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Pleurisy, also known as pleuritis, is an inflammation of the pleural tissue that lines and cushions the lungs and chest cavity. The pleura is comprised of two membranes that offers a thin layer of protection for the lungs. The inner membrane wraps around the lungs while the outer layer lines the inside of the chest wall.
Pleural mesothelioma begins with tumors in these tissues. Both pleuritis and mesothelioma can cause pleural symptoms like pain, difficulty breathing, and coughing. Because symptoms are so similar, these conditions are often misdiagnosed. Someone with developing mesothelioma could potentially be diagnosed with benign pleuritis. On the other hand, pleuritis can be caused by mesothelioma. Pleuritis can also be caused by asbestos exposure without becoming malignant.
It is important to understand the different types of pleuritis, how it relates to mesothelioma and asbestos, and how to ensure accurate diagnosis of pleural symptoms.
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. There is a small amount of fluid in the small space between the two layers. When the pleural tissue is healthy, this fluid allows the two layers to move smoothly against each other during inhalation and exhalation. When the tissue becomes inflamed, the two layers rub painfully against each other.
Pleurisy can cause a number of 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.
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.
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.
These terms refer to a hardening of 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.
Malignant vs. Benign Pleurisy
Pleuritis can be caused by a number of things, including infection, autoimmune disorders, medication, injury, and cancer. When pleurisy is related to cancer it is considered malignant. Benign pleurisy is triggered by noncancerous causes. 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. However, the cancer itself can also trigger pleural inflammation. In these cases, pleuritis is a symptom or complication of the cancer. Symptoms like can be very uncomfortable. Pleurisy caused by mesothelioma may be treated with anti-inflammatory drugs like steroids.
Because pleuritis can be triggered by a number of causes, diagnosis is challenging. While determining 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 difficult when it finally is diagnosed.
Diagnosing pleuritis starts with blood tests to determine if there is an underlying infection. The nest 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.
An acurate 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 focus on reducing symptoms. Pain medication, anti-inflammatory drugs, draining of pleural fluid, or surgery may be used to manage symptoms and provide relief.
Pleurisy is a wide-ranging condition that can be caused by many factors. Asbestos is a known potential cause for patients with or without mesothelioma or lung cancer. Treatment primarily depends on the underlying cause, making accurate diagnosis crucial. 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.