Pleurisy

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Written by Luo Peng
Thoracic Surgery
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What medicine to take for pleurisy

Regarding what medicine to take for pleurisy, it depends on the specific actual situation. If it is simple mild pleuritis without pleural effusion and only pain, generally, if the pain is not severe, medication may not be necessary. If the pain is severe, one can (under the guidance of a doctor) take oral pain relievers like ibuprofen or acetaminophen with codeine for symptomatic treatment. If there are symptoms such as fever, coughing up phlegm, pleural effusion, or even suspected tuberculous pleuritis, long-term oral anti-tuberculosis drugs are required for treatment. If tuberculosis cannot be confirmed and there are no significant symptoms, symptomatic treatment can be administered temporarily.

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Written by Li Hu Chen
Imaging Center
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Post-pleurisy chest X-ray presentation

Patients with pleurisy, after their recovery, often exhibit certain signs on chest X-rays, such as thickening and adhesion of the pleura, and blunting of the costophrenic angle. These conditions commonly arise because diseases like pleurisy might have a somewhat extended duration or are not detected timely, lacking prompt medical treatment. Hence, pleural thickening is prone to occur, visible on X-rays at the lung margins, where localized soft tissue density appears slightly thicker. Normally, the edge of the lung at the costophrenic angle would be quite sharp, but after pleural thickening, this angle becomes blunted or even rounded. In some cases, encapsulated effusions might be seen on a chest X-ray as a spindle-shaped high-density shadow near the chest wall, which appears as a notably bright shadow.

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Written by Liu Jing Jing
Pulmonology
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Is pleurisy ascites easy to treat?

Whether pleurisy with effusion is easy to treat depends on identifying the cause of the pleurisy, which commonly includes tuberculosis, infection, and tumors. Tuberculous pleurisy can usually be cured about six months to a year after standard anti-tuberculosis treatment; infectious pleurisy generally has a good prognosis if it is sensitive to anti-infective drugs; however, pleurisy caused by tumors often indicates metastasis to the pleura, and at this stage, surgical options are no longer viable, leading to a poor prognosis. Therefore, if pleurisy is present, it is necessary to go to the hospital to complete thoracic puncture and clarify the nature of the pleural effusion, and treat according to the cause.

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Written by Yuan Qing
Pulmonology
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Sequelae of pleurisy with pulmonary effusion

The main sequelae of pleurisy with pleural effusion are pleural adhesions, which can affect respiratory function. Pleurisy is mostly caused by infectious diseases, although a portion is also due to non-infectious diseases. In the case of pleural effusion caused by infectious diseases, it contains a large amount of fibrinogen, which has the function of adhering to our pleura, thereby causing the pleura to thicken. At this time, the pleura will compress our lungs, significantly reducing the respiratory volume of our lungs, which greatly affects our respiratory function. Patients mainly exhibit symptoms such as shortness of breath, chest tightness, and rapid breathing even with slight activity or while lying in bed. Therefore, if pleurisy is detected, it is crucial to drain the fluid from the patient as soon as possible to avoid delaying treatment and the subsequent development of severe sequelae.

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Written by Shen Jiang Chao
Radiology
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Pleural inflammation CT manifestations

The causes of pleurisy mainly include tuberculous, purulent, bacterial, tumorous, traumatic, and rheumatic types, with the tuberculous type being the most common. Pleurisy is predominantly characterized by pleural effusion, which generally looks similar on a CT scan. CT scans cannot distinguish the cause of pleurisy. A small amount of pleurisy manifests as a minor amount of free effusion, appearing as an arc or crescent of uniform density along the posterior chest wall. As the effusion gradually increases to a moderate or large amount, it can compress lung tissue, leading to compressive atelectasis. In cases of large volume effusion, aside from causing atelectasis, it can also significantly push the mediastinum towards the healthy side.

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Written by Xu Jun Hui
General Surgery
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The difference between pleurisy and peritonitis

Peritonitis generally refers to a severe disease caused by bacterial infection, chemical irritation, or injury, most of which are secondary peritonitis originating from infections and necrosis of abdominal organs, perforations, trauma, etc. The main symptoms include abdominal pain, tense abdominal muscles, tenderness, and board-like abdomen. Pleurisy generally refers to the inflammation of the pleura caused by pathogenic microorganisms, also known as pleuritis, which can be accompanied by pleural effusion. Pleurisy is commonly caused by tuberculosis. Generally, the symptoms of peritonitis are more severe than those of pleurisy. Both pleurisy and peritonitis require active, timely, and regular treatment.

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Written by Shen Jiang Chao
Radiology
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Can pleurisy be seen on a chest X-ray?

Pleurisy can also be detected in chest radiographs, but it depends on the type. There are two types of pleurisy: dry and wet. Dry pleurisy cannot be clearly identified, while wet pleurisy, which is mostly caused by tuberculosis, can show more typical characteristics. Tuberculous pleurisy primarily manifests as pleural effusion. A small amount of pleural effusion on an X-ray appears as blunting of the costophrenic angle on the same side and blurring of the diaphragm. A moderate amount of pleural effusion is shown on the chest radiograph as a uniformly consistent high-density shadow on the same side, which appears higher on the outside and lower on the inside, with an arc-shaped shadow. The muscle costophrenic angle and diaphragm are obscured. A large amount of pleural effusion presents as a high-density shadow in the pleural cavity on the same side, with the mediastinal cardiac silhouette clearly shifting to the interlateral side.

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Written by Wang Chun Mei
Pulmonology
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Can pleurisy cause hemoptysis?

Pleurisy, this disease in clinical practice, does not cause symptomatic hemoptysis on its own. This is because pleurisy is mainly due to bacterial invasion into the pleural cavity causing inflammatory lesions. The pleural cavity is a sealed space, which, when inflamed, often causes symptoms such as fever, cough, chest tightness, shortness of breath, and breathing difficulties when there is a significant accumulation of fluid in the chest cavity. Generally, it does not cause hemoptysis. There is only one possibility, for example, intense irritative coughing in patients with pleurisy may rupture the capillaries in the bronchial walls. In this case, patients might experience varying degrees of coughing with blood, but this is not a direct clinical symptom caused by pleurisy itself.

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Written by Wang Chun Mei
Pulmonology
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Is it normal to occasionally have chest pain with pleurisy?

Pleurisy is a very common type of disease, with many triggering factors. Most cases of pleurisy are caused by infection of the pleural cavity by Mycobacterium tuberculosis, leading to inflammatory lesions. Once pleurisy is diagnosed, patients should promptly receive anti-tuberculosis medication for effective treatment. It is commonly known that if pleurisy is not controlled promptly and effectively, it may lead to worsening symptoms such as cough, fever, shortness of breath, chest tightness, and chest pain, so these clinical symptoms are also very common in patients with pleurisy. Therefore, it is very common for patients with pleurisy to experience chest pain. Even after complete recovery from pleurisy, there may be varying degrees of chest pain, which is considered normal. This is because pleurisy in the acute phase may involve different degrees of adhesions, hence chest pain may occur later on as well.

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Written by Wang Chun Mei
Pulmonology
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What is the cause of hemoptysis in pleurisy?

Pleurisy is generally more commonly seen in young adults and children clinically, and is most commonly caused by an infection of the pleura by Mycobacterium tuberculosis. Usually, patients with this type of pleurisy do not experience symptoms of coughing up blood. The typical symptoms caused by pleurisy primarily include chest pain, coughing, chest tightness, shortness of breath, and in severe cases with a lot of pleural effusion, it can cause the patient to experience breathing difficulties and sometimes chills. Therefore, the clinical symptoms presented by different patients can vary. When a patient with pleurisy has a severe cough, it can lead to the rupture of the capillaries in the bronchial walls, which can cause the patient to have varying degrees of blood in the sputum, or even coughing up blood.