Dr. Nabi Darya Vali (AIIMS)MBBS

February 05, 2020

June 04, 2022


Pleura is a serous membrane, which means it is a thin, transparent, two-layered membrane that is lubricated by a fluid called serum. The serous membrane is made up of simple squamous epithelial cells and is also known as the mesothelium.

The human body has two pleurae, one pleura covering each lung. Each pleura can be divided into two parts:

  • Visceral pleura: covers the lungs.
  • Parietal pleura: covers the inner surface of the chest cavity.

These two layers are continuous with each other - they start on the lungs and go on to cover the inside of the chest. The space between the visceral pleura and parietal pleura creates a cavity which is known as the pleural cavity. The pleural cavity is filled with a small amount of fluid that helps the two layers of the pleura to slide past each other smoothly when we breathe in and out.

What is pleurisy?

Pleurisy is the inflammation of the pleura. In the case of pleurisy (also known as pleuritis), the two layers of pleura swell up and rub against each other every time the lungs expand to allow air in. This causes the pleura to become inflamed, and breathing becomes painful.

Most of the time, a person with pleurisy presents with sharp chest pain, difficulty breathing, fever and persistent cough.

Pleurisy is usually caused due to bacterial infections including tuberculosis (TB) and pneumonia, but other causes for it could be trauma, pulmonary embolism (blood clot in the lungs), lupus (an autoimmune disease) and even cancer.

Preventing respiratory disorders like TB in the early stages can help prevent the development of pleurisy. With the help of X-ray, ultrasound, CT scan and biopsy, the underlying cause of pleurisy can be detected. 

The treatment of pleurisy depends on the cause. For instance, if pleurisy is caused due to TB, treatment for TB will help relieve the symptoms of pleurisy.

Pleurisy symptoms

A person suffering from pleurisy will experience some of these symptoms:  

  • Sharp chest pain which may spread to the shoulders and back. Pain may be relieved by taking shallow breaths.
  • Shortness of breath, which may be followed by hyperventilation.
  • Persistent cough.
  • Fever with chills.
  • Sore throat.
  • Joint pain and swelling in the joints, when seen in addition to symptoms like chest pain while breathing and persistent cough.
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Causes of pleurisy

Pleurisy may be caused by any one of the following conditions:

  • Bacterial infection: Bacteria like staphylococcus, pneumococcus and Haemophilus influenza and many others are responsible for pleurisy. Bacterial lung infection can lead to pus-filled pleural effusion (filling of fluid inside the lungs), medically known as empyema.
  • Tuberculosis: One of the major causes of pleurisy is pulmonary tuberculosis. It is a contagious infection caused by Mycobacterium tuberculosis which presents with severe coughing, shortness of breath and chest pain.
  • Pneumonia: A life-threatening infection of the lungs, pneumonia can cause the lungs to become inflamed. Fluid fills up in the air sacs in this condition. Pleurisy is very common in pneumonia.
  • Pleurodynia: Pleurodynia is a viral infection caused by a coxsackievirus, which can further lead to pleurisy. Symptoms of this infection include pain in the chest or upper abdomen when you breathe.
  • Trauma: Any injury leading to fractured ribs can cause pleurisy.
  • Pulmonary embolism: When a blood clot gets stuck in the blood vessels of the lungs, it is called a pulmonary embolism. When the blood clot is small and gets lodged in a part near the pleura, it causes pleurisy.
  • Lung cancer: Development of pleurisy in people with lung cancer is pretty common. Along with inflammation of the pleura, the lungs also get filled with blood coloured fluid (bloody pleural effusion).
  • Connective tissue disorders: Connective tissue disorders like systemic lupus erythematosus (also called lupus) and rheumatoid arthritis can lead to inflammation of the pleura.
  • Cancer therapy: Pleurisy is also seen in people getting radiation therapy for cancer treatment.

How to prevent pleurisy

There are a few measures which can help in preventing pleurisy: 

  • Get treatment for any upper respiratory tract infections (affecting the nose, throat, airways) or lower respiratory tract infections (chest infections) as soon as possible and do not let them get aggravated. For instance, if you have a persistent cough for more than a week, seek medical help.
  • Vaccinations like the pneumococcal conjugate vaccine (PCV13) and the pneumococcal polysaccharide vaccine (PPSV23) are available for both children and adults. They prevent infection from 23 different variants of pneumococcal bacteria, including pneumonia. Similarly, the BCG vaccine is administered to prevent tuberculosis. 
  • Do not indulge in harmful habits like smoking.

Read more: How to quit smoking

Pleurisy diagnosis

Pleurisy can be diagnosed by the following measures:

  • Physical exam: The doctor will listen to the lungs with a stethoscope. A rubbing sound from the lungs can be a sign of pleurisy.
  • X-ray: Chest X-rays can help look for air or fluid that could be present in the pleural space. They can also help uncover any underlying diseases like pneumonia, a fractured rib, or a lung tumour which could be causing pleurisy.
  • Ultrasound: An ultrasound can help find any air, fluid or any abnormality in the lungs.
  • CT scan: CT scan can help in finding the areas filled with fluid. For example, the lungs can fill up with fluid in the case of pneumonia. CT scans are also effective for finding any blood clots or lung abscess that could be causing pleurisy.
  • Biopsy: A small piece of lung tissue or the pleura is taken out for further diagnosis
  • Thoracentesis: In this procedure, a tiny sample of pleural fluid is removed from the chest cavity. It is then examined under a microscope to look for signs of infection, cancer, or any other disease which could be causing fluid collection in the pleural space.
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Treatment and medicines for pleurisy

In order to treat pleurisy, one needs to know the underlying cause. These are some of the measures for treating pleurisy:

  • Medications for pain and inflammation: Doctors may prescribe over-the-counter painkillers, specifically nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen to relieve the pain of pleurisy. Some doctors may also prescribe corticosteroids, which help to reduce inflammation. Bronchodilators are also given to help with breathing difficulties. 
  • Antibiotics for bacterial infections: For the treatment of tuberculosis, the doctor may prescribe a long-term regime of TB medications: isoniazid, rifampin, ethambutol and pyrazinamide. Antibiotics like ciprofloxacin and levofloxacin are given to treat pneumonia.
  • Draining the fluid: In the case of pleural effusion, the doctor may drain fluid, blood, or air from the pleural space with the use of a chest tube, thus relieving the pain. For this process, the patient needs to be hospitalized as it can take several days for proper drainage.
  • Anticoagulants: For the treatment of pulmonary embolism, anticoagulants like low molecular weight heparins (LMWH) are prescribed by the doctor.

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Medicines for Pleurisy

Medicines listed below are available for Pleurisy. Please note that you should not take any medicines without doctor consultation. Taking any medicine without doctor's consultation can cause serious problems.