Pleurisy

Pleurisy, or pleuritis, is an inflammation of the parietal pleura, the outer lining of the lungs, causing sharp, localized chest pain that worsens with breathing, coughing, sneezing, or laughing. While it may sometimes occur without a known cause, pleurisy often indicates an underlying condition. Although viruses such as coxsackieviruses, influenza, and respiratory syncytial virus are the most common causes of pleurisy, healthcare professionals must adopt a comprehensive diagnostic approach to rule out life-threatening conditions before considering alternative diagnoses such as systemic lupus erythematosus (SLE), medication toxicity, or malignancy. Pulmonary embolism is the most frequent severe condition associated with pleuritic pain, with other potential causes including myocardial infarction, aortic dissection, pneumothorax, pneumonia, and pericarditis.

Clinicians can guide diagnostic and treatment decisions using a detailed history, physical examination, clinical decision-making rules (eg, Wells criteria and the modified HEART score), chest radiograph, electrocardiogram (ECG), and troponin assays. Treatment primarily focuses on pain management, typically with nonsteroidal anti-inflammatory drugs (NSAIDs), while addressing the underlying cause. The duration of symptoms varies based on the underlying cause; acute cases typically resolve within 2 to 4 weeks, while those linked to malignancy or poorly controlled inflammatory conditions may persist longer.