Post-pleurisy chest X-ray presentation

Written by Li Hu Chen
Imaging Center
Updated on September 23, 2024
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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 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 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 An Yong Peng
Pulmonology
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Pleurisy is caused by what?

Pleurisy is often caused by various pathogens, such as viral infections, which can lead to pleurisy termed viral pleurisy. Viral pleurisy typically presents with noticeable chest pain, and may even be accompanied by tenderness in the chest wall. Similarly, bacterial infections can also cause pleurisy. If the infection is a purulent bacterial infection, it is known as purulent pleurisy. Generally, those with purulent pleurisy experience high fever symptoms. Another common cause of pleurisy is tuberculosis infection, known as tuberculous pleurisy. Typical symptoms of tuberculous pleurisy include low-grade fever in the afternoon, night sweats, and may also include chest tightness and chest pain.

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Written by Wang Chun Mei
Pulmonology
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Is pleurisy serious in young people?

Pleurisy, when it occurs in young people, is also relatively common in clinical settings. It is primarily caused by an invasion of the pleura by Mycobacterium tuberculosis, resulting in an inflammatory lesion. The symptoms manifested by these patients mainly include coughing, shortness of breath, chest tightness, chest pain, and in severe cases, respiratory difficulties. Tuberculous pleurisy is mostly seen in adolescents and children. If young people are diagnosed with pleurisy and receive timely and accurate diagnosis, along with systematic and effective treatment with anti-tuberculosis drugs, their condition can generally be effectively controlled. However, it is important to note that although young people have better resistance, they must strictly adhere to the treatment duration for anti-tuberculosis medication, which usually spans six to nine months to completely cure pleurisy.

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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.