Pleuritis
Background
- Pleuritis (also known as pleurisy) is nonspecific inflammation of the parietal pleura[1]
- Most often follows a viral illness
Clinical Features
- Pleuritic chest pain
- Typically sharp in nature, worse with respiration, coughing, sneezing, etc
- May complain of shortness of breath as a result of pain
Differential Diagnosis
- Pulmonary embolism
- Pneumonia
- Pericarditis
- Myocardial infarction
- Pneumothorax
- Pleural effusion
Chest pain
Critical
- Acute Coronary Syndromes
- Aortic dissection
- Cardiac tamponade
- Pulmonary embolism
- Tension pneumothorax
- Esophageal perforation (Boerhhaave's syndrome)
- Coronary artery dissection
Emergent
- Pericarditis
- Myocarditis
- Pneumothorax
- Mediastinitis
- Cholecystitis
- Pancreatitis
- Cocaine-associated chest pain
- Myocardial rupture
Nonemergent
- Stable angina
- Asthma exacerbation
- Valvular Heart Disease
- Aortic Stenosis
- Mitral valve prolapse
- Hypertrophic cardiomyopathy
- Pneumonia
- Pleuritis
- Tumor
- Pneumomediastinum
- Esophageal Spasm
- Gastroesophageal Reflux Disease (GERD)
- Peptic Ulcer Disease
- Biliary Colic
- Muscle sprain
- Rib Fracture
- Arthritis
- Costochondritis
- Spinal Root Compression
- Thoracic outlet syndrome
- Herpes Zoster / Postherpetic Neuralgia
- Psychologic / Somatic Chest Pain
- Hyperventilation
- Panic attack
Evaluation
Workup
Pleuritis is a diagnosis of exclusion
- EKG
- CXR
- Consider lab testing and/or more advanced imaging per history and physical exam
Diagnosis
- Typically made clinically after ruling out emergent causes of chest pain
Management
- NSAIDs
- Indomethacin is recommended agent (most studied)
Disposition
- Discharge
See Also
External Links
References
- Kass SM, Williams PM, Reamy BV. Pleurisy. Am Fam Physician. 2007;75(9):1357-1364.
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