I. Definition

  1. Pleuritic Chest Pain (Symptom)
    1. Chest Pain exacerbated by forceful breathing
  2. Pleurisy
    1. Inflammation of parietal pleura
    2. One of many conditions resulting in Pleuritic Pain

II. Pathophysiology

  1. Parietal pleura (not visceral) has Sensory Nerves
  2. Nerve distribution
    1. Intercostal nerves referred to associated dermatomes
      1. Rib Cage
      2. Lateral hemidiaphragm
    2. Phrenic nerve referred to ipsilateral neck, Shoulder
      1. Central hemidiaphragm

III. Causes: Serious and life-threatening

  1. Pulmonary Embolism (represents 5-20% of Pleurisy in ER)
  2. Pneumothorax
  3. Pneumonia
  4. Pericarditis
  5. Myocardial Infarction (Pleuritic Pain is atypical)
  6. Spontaneous Pneumomediastinum

IV. Causes: Infection

  1. Bacteria
    1. Bacterial Pneumonia
    2. Tuberculous pleuritis
    3. Mediterranean Spotted Fever, Tuberculosis
  2. Virus
    1. Adenovirus
    2. Coxsachievirus
    3. Cytomegalovirus (CMV)
    4. Epstein-Barr Virus (EBV)
    5. Influenza
    6. Parainfluenza
    7. Respiratory Syncytial Virus
    8. Mumps
  3. Parasite
    1. Amebiasis

V. Causes: Other

  1. Musculoskeletal Causes
    1. Musculoskeletal Chest Pain
    2. Cough fracture
  2. Cardiopulmonary Causes
    1. Post-Myocardial Infarction, Cardiac injury, surgery
    2. Asbestosis
  3. Hematologic and oncologic conditions
    1. Malignancy
    2. Familial Mediterranean Fever (recurrent episodes)
    3. Sickle Cell Anemia
  4. Inflammatory Conditions
    1. Reactive Eosinophilic pleuritis
    2. Rheumatologic pleuritis (Lupus, Rheumatoid Arthritis)
    3. Sjogren's Syndrome
  5. Other Conditions
    1. Inflammatory Bowel Disease
    2. Chronic Renal Failure

VI. Symptoms

  1. Sharp Chest Pain on forceful breathing
  2. Perceived Dyspnea (due to suppressed respirations)
  3. Provocative factors
    1. Movement
    2. Forceful breathing
      1. Deep breathing
      2. Coughing
      3. Sneezing

VII. Symptoms: Red flags for serious or atypical causes

  1. Night Sweats
  2. Significant weight loss
  3. Joint pain
  4. Syncope
  5. Productive cough

VIII. Signs: Red Flags on cardiopulmonary exam

  1. Hypotension
  2. Tachycardia
  3. Tachypnea
  4. Pericardial Friction Rub
  5. Rales, asymmetric or absent lung sounds

IX. Labs

  1. Consider D-Dimer
  2. Consider cardiac enzymes

X. Diagnostic Tests

  1. Chest XRay (obtain in all patients)
  2. Consider Electrocardiogram

XI. Management

  1. NSAIDs for analgesia (preferred over Narcotics)
    1. Indomethacin 50-100 mg PO tid with food or milk
  2. Identify cause
    1. Evaluate first for serious causes
    2. Consider Medication Causes of Pleural Disease

Images: Related links to external sites (from Google)

Ontology: Pleurisy (C0032231)

Definition (CHV) inflammation of the lining of the lung (pleura)
Definition (CHV) inflammation of the lining of the lung (pleura)
Definition (CHV) inflammation of the lining of the lung (pleura)
Definition (CSP) inflammation of the pleura, with exudation into its cavity and upon its surface; may occur as either an acute or a chronic process.
Definition (MSH) INFLAMMATION of PLEURA, the lining of the LUNG. When PARIETAL PLEURA is involved, there is pleuritic CHEST PAIN.
Concepts Disease or Syndrome (T047)
MSH D010998
ICD9 511
ICD10 R09.1
SnomedCT 32203001, 196075003, 266406002
English Pleurisies, PLEURISY, PLEURITIS, Pleurisy, NOS, Pleuritis, NOS, pleurisy, pleurisy (diagnosis), Pleurisy [Disease/Finding], pleurisies, pleuritis, Pleurisy (excl TB), Pleurisy (disorder), Pleurisy (disorder) [Ambiguous], Pleurisy, Pleurisy NOS, Pleuritis, Pleuritides, Pleurisy (excluding TB)
French PLEURESIE, Pleurite, Pleurésie (excl TB), PLEURITE, Pleurésie
Portuguese PLEURISIA, Pleurisia (excl.TB), PLEURITE, Pleuris, Pleurite, Pleuresia, Pleurisia
Spanish PLEURESIA, Pleuresía (excl TB), Pleuritis, Pleurisy, PLEURITIS, pleuresía, pleuritis (concepto no activo), pleuritis (trastorno), pleuritis, Pleuresía, Pleuresia
German PLEURITIS, Pleuritis (ausser TB), RIPPENFELLENTZUENDUNG, Pleuritis, Brustfellentzündung
Dutch pleuritis, pleuritis (excl. TBC), pleura-ontsteking, Pleuritis
Italian Pleurite (tubercolare esclusa), Pleurite
Japanese 胸膜炎(結核性を除く), キョウマクエン, キョウマクエンケッカクセイヲノゾク, 胸膜炎, 肋膜炎
Swedish Lungsäcksinflammation
Czech zánět pohrudnice, pleuritida, pleura - zánět, Pleuritida (mimo TBC), Zánět pohrudnice, Pleuritida
Finnish Keuhkopussitulehdus
Russian PLEVRIT, ПЛЕВРИТ
Korean 늑막염
Croatian PLEURITIS
Polish Zapalenie opłucnej
Hungarian Mellhártyagyulladás, Pleuritis (kivéve TBC), Pleuritis

Ontology: Chest pain on breathing (C0423729)

Concepts Sign or Symptom (T184)
ICD9 786.52
ICD10 R07.1
SnomedCT 309552003, 207082006, 75483001, 158395001, 274664007
English Painful respiratory movement, Painful respiration NOS, [D]Painful respiration NOS, [D]Painful respiration (context-dependent category), [D]Painful respiration NOS (context-dependent category), Painful respiration [D], Breathing painful (situation), painful respirations were observed, [D]Painful respiration NOS (situation), painful respiration, painful respiration (physical finding), [D]Painful respiration, [D]Painful respiration (situation), breathing pains, pain breathing, Pain;breathing, Pain;respiratory;chest, breath chest pains, painful breath, breath pain, breathing chest pain, breaths painful, pain respiratory, chest breathing pain, Pain;respiration, Pain;respiratory, pain respiration, pain respirations, respiration pain, breathing painful, chest pain breathing, pain chest breathing, breath chest pain, breathing pain, breathing chest pains, Painful respiration, Breathing painful, Chest pain on breathing, Breathing painful (finding), Chest pain on breathing (finding), chest; pain, on breathing, pain; chest, on breathing, pain; respiration, painful; respiratory, respiration; painful, respiration; pain, Painful respiration [D] (finding), pain during respiration, painful breathing, respiratory chest pain, respiratory pain
Italian Respirazione dolorosa
Japanese 呼吸時疼痛, コキュウジトウツウ
Spanish [D]respiración dolorosa (categoría dependiente del contexto), [D]respiración dolorosa, SAI (categoría dependiente del contexto), Breathing painful, [D]respiración dolorosa, SAI, [D]respiración dolorosa, SAI (situación), [D]dolor al respirar, SAI, [D]respiración dolorosa, [D]respiración dolorosa (situación), dolor de pecho al respirar, dolor torácico al respirar (hallazgo), dolor torácico al respirar, movimiento respiratorio doloroso, respiración dolorosa (hallazgo), respiración dolorosa [D] (hallazgo), respiración dolorosa [D], respiración dolorosa, Respiración dolorosa
German Brustschmerzen bei der Atmung, schmerzhafte Atmung
Czech Bolestivá respirace
Korean 숨쉴때의 가슴통증
Hungarian Fájdalmas légzés
Dutch ademhaling; pijnlijk, ademhaling; pijn, borst; pijn, bij ademhaling, pijn; ademhaling, pijn; borst, bij ademhaling, pijnlijk; ademhaling, Pijn op borst bij ademhaling, pijnlijke ademhaling
Portuguese Respiração dolorosa
French Respiration douloureuse