pleurisy on one side

Overview

Pleurisy is when the thin lining around your lungs (called the pleura) becomes swollen and painful. This often causes a sharp chest pain that gets worse when you breathe in, cough, or sneeze. It usually affects only one side of the chest.

Pleurisy is not extremely common, but it does happen. It often occurs as a complication of another lung infection, like pneumonia or a chest cold.

Pleurisy can affect people of any age, but it is more common in younger adults. People with certain health conditions, such as autoimmune diseases or kidney failure, may be at higher risk.

Symptoms

Common symptoms

• Sharp chest pain on one side that worsens when you breathe deeply, cough, or sneeze
• Pain that may travel to your shoulder or back
• Shortness of breath (because you may breathe shallowly to avoid pain)
• Dry cough
• Fever and chills (if caused by infection)

Symptoms in children

• Children might not describe the pain well; they may just seem irritable or cry more
• Rapid breathing or breathing that looks difficult
• Fever
• Refusing to eat or play

Symptoms in older adults

• Pain may be less sharp, but they often feel more breathless or weak
• Confusion or feeling very tired (could be a sign of serious infection)
• Cough that does not go away

Causes

Main causes

• Viral infections, such as flu or a cold
• Bacterial infections, like pneumonia or tuberculosis
• Autoimmune diseases, where your immune system attacks the pleura (e.g., lupus, rheumatoid arthritis)
• A blood clot in the lungs (pulmonary embolism)
• Injury to the chest, such as a broken rib
• Certain cancers that spread to the pleura (rare)

Risk factors

• Having a lung infection like pneumonia or bronchitis
• Weakened immune system (from medicine or illness)
• Recent chest surgery or injury
• Autoimmune diseases
• Kidney problems

When to see a doctor

See a doctor urgently if:

• You have sudden, severe chest pain or trouble breathing
• You cough up blood
• You have a very high fever (over 101°F or 38.3°C)

Book a routine appointment if:

• You have mild chest pain that lasts longer than a few days
• You have a low fever along with chest pain
• You are worried about your symptoms

Diagnosis

Your doctor will ask about your symptoms, listen to your chest with a stethoscope (they might hear a rough rubbing sound, which is a sign of pleurisy), and check for fever or signs of infection.

Tests that may be done

• Chest X-ray to look for fluid, infection, or other problems
• Blood tests to check for infection or autoimmune conditions
• CT scan or ultrasound for a closer look at the pleura
• Sometimes a sample of fluid from the pleura (thoracentesis) is taken if there is a large amount

What to expect at your appointment

The tests are usually quick and painless. The doctor might ask you to breathe slowly and deeply while they listen. You may have to go for an X-ray or blood test. If fluid needs to be drained, the doctor will numb the area first.

Treatment

The treatment for pleurisy depends on what is causing it. The goal is to treat the underlying cause and relieve pain so you can breathe normally.

Self-care at home

• Rest and take it easy until you feel better
• Breathe slowly and shallowly to ease pain, but try to take deep breaths a few times each hour to avoid pneumonia
• Apply a warm compress to the painful area
• Use over-the-counter pain relievers (like paracetamol or ibuprofen) as recommended on the label, but check with your doctor first if you have other health conditions

Medical treatments

Your doctor may prescribe anti-inflammatory medicines or antibiotics if there is a bacterial infection. If the pleurisy is caused by an autoimmune condition, they may give medicines that calm the immune system. For a blood clot, you would receive blood-thinning medicines.

When is surgery considered?

Surgery is rarely needed. It might be used to drain a large collection of fluid or pus from the pleural space, or to remove scarred tissue if it causes long-term breathing problems.

Living with this condition

While you recover, try to get plenty of rest. Avoid heavy lifting or strenuous exercise. As your pain improves, gradually return to your normal activities. Listen to your body and don't push yourself too hard.

Lifestyle tips

• Do not smoke, and avoid second-hand smoke
• Avoid things that can irritate your lungs, like strong fumes or dust
• Stay hydrated by drinking water
• Manage stress with relaxation techniques like deep breathing or meditation

Diet and exercise

Eat a balanced diet with fruits, vegetables, and protein to help your body heal. Gentle exercises like walking can be started once your chest pain is under control, but check with your doctor first.

Mental health and emotional wellbeing

Dealing with chest pain and breathlessness can be scary and stressful. It is normal to feel anxious. Talk to your family, friends, or a counsellor about your feelings. If you feel very anxious or depressed, tell your doctor – there is help available.

Prevention

Pleurisy cannot always be prevented, but you can lower your risk by treating infections early, getting recommended vaccines, managing chronic health conditions, and avoiding smoking.

Vaccines

Getting the annual flu vaccine and the pneumonia vaccine can help prevent some of the infections that lead to pleurisy.

Screening programmes

There is no routine screening for pleurisy. If you have a condition that puts you at risk, your doctor will watch you closely.

Complications

If left untreated

• Pleural effusion – fluid builds up around the lung, which can cause breathing problems
• Empyema – pus collects in the pleural space, requiring drainage
• Scarring of the pleura (pleural thickening) that can restrict lung expansion
• Spread of infection to other parts of the body

Long-term outlook

With proper treatment, most people with pleurisy recover fully without long-term problems. If the cause is a serious condition like a blood clot or cancer, the outlook depends on that condition. The key is to see a doctor early so the right treatment can be started. You have good reason to be hopeful.

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