Pleuritic pain: what is the cause?

Pleuritic pain is a sharp stabbing pain in the chest. It can occur in anyone at any age but it is more common in older adults who have underlying lung problems, or who smoke heavily. One of the most common causes is a viral infection or a bacterial infection, which take hold more successfully because of the damage already in the lungs.

Knowing the symptoms of pleuritic pain and understanding the possible causes can help you recognise the problem early and distinguish it from other sorts of chest pain. In general, if you have severe chest pain of any sort, or troublesome chest pain that lasts more than a week, you should see your GP urgently.

This article on pleuritic pain is written by Kathryn Senior, a freelance journalist who writes health, medical, biological, and pharmaceutical articles for national and international journals, newsletters and web sites.

What is pleuritic pain?

The membranes around the lungs are called the pleura. These come in two layers, one of which covers the lungs, the other that lines the chest cavity. The two membranes are well lubricated to allow them to move relative to one another as you breathe in and out. Pleuritic pain occurs when these membranes become inflamed, damaged or dry, and can no longer move smoothly. Every time you breathe in and out, the pleura scrape together rather than sliding, and this is very painful.

Pleuritic pain is often described as a sharp or stabbing pain and is often felt most intensely at a specific site. It is often felt only on one side and is made worse by coughing or sneezing. It can also be irritated by deep breathing and this may lead you to take only shallow breaths to avoid the pain. This may bring temporary relief but it can lead to further complications. You will usually have other symptoms associated with your pleuritic pain, and these will help your doctor to diagnose the cause.

Viral causes of pleuritic pain

The most common cause of pleuritic pain is viral pleurisy, where the pleura become inflamed in response to a viral infection such as influenza or a cold virus. This is not a serious condition, although it is generally associated with flu-like symptoms such as a high temperature and a cough. The pain may feel quite severe, but will usually subside within a few days as your body deals with the virus.

Other common infections can also spread to the pleura causing pleuritic pain. These include pneumonia, tuberculosis and other viral and bacterial infections that affect the lungs or chest cavity.

Auto-immune causes of pleuritic pain

In auto-immune conditions, the body attacks its own healthy tissue causing inflammation. If this occurs in the chest cavity it will result in damage and soreness in the delicate tissues in the lung and surrounding them. Lupus (also known as SLE or systemic lupus erythematosus) and rheumatoid arthritis are both fairly common causes of pleuritic pain.

Physical causes of pleuritic pain

Pleuritic pain can also be caused by physical damage to the chest that results in bruising or fracturing of the ribs. In severe cases, the broken rib can puncture the lung allowing air into the chest cavity. This is called pneumothorax and results in a collapsed lung as well as severe pain.

Irritation due to exposure to toxic substances can also cause pleuritic pain. These conditions include asbestosis (also called mesothelioma) and silicosis, caused by exposure to asbestos and silicone respectively.

Medical causes of pleuritic pain

Pleuritic pain can sometimes be caused by more serious medical conditions, including heart and lung problems such as pleural effusion or pulmonary embolism.

• Heart problems such as pericarditis cause the membrane around the heart to become inflamed and this then presses on the pleura. Heart failure can also cause pleuritic pain, as the drop in blood pressure allows fluid to leak from the bloodstream into the pleural cavity. This is called pleural effusion and only causes pain in the early stages; the pain tends to ease as the fluid builds up.

• Lung problems include pulmonary embolism, where blood clots become trapped in the pulmonary arteries and cause inflammation. Lung tumours and abscesses can also cause inflammation that leads to pleuritic pain.

Less common causes of pleuritic pain

A range of other less common conditions can also cause pleuritic pain:

• Connective tissue disease (including inherited conditions and auto immune disorders such as lupus and rheumatoid arthritis)
• Diaphragm disorders (including ruptures and hernias)
• Blastomycosis (a highly invasive fungal infection)
• Sarcoidosis (also known as Besnier-Boeck disease – in which small inflammatory nodules accumulate around the lungs or lymph nodes)
• Sickle cell syndrome (a blood disorder that usually only effects people of Afro-Caribbean descent)

When to see your GP

Since the most common cause of pleuritic pain is a viral infection, and most viruses are not treatable, you may not feel it is worth bothering your GP. However, pleuritic pain can also be an indicator or far more serious conditions. So when should you consult your GP?

You should see your GP if you experience any of the following symptoms:

• Pleuritic pain that develops slowly over days or weeks
• Any kind of breathing difficulties (aside from the sharp pain itself)
• Your chest pain does not begin to ease after a few days
• Any signs of blood in your sputum
• Any other symptoms that you feel cannot be explained by a common infection like a cold or flu.

You should waste no time in getting checked out if you experience pleuritic pain and have been exposed to asbestos at any time in the past. Your GP will often refer you for a chest X-ray, which can quickly determine what is wrong, either putting your mind at ease or ensuring you get the correct treatment.

Profile of the author

Dr Kathryn Senior is an acclaimed medical journalist who has written over 500 feature articles for leading international journals within The Lancet group. As Senior Writer at Freelance Copy she produces high quality scientific and medical content for websites and printed publications for companies and organisations in the health, medical and pharmaceutical sectors. 

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