Disease of Pleura

Introduction

The visceral pleura that lines the lungs, folds back itself at the hilum to form
the parietal pleura which lines the inner thoracic wall, the mediastinum and
the diaphragm. The cavity between the visceral and the parietal pleura is
termed as pleural space and it normally contains a very thin layer of fluid
(0.13mL/kg) which acts as lubricant. Only the parietal pleura is pain sensitive as
it contains sensory nerve fibres, supplied by the intercoastal and phrenic
nerves.

Pleurisy

Inflammation of the pleura results in pleurisy (or pleuritis). Pleurisy may start
as dry pleurisy, but may later on resolve or develop into wet pleurisy (pleural
effusion).

Causes of Dry Pleurisy

Common Causes of Dry Pleurisy

Epidemic myalgia (pleurodynia, Bornholm disease)
Extension of infection from the underlying lung (e.g. pneumonia )
Tuberculous pleurisy
Chest Trauma
Serositis due to connective tissue diseases (e.g. rheumatoid arthritis, systemic
lupus erythematosus)
Pulmonary infraction
Pleural malignancy (metastatic, primary)
Radiation injury
Uraemia

Pleurodynia (also called epidemic myalgia, Bornholm disease) is caused by

Coxsackie B virus infection, which is a form of dry pleurisy which occasionally
be complicated with pleural effusion. It occurs in epidemic and commonly
affects children and young adults. Patient presents with fever, severe
incapacitating pleuritic chest pain. On the affected side, movements of the
thorax is reduced, the chest wall muscles are tender and a pleural friction rub
may be heard.
Symptoms

 Patients with pleurisy present with localised, sharp, stabbing pain on the
affected side that worsens on deep inspiration, coughing and sneezing
(pleuritic pain).
 When the diaphragmatic pleura is affected the pain may be referred to
the tip of the shoulder or to upper abdomen from pleurisy affecting the
lower lobes.
 There may be rapid shallow breathing with unproductive cough.
 Chilly sensation at onset and moderately intermittent fever.

Signs

Physical examination reveals reduced movement on the affected side. A

pleural rub may be heard on auscultation. The pleural rub is a crackling sound
heard during both inspiration and expiration, localised usually to a small area
of the chest wall and often heard better on increasing the pressure of the
stethoscope.

Management

 Rest in bed
 Relief on pain with – hot water bag, splinting of chest with strapping,
analgesics and sedatives.
 Relief of cough – by medicine
 Specific treatment, depending on the cause of pleurisy.