Pleuritis and Pleurisy

Pleuritis and pleurisy are the same thing and describe inflammation of the pleural tissue around the lungs. Pleuritis may be benign, but it can also be caused by pleural mesothelioma. Treatment involves finding and managing the underlying condition.

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What is Pleurisy?

Pleurisy, or pleuritis, is an inflammation of the pleura that surrounds the outside of both lungs and lines the inside of the chest cavity.

A small amount of fluid between the tissue layers allows them to move smoothly against each other during inhalation and exhalation. When the tissue becomes inflamed, the two layers rub painfully against each other.[1]

Pleurisy can cause several uncomfortable symptoms, including chest pain that worsens during breathing. The pain typically intensifies when taking a deep breath or when coughing or sneezing. The pain may also be localized in the back or around the shoulders.

Pleurisy causes shortness of breath as the individual experiencing the pain of breathing begins to avoid breathing deeply. Pleuritis can also cause a cough or fever, although these symptoms are less common.[1]

Pleuritis may cause extra fluid to build up between the two pleural layers. This can relieve the pain caused by inflammation but also puts pressure on the lungs. This added pressure makes breathing even more difficult and can trigger a persistent cough. Infections may develop in the extra fluid as well, causing a fever.

Fibrosing Pleuritis

If the underlying cause of pleuritis is something simple like an infection, treatment with antibiotics can reduce inflammation. If the condition is left untreated, pleuritis can turn into a serious illness described as fibrosing or sclerosing pleuritis.[2]

These terms refer to a hardening of the tissue. Fibrosing pleuritis means that fibrous tissue forms in the pleura, making it more rigid. Sclerosing pleuritis occurs when scar tissue builds up that is also fibrous and rigid.

This rigidity significantly reduces lung volume and capacity, making breathing more difficult. Ultimately, the condition can be fatal. Not everyone who has pleurisy will develop fibrosis or sclerosis. Why some do and others do not is not well understood.[2]

Malignant vs. Benign Pleurisy

Pleuritis can be caused by a number of things, including:

• Infection
• Autoimmune disorders
• Medication
• Injury
• Cancer

When pleurisy is related to cancer, it is considered malignant. Noncancerous causes trigger benign pleurisy. Cancers that can cause pleurisy include lung cancer and mesothelioma.

Although asbestos is a known cause of mesothelioma and some lung cancer cases, exposure to this mineral can also cause benign pleuritis.

Benign asbestos-triggered pleurisy can occur with and without asbestosis. Asbestosis is a non-cancerous disease caused by asbestos exposure and is characterized by scarring and fibrosis in the lungs. This can trigger pleuritis, but the inflammation may also occur after asbestos exposure without developing asbestosis.

Benign pleurisy related to asbestos is fairly common in cases of asbestosis. It tends to be chronic and worsens as the disease progresses; however, there have been reported cases of acute pleurisy resulting from asbestos exposure.

Pleurisy with Mesothelioma

Mesothelioma is the cancer of the pleural tissue and is most often caused by asbestos exposure. Mesothelioma may occur alongside pleurisy triggered by asbestos, but the cancer itself can also trigger pleural inflammation.

In these cases, pleuritis is a symptom or complication of cancer. Symptoms like these can be very uncomfortable. Pleurisy caused by mesothelioma may be treated with anti-inflammatory drugs like steroids.

Diagnosing Pleurisy

Because several causes can trigger pleuritis, diagnosis is challenging. While identifying pleuritis is not difficult, determining its cause is more complicated. There are cases noted of patients misdiagnosed with mesothelioma when they only had a benign type of pleurisy.

A worse scenario is a patient diagnosed with benign inflammation when they actually have mesothelioma. When this occurs, the cancer continues to develop, making treatment more complicated when it is finally diagnosed. Diagnosis typically follows these steps:[3]

• Diagnosing pleuritis starts with blood tests to determine if there is an underlying infection.
• The next step is typically chest X-rays to look for inflammation and fluid buildup.
• Other imaging scans may be conducted to identify tumors, cysts, or fibrous tissue.
• If a malignancy is suspected, a specialist may take a biopsy of the fluid from the lungs or a piece of tissue from the pleura or lungs.
• A pathologist then examines these samples to determine if there are cancerous cells.

Treating Pleuritis

An accurate diagnosis is key to getting appropriate treatment. The underlying cause of inflammation must be identified. If the cause can be treated, the patient will recover.

However, in cases of cancer, fibrosing pleurisy, and asbestosis, treating the underlying cause will not cure the condition. Treatment for these progressive conditions mostly focuses on reducing symptoms. Pain medication, anti-inflammatory drugs, draining of pleural fluid, or surgery may be used to manage symptoms and provide relief.[3]

Pleurisy is a wide-ranging condition that many factors can cause. Treatment primarily depends on the underlying cause, making accurate diagnosis crucial. Asbestos is a known potential cause for patients with or without mesothelioma or lung cancer. If you experience these symptoms, insist on careful diagnostic procedures and inform your doctor of previous asbestos exposure.

Page Medically Reviewed and Edited by Anne Courtney, AOCNP, DNP

Anne Courtney has a Doctor of Nursing Practice degree and is an Advanced Oncology Certified Nurse Practitioner. She has years of oncology experience working with patients with malignant mesothelioma, as well as other types of cancer. Dr. Courtney currently works at University of Texas LIVESTRONG Cancer Institutes.

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