Pleuritic chest pain results from an inflammation of the membrane surrounding the lungs. The double-layered membrane, called the pleura, separates the lungs from the chest wall. The pleura acts as a lubricant and allows the lungs to expand and contract freely without rubbing against the chest wall. When the pleura becomes inflamed, such as from an infection, the layers of the pleura may stick and rub together rather than sliding past each other. The result is a sharp chest pain when inhaling, exhaling, or coughing. Inflammation of the pleura is called pleurisy or pleuritis.
Bacterial or viral infections are the most common causes of pleurisy. Pneumonia, tuberculosis, rheumatic or autoimmune diseases, blood clots in the lungs, trauma to the chest area, and asbestos-related illnesses may all lead to pleurisy. Lung cancers rarely cause pleurisy and smoking has not been associated with pleuritic chest pain, notes the Mayo Clinic. A process called thoracentesis uses a needle to draw a sample of fluid from the lungs to test for the presence of bacteria or viruses. X-rays or other imaging tests may be used to confirm pneumonia, tuberculosis, or the presence of a cancerous mass.
Chest pain is the primary symptom of pleurisy. The pain is sharp and occurs when the lungs are expanding or contracting. Almost no pain occurs between breaths. Pleuritic chest pain usually is felt in a specific location and may run parallel to the ribs from the spine to the chest. In some cases, pain is also felt in the shoulders. Other symptoms of pleurisy include shortness of breath, dry cough, rapid breathing, and fever and chills. Fluid may accumulate, which acts as a cushion and eases the pain. If excessive fluid builds up, however, it may exert pressure on the lungs and hamper breathing, or the fluid may become infected.
Treatment for pleuritic chest pain depends on the cause. Bacterial infections are treated with antibiotics, whereas viral infections resolve without treatment. Nonsteroidal anti-inflammatory agents, such as acetaminophen or ibuprofen, can ease chest pain. Surgery may be required to drain excessive amounts of fluid. Prompt treatment of bacterial lung infections can help prevent pleurisy.
Untreated pleuritic chest pain can lead to breathing difficulties or complications resulting from the underlying condition. Thoracentesis may cause a lung to collapse. Contact your health care provider if you have chest pain or other symptoms of pleurisy. Seek immediate medical attention if you have difficulty breathing, high fever, intense pain, or if your skin takes on a bluish hue.
National Library of Medicine: MedLinePlus: Pleurisy https://www.nlm.nih.gov/medlineplus/ency/article/001371.htm
The Merck Manual: Lung and Airway Disorders https://www.merck.com/mmhe/sec04/ch039/ch039b.html
MayoClinic.com: Pleurisy https://www.mayoclinic.com/health/pleurisy/DS00244
InteliHealth: Pleurisy and Pleural Effusion https://www.intelihealth.com/IH/ihtIH/c/9339/23663.html