Pleurisy: Symptoms, Causes, and When to Seek Care

Introduction
Pleurisy, also called pleuritis, is a painful condition caused by inflammation of the pleura. The pleura is the thin membrane that lines the lungs and the inner chest wall. When this tissue becomes inflamed, it creates sharp chest pain that often worsens when you breathe, cough, or sneeze. Pleurisy is not a disease on its own but usually a complication of another illness, such as pneumonia, infection, autoimmune disorders, or blood clots in the lung.

Many people with pleuritic chest pain wonder whether to go to urgent care or the emergency room. This article explains pleurisy symptoms, causes, diagnosis, treatment, and how to decide where to seek care.

What Causes Pleurisy?

Pleurisy develops when the two layers of the pleura rub against each other because of inflammation. Common causes include:

• Viral respiratory infections such as influenza (CDC)

• Bacterial pneumonia (Mayo Clinic)

• Pulmonary embolism, which is a blood clot in the lungs (CDC)

• Autoimmune diseases like lupus or rheumatoid arthritis (NIH)

• Chest injury or trauma

• Lung cancer or tumors near the pleura

Because pleuritic chest pain can mimic other emergencies, doctors often rule out conditions such as heart attack, pneumothorax (collapsed lung), or aortic dissection before confirming pleurisy (AAFP).

Symptoms of Pleurisy

The main symptom of pleurisy is pleuritic chest pain. This pain is usually sharp, stabbing, and worse when breathing deeply, coughing, sneezing, or moving. Other symptoms may include:

• Pain that radiates to the shoulder or back

• Shortness of breath from shallow breathing to avoid pain

• Persistent cough

• Fever, chills, and fatigue

• Pleural effusion, which is when fluid builds up in the pleural space. This may reduce the sharp pain but cause more difficulty breathing (Mayo Clinic).

How Is Pleurisy Diagnosed?

Doctors use a combination of medical history, physical exam, and diagnostic tests to confirm pleurisy and identify its cause. Evaluation may include:

• Listening to the chest for a “pleural friction rub”

• Chest X-ray to check for pneumonia or pleural effusion

• CT scan for detailed imaging of the lungs and pleura (Mayo Clinic)

• Ultrasound of the chest to detect fluid buildup

• Blood tests to look for infection or autoimmune disorders

• ECG to rule out cardiac causes

• Thoracentesis, which is the removal and testing of pleural fluid, if pleural effusion is present (NIH)

• In rare cases, pleural biopsy if cancer or tuberculosis is suspected

Treatment for Pleurisy

Treatment focuses on relieving pain and addressing the underlying condition:

• Pain relief with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen (Mayo Clinic)

• Corticosteroids for autoimmune-related inflammation

• Antibiotics for bacterial infections

• Anticoagulation therapy if caused by a blood clot

• Therapeutic thoracentesis to drain fluid in cases of pleural effusion

• Rest and supportive care

Uncomplicated pleurisy often improves within two to four weeks. Chronic or severe causes may require ongoing management (NIH).

When to Go to Urgent Care vs the ER

Mild to moderate pleurisy symptoms without breathing difficulty can often be evaluated at an urgent care center. Urgent care providers can order chest X-rays, blood work, and provide treatment for pain and underlying infections.

Go to the emergency room immediately if you experience:

• Severe or unrelenting chest pain

• Shortness of breath, rapid breathing, or difficulty catching your breath

• High fever that does not respond to medication

• Coughing up blood

• Fainting or confusion

• Pleurisy symptoms along with heart or lung conditions such as heart disease, COPD, or a weakened immune system

Conclusion

Pleurisy, or pleuritis, is a painful condition that can have many different causes. While some cases are mild and manageable in urgent care, others require emergency attention. The safest approach is to seek medical evaluation quickly if you develop sudden chest pain that worsens with breathing or coughing.

At iCare ER & Urgent Care, our locations in Frisco and Fort Worth provide on-site imaging and diagnostics to evaluate pleuritic chest pain, pleural effusion, and other related conditions. If you are concerned about chest pain, do not delay care. Visit us for timely evaluation and treatment.