Pleurisy is the inflammation of the pleura. It is usually caused by another condition, such as an infection.

In some cases, no cause is indentified.

The pleura

The pleura is the layer located between the lungs and ribcage. It is made up of two parts, one is attached to the ribcage and the other is attached to the lungs.

Between these sections is a thin layer of liquid that lubricates the pleura, helping to reduce friction when you breathe in and out.

If the pleura is inflamed, the surfaces of the two layers can become rough and the fluid can become sticky. This can cause the layers to rub together, resulting in pain and discomfort.

Infection

An infection is the most common cause of pleurisy. Any type of infection has the potential to spread to the pleura, but viral infections are usually responsible.

Viruses known to cause pleurisy include:

• the influenza (flu) virus
• the Epstein-Barr virus – which causes glandular fever
• cytomegalovirus (CMV) – a common virus found in most people which does not usually cause any noticeable symptoms
• parainfluenza – the virus that causes the childhood condition called croup

In some cases, pleurisy is caused by bacteria, such as:

• streptococcal bacteria – often associated with pneumonia, throat infections and some types of skin infections, such as impetigo and cellulitis
• staphylococcal bacteria – often associated with skin infections, food poisoning and, more seriously, blood poisoning (sepsis)

Meticillin-resistant Staphylococcus aureus (MRSA) is a common cause of bacterial pleurisy which can sometimes affect hospital patients. MRSA is a type of bacteria that has developed a resistance to a number of commonly used antibiotics.

Other causes

Other possible causes of pleurisy include:

• injury – if the ribs are bruised or fractured the pleura can become inflamed
• pulmonary embolism – a blood clot that develops inside the lungs
• sickle cell anaemia – a blood disorder that usually affects people of African or Caribbean descent
• chemotherapy and radiotherapy
• HIV or AIDS 
• lung cancer
• mesothelioma – a type of cancer caused by inhaling asbestos

Autoimmune conditions, such as rheumatoid arthritis and lupus, are another possible cause of pleurisy. In these conditions, something goes wrong with the immune system (the body’s natural defence against infection and illness) and it begins to attack healthy tissue.

Pleurisy can usually be diagnosed by studying your symptoms, although further tests are sometimes needed.

Your GP will ask about your symptoms and recent medical history. The doctor will also use a stethoscope to listen to your chest. If you have pleurisy, your lungs will make a distinctive dry, crunching sound known as a friction rub.

Further tests

Further tests may be needed to identify the underlying cause of your pleurisy and to assess the severity of the condition. These tests can include:

• blood tests to determine whether you have an infection or an autoimmune condition
• chest X-rays
• an ultrasound scan, where sound waves are used to build up a picture of the inside of your lungs
• a computerised tomography (CT) scan, where a series of X-rays is taken and a computer used to create a more detailed three-dimensional image of your lungs

Biopsy

If lung cancer or tuberculosis is suspected, it may be necessary to remove a small sample of pleural or lung tissue for further testing. The tissue can be removed using a thin tube or fine needle which is inserted through your skin into the pleural space or lungs. Before the procedure, local anaesthetic is used to numb your skin so you do not feel any pain.

Alternatively, a small tube called a bronchoscope can be passed down your throat and used to remove a tissue sample. The procedure can be uncomfortable but you will be given a mild sedative to help you relax, and local anaesthetic to numb your throat. The procedure is quick and only takes a few minutes.

Pleurisy is a condition in which the layer covering the lungs, called the pleura, becomes inflamed. It is sometimes called pleuritis.

The most common symptom of pleurisy is a sharp chest pain that feels worse with breathing.

Other symptoms include shortness of breath and a dry cough.

Read more about the symptoms of pleurisy.

When to see your GP

You should visit your GP if you have chest pain that does not improve or gets worse after three to five days.

However, if your chest pain is accompanied by a high temperature, coughing up phlegm or blood, or breathing difficulties, you should seek immediate medical attention.

Your GP can listen to your chest to check for the distinctive dry, crunching sound that suggests you may have pleurisy. 

Read more about diagnosing pleurisy.

What causes pleurisy?

Pleurisy is usually caused by another condition. In most cases it’s the result of a viral infection (such as the flu) or a bacterial infection (such as pneumonia).

In rarer cases, pleurisy can be caused by conditions such as a blood clot that blocks the flow of blood into the lungs (a pulmonary embolism) and lung cancer.

Read more about the causes of pleurisy.

How is pleurisy treated?

Treatment for pleurisy will depend on the underlying cause. For example, pleurisy that is caused by a viral infection will often resolve without needing treatment.

However, pleurisy caused by a bacterial infection will usually need to be treated with antibiotics, and people who are frail or already in poor health may be admitted to hospital.

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often used to relieve the chest pain associated with pleurisy.

In some cases of pleurisy, the pleura can become filled with too much fluid. If this happens, it may be necessary to drain the fluid to prevent breathing difficulties.

Read more about treating pleurisy.

The Map of Medicine is used by doctors throughout the NHS to determine the best treatment options for their patients. NHS Choices offers everyone in England exclusive and free access to this cutting-edge internet resource, which lets you see exactly what your doctor sees.

The information in the Map has been approved by the UK’s leading clinical experts, is based on the best available clinical evidence, and is continually updated. To take advantage of this unique resource go to:

Map of Medicine: pleural effusion

The most common symptom of pleurisy is sharp chest pain when breathing in and out.

The pain may be worse when you cough, sneeze or move around and it may be relieved by taking shallow breaths.

As well as chest pain, other symptoms of pleurisy include shortness of breath and a dry cough.

When to seek medical advice

Visit your GP if you have chest pain that does not improve or gets worse after around five to seven days.

When to seek immediate medical advice

Contact your GP immediately if your symptoms suggest that you have a serious underlying condition. For example, if you have symptoms such as:

• a high temperature (fever) of 40°C (104°F)
• coughing up thick phlegm or blood
• serious breathing difficulties
• intense chest pain that comes on suddenly
• swelling in your arms or legs (this could indicate a blood clot)
• persistent cough
• unexplained weight loss

If it is not possible to talk to your GP immediately, you can call NHS Direct on 0845 46 47 or contact your local out-of-hours service.

Treatment for pleurisy usually involves relieving pain and treating the underlying cause of the condition.

If treated promptly, pleurisy usually resolves without any lasting damage to the lungs.

Treating pain

The chest pain associated with pleurisy can be treated using a type of painkiller known as non-steroidal anti-inflammatory drugs (NSAIDs). Most often, ibuprofen is used. If NSAIDs are ineffective or unsuitable, you may be prescribed another painkiller such as paracetamol or codeine.

It may seem strange, but lying down on the side of your chest that hurts may also help reduce the pain.

Treating the underlying cause

It may also be necessary to treat the underlying cause of your pleurisy.

If you have pleurisy caused by a bacterial infection, you will need a course of antibiotics. Depending on the severity of your symptoms, this may be either in the form of tablets or injections. Combinations of different antibiotics are usually used.

However, if you have pleurisy caused by a viral infection, further treatment may not be required because the infection will usually resolve on its own after a few days.

In cases where your symptoms are particularly severe or you are already in poor health, you may need to be admitted to hospital so your body’s functions can be supported until your condition stabilises.

Pleural effusion

In some cases, pleurisy causes a build up of excess fluid around the lungs called pleural effusion.

Pleural effusion can result in shortness of breath that gets progressively worse. This is more likely to occur in cases of pleurisy caused by a pulmonary embolism or a bacterial infection.

If pleural effusion does not clear up as your pleurisy is treated, or if you are very short of breath, a tube will need to be inserted so the fluid can be drained away.

The tube may be inserted either using general anaesthetic (where you are asleep) or local anaesthetic (you are awake and the area where the tube is inserted is numbed).

If a lot of fluid has to be drained away, you may need to stay in hospital for a few days.