnosed as early as possible.

If you or someone you know is showing symptoms of pleurisy, please contact our Chest (Pulmonary Disease, Lung), or call 1719 (24 hours) to set up a doctor’s appointment.

 




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Bangkok Hospital, 2 Soi Soonvijai 7, New Petchaburi Rd., Bangkok, Thailand 10310 Tel.(+66) 2310-3000, 1719 (local mobile calls only)