Pleurisy

Respiratory (12%) Core Clinical Conditions

1B The Physician Associate is able to identify the condition as a possible diagnosis: may not have the knowledge/resources to confirm the diagnosis or to manage the condition safely, but can take measures to avoid immediate deterioration and refer appropriately

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Definition Aetiology Pathophysiology Risk factor Sign and Symptoms Investigations Management

Pleurisy is a medical condition where there is inflammation of the pleural space.

• Viral infection: adenovirus, herpes simplex or flu. 

• Bacterial infection: tuberculosis (TB), bacterial pneumonia + other bacteria infections. 

• Fungal infections. 

• Autoimmune disorders such as lupus, rheumatoid arthritis and sarcoidosis. 

• Cancer. 

• Chest trauma.

1. Inflammation of pleural membrane > thickening and swelling of pleura. 

2. Friction caused by rubbing of the pleural membrane against each other > causing discomfort and pain. 

3. Fluid accumulation > impaired lung function as lungs unable to fully expand > reduced oxygen supply to the body. 

4. If not severe = self resolve. If severe > scarring occurs > pleural thickening. 

• Repeated or frequent infections.

• Autoimmune disorders.

• Chest trauma. 

• Smoking. 

• Lung cancer.

• Pleuritic chest pain. 

• Fever, weight loss, productive cough.

• O/E: hyperresonance on percussion (if pneumothorax), dullness on percussion (if pleural effusion), haemoptysis (if PE). 

• Chest x-ray: to rule out pneumothorax / pleural effusion. 

• ECG + Troponin blood test, as the patient may present with chest pain. 

• Sepsis screen. 

• D-dimer: if suspecting PE.

• Pain relief: mainly NSAIDs e.g naproxen, ibuprofen. 

• Treating the underlying cause.

• Chest drainage if fluid in pleural space. 

• Antibiotic treatment. 

• Oxygen therapy.

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