Pleurisy: causes, symptoms and when to seek care

Medical disclaimer: This page is general health information for education only. It is not medical advice and is not a substitute for diagnosis or treatment by a qualified health professional. It has not been reviewed by a clinician. In an emergency, call 911 or your local emergency number.

Pleurisy is inflammation of the pleura, the thin tissue that covers your lungs and lines the inside of your chest. It usually causes sharp chest pain that gets worse when you breathe in. This guide explains pleurisy symptoms, common causes, how clinicians find the cause, and when chest pain needs emergency care. It is part of our library of health conditions.

What is pleurisy?

Pleurisy is inflammation of the pleura, the two-layer tissue that covers the outside of your lungs and lines your chest cavity.

• The thin space between the two layers of the pleura is called the pleural space.
• A small amount of fluid in the pleural space helps the layers glide smoothly as you breathe.
• Inflammation can make the pleural surfaces rough, so the layers rub together with each breath.
• Pleurisy is also called pleuritis. Its pain is often called pleuritic chest pain.

These definitions come from the National Heart, Lung, and Blood Institute (NHLBI) overview of pleural disorders and MedlinePlus.

Pleurisy names the inflammation, not a single cause. This page does not cover the related pleural disorders pleural effusion (extra fluid around the lung) or pneumothorax (a collapsed lung) in depth.

Pleurisy symptoms

The main symptom of pleurisy is sharp chest pain that gets worse when you breathe deeply, cough, or sneeze.

The pain of pleurisy often has these features:

• It feels sharp or stabbing.
• Deep breathing, coughing, sneezing, and chest movement make it worse.
• It happens in one specific place in the chest.
• It sometimes spreads to the shoulder or back.
• It can make you breathe and swallow carefully to avoid the pain.

Pleurisy can cause fluid to collect inside the chest. That fluid can lead to coughing, shortness of breath, and rapid breathing, according to the MedlinePlus medical encyclopedia entry on pleurisy. Fever and extreme tiredness can also occur, as Cleveland Clinic’s pleurisy guide notes.

Chest pain has many causes, and this page cannot help you rule out a heart attack or a blood clot in the lung. Only a clinician can tell pleurisy apart from those conditions.

Common causes of pleurisy

Viral infection is the most common cause of pleurisy, but blood clots, autoimmune diseases, and chest injuries can also cause it.

The MedlinePlus pleural disorders page names viral infection as the most common cause. Other known causes include:

• Lung infections such as pneumonia or tuberculosis.
• A virus such as the flu. Our guide to colds and the flu explains those infections.
• A blood clot in the lung, called a pulmonary embolism.
• Autoimmune diseases such as lupus and rheumatoid arthritis.
• Chest trauma, chest surgery, or rib fractures.
• Certain cancers.
• Sickle cell disease.
• Certain medicines.

Adults over 65 and people with autoimmune diseases have a higher risk of pleurisy, according to Cleveland Clinic.

This list is not complete. Your clinician may look for other causes based on your health history.

How clinicians diagnose pleurisy

Clinicians diagnose pleurisy with a medical history, a physical exam, and tests that look for the underlying cause.

During the medical history, your clinician will ask about your chest pain:

• What the pain feels like.
• Where it is and whether you feel it in your arms, jaw, or shoulders.
• When it started and whether it comes and goes.
• What makes it better or worse.

These answers help show whether the pain comes from the heart, chest muscles, lungs, or digestive system. During the exam, inflamed pleura may make a rough, scratchy sound called a pleural friction rub. Clinicians listen for it with a stethoscope, as the NHLBI guide to diagnosing pleural disorders describes.

Tests your clinician may order include:

• Blood tests, such as a complete blood count, to look for infection or other illness.
• An electrocardiogram (ECG), a test that records the heart’s electrical activity, to rule out heart conditions.
• A chest X-ray, CT scan, or ultrasound of the chest.
• Thoracentesis, which uses a needle to remove a sample of pleural fluid for testing.

These tests can also rule out other causes of chest pain. This section describes what clinicians do. It is not a way to diagnose yourself.

Emergency signs: when to call 911

Call 911 for sudden, sharp chest pain with shortness of breath, or for chest pressure that spreads to your arm or jaw.

The MedlinePlus chest pain guide says to call 911 if you have:

• Sudden crushing, squeezing, tightening, or pressure in your chest.
• Pain that spreads to your jaw, left arm, or between your shoulder blades.
• Nausea, dizziness, sweating, a racing heart, or shortness of breath.
• Sudden, sharp chest pain with shortness of breath, especially after a long trip or bed rest, or if one leg is swollen. This could be a blood clot in the lungs.

The NHLBI also advises calling 911 for severe chest pain or trouble breathing. If you have pleurisy symptoms with trouble breathing or skin that turns blue, seek medical care right away. Read the CDC list of heart attack warning signs so you can recognize them.

Warning signs can look different in women. See our page on heart attack symptoms in women and our first aid basics.

This list does not cover every emergency. If your chest pain is new and unexplained, Cleveland Clinic advises calling 911 or going to the emergency room.

How care for pleurisy is approached

Care for pleurisy depends on its cause, so clinicians focus on treating the underlying condition and relieving your symptoms.

• Bacterial infections are treated with antibiotics.
• Viral infections normally run their course without medicines.
• Clinicians may recommend medicines to ease pain and inflammation. The NHLBI treatment page names nonsteroidal anti-inflammatory drugs and corticosteroids as options.
• If fluid builds up, a clinician may drain it with a needle or a chest tube.

Recovery depends on the cause and your general health. Pleurisy caused by an infection should go away as you recover. Pleurisy linked to an ongoing illness, such as an autoimmune disease, may come back. Possible complications include fluid around the lungs, pus around the lungs (empyema), and partial lung collapse.

This section is general information. It does not tell you which medicine to take or how much, and it does not replace a care plan from your clinician.

Questions to bring to your appointment

Written questions help you get clear answers about the cause of your chest pain and your next steps.

• What do you think is causing my pleurisy?
• Which tests do I need, and what will they rule out?
• Is there fluid around my lung, and does it need to be drained?
• Which pain relief options are safe with my other health conditions and medicines?
• Which symptoms mean I should call 911 or come back right away?
• How long should the pain last, and when should I follow up?

These questions are a starting point, not a complete list. Our guide on how to prepare for an appointment has more tips.