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Pleuritis and Pleurisy

Pleurisy, which is also known as pleuritis, is an inflammation of the pleural tissue that lines the outsides of the lungs and the interior of the chest cavity. The pleura are where tumors begin to form in the development of pleural mesothelioma. Both pleuritis and mesothelioma can cause pleural symptoms like pain, difficulty breathing, and coughing.

The similarities in symptoms can mean that misdiagnoses may occur. Someone with developing mesothelioma may actually be diagnosed with benign pleuritis. On the other hand, pleuritis can be caused by mesothelioma. It can also be caused by asbestos exposure without becoming malignant. It is important to understand what pleuritis is, the different types, how it relates to mesothelioma and asbestos, and how to ensure an accurate diagnosis of pleural symptoms.

What is Pleurisy?

Pleurisy, or pleuritis, is an inflammation of the pleura. The pleura consist of two thin layers of tissue, one that surrounds the outside of both lungs, and the other that 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, an individual will not feel the two layers of tissue at all, as the fluid in between keeps them lubricated so they can move smoothly against each other.

When the tissue becomes inflamed, the two layers rub painfully against each other. Pleurisy can cause a number of uncomfortable symptoms, including chest pains. The pain is usually more intense when taking a deep breath, or when coughing or sneezing. The pain may also be 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, but these symptoms are less common.

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

Fibrosing Pleuritis

If the underlying cause of pleuritis can be determined and it is simple to treat, the condition can be cured. For instance, if it is caused by an infection, like pneumonia, treatment with antibiotics can bring down the inflammation. However if the condition is caused by something that cannot be treated easily, like lung cancer or mesothelioma, or if it is left alone for too long and worsens, it can turn into a serious illness described as being fibrosing or sclerosing pleuritis.

These terms refer to a hardening of tissue. Fibrosing pleuritis means that fibrous tissue begins to form that makes it more rigid. Sclerosing pleuritis occurs when scar tissue builds up that is also fibrous and rigid. This rigidity can quickly and significantly reduce lung volume and capacity, making breathing more difficult. Ultimately the condition can be fatal. Not everyone who has pleurisy will develop this fibrosis or sclerosis, and why some people do and others do not is not well understood.

Malignant vs. Benign Pleurisy

Pleuritis can be caused by a number of things, from infections to autoimmune disorders, medications, physical injury, and cancer. When the pleurisy is related to cancer it is considered malignant. When it is triggered by other causes that are not cancerous, it is benign pleurisy. Cancers that can cause pleurisy include lung cancer and mesothelioma, the cancer that begins in the pleural tissue

Although asbestos is a known cause of mesothelioma and of some cases of lung cancer, exposure to this mineral can also cause benign cases of pleuritis. This kind of benign, asbestos-triggered pleurisy is known to occur with and without asbestosis. Asbestosis is a non-cancerous disease caused by asbestos exposure that is characterized by scarring and fibrosis in the lungs. This can trigger pleuritis as a symptom or complication, but the inflammation may also occur after asbestos exposure without the development of asbestosis.

Benign pleurisy related to asbestos is fairly common in cases of asbestosis. It tends to be chronic and worsens as the disease progresses. There are also, however, some cases recorded of acute pleurisy resulting from asbestos exposure. These are instances of inflammation triggered by asbestos that do not persist and eventually go away.

Pleurisy with Mesothelioma

Mesothelioma is the cancer of the pleural tissue that is most often caused by asbestos exposure. Mesothelioma may occur along with pleurisy triggered by asbestos, but the cancer itself can also be a cause of pleuritis. The pleuritis in that case is a symptom or complication of the cancer. Symptoms like these of advancing mesothelioma can be very uncomfortable, and treatments may be used to target the cancer but also to reduce symptoms. Pleurisy caused by mesothelioma may be treated with anti-inflammatory drugs, like steroids.

Diagnosing Pleurisy

Pleuritis can be related to or caused by a number of conditions, which makes diagnosis challenging. Actually determining that an individual has pleurisy is not difficult in itself, as any sign of inflammation in the pleural tissue is considered to be pleurisy. However, the challenge of determining what caused it or if it is a complication of cancer or something benign can lead to misdiagnoses or missed diagnosis of mesothelioma.

There are cases noted of patients being misdiagnosed as having mesothelioma, when really they had a benign type of pleurisy. Worse is when physicians diagnose a patient with benign inflammation but fail to diagnose mesothelioma. When this occurs the cancer continues to develop making treatment more difficult when it finally is diagnosed later.

The process of diagnosing pleuritis includes doing blood tests to determine if there is an underlying infection, chest X-rays to look for inflammation and fluid buildup, and other imaging scans to look for tumors, cysts, or fibrous tissue. If a malignancy is suspected, the next step is to remove fluid from the lungs or a piece of tissue from the pleura or lungs. These samples can then be investigated by a pathologist to determine if there are cancer cells.

Treating Pleuritis

Getting an accurate diagnosis for pleurisy and what is causing it is so important because it determines treatment. Whatever underlying condition is causing the inflammation needs to be treated. If the cause can be treated the patient will recover, but in cases of cancer, fibrosing pleurisy, and asbestosis, treating the underlying cause will not lead to a cure. These progressive conditions will continue to worsen and treatments focus on reducing symptoms and the spread of the tumors in the case of cancers. Pain medications, anti-inflammatories, draining of pleural fluid, or surgery to remove tumors and fibroses or scar tissue may be used to manage symptoms and provide relief.

Pleurisy is a wide-ranging condition that can be caused by many different factors. Asbestos is a known potential cause, both in people with and without mesothelioma or lung cancer. How the condition is treated depends a lot on the underlying cause, which is what makes accurate diagnosis for pleural symptoms so crucial. If you are experiencing these symptoms insist on careful and detailed diagnostic procedures and tell your doctors if you were ever exposed to asbestos.

Page Edited by Dave Foster

Dave has been a mesothelioma Patient Advocate for over 10 years. He consistently attends all major national and international mesothelioma meetings. In doing so, he is able to stay on top of the latest treatments, clinical trials, and research results. He also personally meets with mesothelioma patients and their families and connects them with the best medical specialists and legal representatives available. Connect with Patient Advocate Dave Foster

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