What are the symptoms of pleurisy?

Written by An Yong Peng
Pulmonology
Updated on January 29, 2025
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Common symptoms of pleurisy include chest pain, which often worsens with deep breathing. This condition is also called pleuritic chest pain. It is important to note that the presence of such chest pain does not necessarily indicate pleurisy; it could also be due to pneumonia, pulmonary embolism, or even rib fractures. Patients with pleurisy may also experience a sensation of chest tightness, especially when there is a significant amount of pleural effusion. Furthermore, severe chest pain caused by pleurisy may lead to patients avoiding deep breaths, which can also result in symptoms of chest tightness. Fever is another common symptom in patients with pleurisy, and the severity of fever can vary depending on the infection causing the pleurisy. For example, tuberculous pleurisy, caused by tuberculosis infection, often results in a low-grade fever in the afternoon, but high fevers can also occur. In the case of purulent pleurisy, which is usually due to a bacterial infection leading to pus formation in the pleural cavity, high fevers are common.

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Written by Wang Chun Mei
Pulmonology
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How to treat pleurisy without effusion?

Pleurisy is a very common type of inflammatory response of the pleura caused by pathogenic factors in clinical practice. In clinical settings, some patients may develop pleural effusion, while others may not. Therefore, the treatment for pleurisy without pleural effusion mainly involves symptomatic management with anti-tuberculosis drugs. Typically, the treatment with anti-tuberculosis drugs should follow a regimen that is early, combined, adequate, regular, and complete. For the treatment of such pleurisy patients, it is known that most cases are caused by infection with Mycobacterium tuberculosis. Therefore, when treating such patients, it is crucial to strictly follow the treatment regimen of anti-tuberculosis medications to effectively control the uncomfortable symptoms caused by pleurisy.

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Written by Wang Chun Mei
Pulmonology
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The dangers of secondary recurrence of pleurisy

Pleurisy is very common in clinical settings, with most cases caused by the invasion of Mycobacterium tuberculosis into the pleural cavity, leading to inflammatory lesions. Patients generally experience pleurisy symptoms, and if their immune function is weak, some may relapse if not careful. Therefore, for patients recovering from pleurisy, it is essential to strengthen their immune system and pay attention to balancing work and rest, avoiding spicy and irritating foods, which can greatly reduce the possibility of pleurisy recurrence. If pleurisy recurs, the clinical symptoms may worsen compared to the initial infection or may present similarly to the initial symptoms. Generally, if pleurisy recurs, there might be severe complications due to adhesions in the pleural cavity, possibly leading to persistent chest pain symptoms.

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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 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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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.